Oregonian – October 27, 1987
Mind Games Oregon’s Mental Health System (3rd of 5 parts)
A warm Indian summer sun draws a handful of tenants out onto the concrete driveway and overgrown lawn beside the Care and Share boarding house, just a few blocks from the orderly grounds and ornate buildings of the Oregon State Hospital.
Little distinguishes the aging white house on Center Street from its neighbors, or identifies it as a home for released mental patients who have nowhere else to turn.
In recent months, however, the house has become the focus of official scrutiny following the suicide of a resident from a medication overdose and questions about its practices.
Around the state, boarding homes such as Care and Share, also called room and boards, form a key link in a chain of virtually unregulated private homes, apartments and hotels that provide shelter and minimal care for thousands of chronically and severely mentally ill Oregonians.
According to the Marion County medical examiner, the death of James H. Lloyd, 47, while residing at Care and Share last May is part of a mounting death toll from suicide by various means in this shadowy residential network outside the state’s formal mental health system.
“It’s distressing to me to see that there are so many cases of premature death in these places,” Dr. Peter J. Batten said. Batten said it has been noted by death investigators that a number of the room and boards are in bad condition.
An official for the Oregon Mental Health Division said that agency has begun a joint investigation with Marion County mental health officials of circumstances surrounding Lloyd’s death and conditions in the home.
Patient advocates say local regulation is not enough.
“The state should hold them to proper standards. The state is not meeting its obligation to provide adequate housing,” said Bob Joondeph, an attorney for the Oregon Advocacy Center, which represents mentally ill and retarded persons in various court cases.
This informal and largely unregulated housing network has received the lion’s share of the thousands of mentally ill patients released from state hospitals since the 1950s under the state’s policy of reducing inmate populations.
The mentally ill typically pay boarding houses about $300 a month, often using the proceeds of monthly checks through the Social Security system that amount to about $340.
State lacks information
At any one time, state hospitals for the mentally ill house about 1,130 of the state’s 34,400 chronicially and severely mentally ill residents.
State-financed and regulated residential care programs provide slots for 1,133 people in subsidized group and foster homes, and 848 more live in semi-independent residential programs backed by the state and counties.
As for where the estimated 31,000 other chronically and severely mentally ill people are, the state has few details.
“We don’t know precisely where these people are living. We have addresses (for some), but not the type of building,” said Don Bray, an assistant administrator of the Oregon Mental Health Division.
He said about 6,500 of them, or fewer than a quarter, regularly are seeing case-managers and are believed to be in decent housing, and that thousands of others are working. He said there is no housing census.
In all, the state monitors 30 licensed group homes and 100 adult foster homes, and investigates complaints about unlicensed homes.
“We have one person to regulate the ones we are regulating. It is a mammoth job,” Bray said. “We don’t have enough people to regulate these other places.”
The “other places” dwarf the state’s licensed residential programs.
Sylvia A. Eckles, the state’s lone full-time housing watchdog for the mentally ill, says boarding houses number “in the hundreds” — serving the mentally ill, the elderly and in some cases, the mentally retarded.
They operate on the edge of legality, technically outside of strict state standards of care, sanitation and safety for licensed homes. Neglect — which would be grounds for license revocation for group and foster homes — pervades the state’s other housing network for the mentally ill, according to mental health experts.
Indeed, some boarding house operators say they are prohibited from providing any care.
“I’m afraid to come here,” says Mary Palomino, an operator of a boarding house in Salem on the same street as Care and Share. She said she has been advised by a Marion County official that she would get in trouble if she should provide care to her residents.
State officials say boarding houses may be closed if they provide care without a license. Oregon law requires licensing for homes that provide care as well as room and board for people in return for money. Foster homes are defined as those serving five or fewer persons. Group homes serve six or more.
