1. Problems facing group homes Institutions of Mental Disease (IMD) More than 16 mental health beds owned by one owner, even if in multiple locations (more than 3 group homes) Clients that live in IMDs will lose their Medicaid until they can be transitioned to an authorized faculty Effect: Larger companies will no longer provide this service. Many agencies have multiple homes. These larger agencies are more likely to be accredited, have more experienced staff. Many group homes will close. Personal Care Services (PCS) Previously most residents in mental health group homes qualified for PCS funds. To qualify for these funds now, clients must need “HANDS ON” assistance with, bathing, dressing, eating…. Effect: Smaller agencies will not be able to take a 30% cut in funds. No alternative funding has been offered. Many group homes will close.

2. 6 bed group home monthly budget Income Expenses Group Homes can not provide basic services with the loss of PCS funds

3. How do group homes save the mental health system money? Group homes keep people out of the hospital Essential part of the service continuum, prepares clients for independent living Less justice system involvement Fewer crisis services utilized Resident A: Was hospitalized at JUH for 12 yrs. (1985-1997) 4300 hospital days at $727 (estimate) per day = $3,139,186.00 Hospital days since 1997 = 0 $118,944 cost of 1yr of 6 bed group home $265,355 cost of 1yr state hospital for 1 person = 2 yrs of grp home service for 6 people $3,139,186.00 could buy 26 years of group home services for six clients

4. Quality group home care saves money! Resident B: Between 1993-2006, admitted to John Umstead Hospital 30 separate times, the final admission lasting 91 days. Between 1991-1999, admitted to UNC Hospitals 6 times. Moved in to Homestead Place in 2006. Days hospitalized since 2006 = 0 Discharged to independent living Jan. 2012, continues to be stable, without hospitalization, 8 months after discharge Resident C: Between 1995-2006, hospitalized at UNC for a total of 405 days 405 days x $1255=$500,000 Moved in to Homestead Place in 2006 Days hospitalized at UNC since 2006 = 5 at a cost of $6,000

5. Group Homes support recovery by… Medication creating positive medication habits and compliance Community Integration – social skills to fostering a sense of belonging by increasing client’s ability to interact with the community of their home, their peers, and the community at large. Physical health monitoring document changes in sleep, energy levels, eating patterns Nutrition proper food preparation, caffeine monitoring, balanced diet Socialization accommodation interpersonal skill building, client empowered communication skills Care Liaison staying in contact with family and other providers, on-going coordination of treatment Behavior intervention without escalation – avoiding power struggles, creative problem solving Ensuring safe living environment - cleanliness, fire safety, sanitation Transportation for treatment, medical appointments, meaningful activity/club house/volunteering/education/emplo yment, & household needs Symptom Management reality verification, reassurance, stress management