According to Gabriella Lang, an assistant attorney general, care may consist of such simple acts as helping residents to dress, make a phone call, catch a bus, clean a room or take medication. Lang said the state to date has gotten one court injunction to close down one boarding house last year, for providing care without a license.
While the state officially does not recognize room and boards, it is not uncommon for social workers at state hospitals to refer outgoing patients to them, sight unseen.
“I would not want you to think we approve of them, or that we disapprove of them,” said Clyde Hockman, director of social services at Dammasch State Hospital.
“What we do is say, `Here are three or four addresses; go take a look and see what you think,’ ” Hockman said.
In the Care and Share case, the 37-year-old Lloyd, a long-time mental patient with a history of depression and suicide attempts, took a drug overdose at the home and died after being found by another resident hours later. An investigation after his death found Lloyd had been on five different medications prescribed by two physicians.
Blood and urine tests did not determine a specific cause of death. Batten said about 40 tablets of phenelzine, a prescribed anti-depressant, were missing from a medication vial, suggesting Lloyd died after swallowing them.
Eckles, the state’s licensing watchdog, said that she and Marion County officials are conducting a joint investigation of Lloyd’s death and conditions in the home, to determine whether they conform with state law.
Lester Robertson, 53, a former state hospital psychiatric aide who owns the home, charged that Lloyd’s death was caused by the county’s decision to enforce strictly state laws banning care in room and boards. He said a county official visited the home several months before Lloyd’s death, and that he complied with the officials’ order to discontinue the practice of monitoring tenant medications by storing them in a locked cabinet.
“I personally blame Jim Lloyd’s death on mental health (officials),” Robertson said. “That’s what killed Jim. If we had kept the meds (locked up), Jim would be alive,” he said.
Eckles confirmed the county asked Care and Share last February to stop keeping medication for patients, but denied his assertion that it contributed to Lloyd’s death. She said that she found 17 residents “living in squalor” when she visited the house in July.
Joondeph, the Oregon Advocacy Center lawyer, said his office was contacted by Lloyd a few weeks before his death. Joondeph said Lloyd complained to one of the center’s investigators that he was being “forced” to stay at Care and Share “because they control his money.”
Joondeph said Robertson was Lloyd’s payee — a representative designated to receive his Social Security checks and help manage his money. Robertson said he gave Lloyd an agreed-upon $5 daily allowance from his check, and that Lloyd became angry when Robertson refused to pay out more money. He denied Lloyd was forced to stay.
Robertson and his son, Jack, who together own the home, moved to Glendale, Ariz., in August.
Batten said that he has documented 11 suicides of former mental patients in apartments or boarding houses in Marion County alone over the last seven years. On average, the victims were released just 4 1/2 months before by the Oregon State Hospital. Lloyd left the hospital, after his ninth stay, 20 days before he died.
Statewide statistics on such deaths are not kept.
Death investigations found some squalid living conditions, although the report does not elaborate.
Batten said the mentally ill also are dying of “easily treatable diseases” because they cannot get proper care.
A bill that would have required state registration and inspection of boarding homes died in a legislative committee earlier this year. There have been no proposals to require registration of hotels and apartments that cater to the mentally ill.
Multnomah County started the first mandatory licensing of boarding houses for the mentally ill in Oregon last year.
William B. Thomas, who managed the county registration program until last month, said many of the county’s 30 licensed boarding houses that cater to the mentally ill have “problems,” including poor sanitation. He said the county can “not resolve them all” without stronger state standards and money for care.
Thomas said that some boarding houses in the county commonly provide medication supervision for residents — keeping drugs in a “locked central location” and handing out doses to those who are “incapable of self-medication.”
“That’s in the interest of the operator that people are stabilized and not having problems,” he said.
When told that such a service might violate state law, Thomas said, “The state does not define what’s the threshold for providing 24-hour care. If the state believes they are (covered by the law), we would welcome the state to enforce its laws.”
Unlike room and board managers, operators of state-licensed group and foster homes must supervise medication for most patients, but are not allowed to dispense drugs.
Thomas said the county has authority to crack down if it finds major defects in yearly inspections, but is reluctant to close substandard houses, except as a last resort. He said the county has sought voluntary closures in extreme cases.
“It’s a question of having something which we know is not adequate, or nothing at all,” he said.
Duane Zussy, Multnomah County’s human service director, said the county’s licensing standards for boarding houses are focused mainly on sanitation and building code standards. He said the county walks a “tightrope” to protect patients and yet not “destroy the economic viability of the homes.”
Not all of Multnomah County’s boarding homes are registered.
Mark Clay, the residential program manager for the North-Northeast Mental Health Clinic, said he became aware of an unregistered boarding house recently when two of his clients told him they paid a Northeast Portland woman for room and board.
Clay said that he phoned Multnomah County out of curiousity and learned that the woman and her house were not on the county’s list of registered boarding homes.
Clay said he was concerned about the lack of county registration, but that he elected not to report the matter to county licensing officials.
“I have not referred clients to them. Neither have I reported them to the county,” Clay said of the unregistered operation. “That’s not my job.
“We’re paid low wages to sweep this problem under the carpet, so no one has to look at it. We live in a society that doesn’t want to see the problem,” he charged.
Largest home serves 36
The largest licensed boarding house in Multnomah County, Westport Villa in Northwest Portland, provides room and meals to 36 residents, 27 of whom are mentally ill.
Its ills offer an insight into conditions that regulations permit.
Emery Huschka, a former Rex Putnam High School principal who has owned the home at 2241 N.W. Hoyt St. for three years, says he began with charitable intentions.
“We wanted to be part of the solution to the problem,” Huschka recalled recently. “But we ended up being part of the problem.”
Huschka says he recently put Westport Villa up for sale. After four years, he says he has had enough of trying to help the chronically mentally ill while also attempting to satisfy critical neighbors and county officials.
Dennis Skiles, a social worker who helps mentally ill people at the Northwest Pilot Project Inc. downtown, says that Huschka and his employees are “good-hearted people.”
“But they really are not trained to handle mentally ill people, and they have too many of them there. When that many are centralized in one place, bad things are bound to happen,” Skiles said.
County inspection reports praise Huschka for good intentions and concern about residents, but criticize sloppy sanitation, inadequate staff and poor supervision of residents. They also repeatedly mention neighbors’ and residents’ complaints about bizarre behavior and disturbances.
Thomas, the county’s former registration manager, said many of the problems “dramatically improved” in recent years but acknowledged continuing problems with sanitation.
“If Westport Villa were closed, there would be 50 more homeless people in Portland and there are no places to absorb them,” Thomas said.
During 1985, Portland police were called to Westport Villa 141 times to respond to reports of disturbances, thefts and emergencies, real and imagined. Since then, Huschka says, the calls for police have declined, in part because he more closely monitors calls made by tenants from a house telephone.
A county inspection of Westport last year found its problems ranged from a dirty kitchen to faulty electrical wiring and exposed asbestos pipe insulation. It criticized “poor housekeeping and inadequate maintenance.”
“The primary issue in this facility has been and continues to be adequate supervision and management,” it said. “It seems that the owners and their staff are unaware of the need to comply with applicable rules.”
For $300 a month drawn from Social Security checks, residents receive three meals a day and weekly maid service. Huschka has told inspectors he cannot afford more staff to provide better supervision.
Once-a-week cleanups do little but rearrange the chaos in some rooms.
Bill Ross, 37, a former University of Oregon art student who has lived at the Villa for five years, spends much of his time in his room amidst piles of cigarette butts, oil paintings and stacks of clothing, books and debris. In his youth, Ross painted surrealistic landscapes, like “Wyoming Moon,” a night scene that leans against a closet full of old military uniforms.
“I was once chairman of the Joint Chiefs of Staff,” Ross confided.