Nevada is still housing mentally ill clients in filthy conditions despite promise to fix

Anjeanette Damon | Reno Gazette-Journal

Show Caption Hide Caption A Fragile System: Mentally ill lived in squalid conditions Sparks homeowner Jeanette McDaniel was shocked at the condition she found her mother's home in after she evicted Project Uplift to be used as a group home for mentally ill state clients. Read more about how this happened at RGJ.com Thursday.

The state of Nevada is continuing to pay private businesses to house people with severe mental illness in unsafe, filthy group homes despite vowing to improve conditions for its vulnerable clients nearly two years ago.

An audit conducted by the Legislative Counsel Bureau and released Wednesday found "excessively dirty" conditions in all but two of the 37 homes visited by auditors. The auditors described homes marred by human waste, infested by bugs and rodents, covered in mold and lacking basic safety equipment such as smoke detectors.

More: Nevada official: 'I have to own this failure' on conditions for mentally ill

Auditors found children in unsafe conditions at two of the homes, including one child who was being supervised by the home's residents while the caretaker was working another job.

"For the home in which the child’s mother was not present, we observed the 3-year-old child running around a filthy home in his underwear and being loosely supervised by clients living in the home," the auditors wrote.

The squalid conditions have persisted despite an investigation by the Reno Gazette Journal nearly two years ago that brought to light the fact that the state's erratic oversight resulted in their mentally ill clients living in atrocious conditions.

In the wake of the newspaper's investigation, Gov. Brian Sandoval promised to fix the problems that led to the squalid conditions and the Legislature passed new laws giving the Department of Public and Behavioral Health new authority to regulate such homes.

Despite those actions, however, living conditions for mentally ill clients funded by the state have continued to deteriorate, the audit found.

The problems at the privately operated homes were so severe that auditors called into question the entire structure for how the state provides living assistance for the mentally ill.

"Without strong inspection and certification processes, we have serious concerns with the current model for funding ... provider homes," auditors wrote.

"Providers operate a business that inherently is driven by a profit motive. In the absence of adequate inspection and certification activities, providers may limit their level of care to maximize profits at the detriment of client services.

In a written statement, Sandoval said he is reviewing the audit and has called for "an emergency action plan to be on my desk by next Monday."

“It was my understanding that all of these homes had been visited by state experts immediately following reports of poor living conditions more than a year ago," he said. "We also passed Assembly Bill 46 which required the department to certify each provider by October 1, but that law has not been enforced, which is unacceptable."

Lawmakers reviewing the audit report Wednesday expressed disgust and outrage.

"This is failure," state Sen. Ben Kieckhefer, R-Reno, said. "Taxpayers are basically paying slumlords to warehouse people with mental illness in unsafe and filthy conditions."

Assemblywoman Theresa Benitez-Thompson, D-Reno, questioned how conditions could be so bad after the public attention was brought to the problems in 2016.

"This came to light through press reports almost two year ago," Benitez-Thompson said. "Everyone was on notice and here comes a legislative audit, the state is coming in and the public is watching, and yet there's been no effective change in the homes."

Assemblyman Jim Wheeler, R-Gardnerville, said: "I hope you all are as disgusted as I am. I wouldn't put my dog in these conditions."

Amy Roukie, the administrator of the Division of Public and Behavioral Health, offered few excuses for her department's failure to improve the living conditions of the homes her department is responsible for certifying.

"It should have been done," she said. "There is no excuse."

Sandoval said he was disappointed in Roukie's department.

"I am incredibly disappointed with the department of Health and Human Services and disturbed that an issue we had made a priority has not been addressed by the department," he said. "The men and women living in these homes are Nevadans and part of a vulnerable population and the state can and will do better to ensure they have the opportunity to live healthy and happy lives.”

Roukie said her department is still working to certify the businesses they use to provide living assistance according to the new requirements passed by the Legislature last year.

But she said case workers face a grim situation with the worsening housing shortage in Reno and Las Vegas. Often the state workers responsible for inspecting the living conditions are the same employees who are desperately seeking a place for their clients to live.

Roukie said the state may explore using inspectors from the Health Care Quality and Compliance division to inspect living conditions at the homes instead of behavioral health caseworkers— the same recommendation that was made after the Reno Gazette Journal investigation.

"That may be a way to move from (having to ask our) service provider to please accept our client to someone coming in and saying the floors are too dirty and need to be cleaned," Roukie said.

The RGJ investigation in 2016 found a similar problem of state mental health caseworkers giving homes a passing grade during an inspection despite obvious signs of unsanitary conditions.

After the newspaper's investigation, Sandoval expressed surprise at the conditions and vowed to fix the problems.

"It's a tough lesson," Sandoval said in 2016. "Obviously, this wasn't something I was aware of and mistakes were made and they need to be fixed and they will be fixed.

"It's important to me we learn lessons from this and going forward we take care of business and make sure this can't happen again," Sandoval said.

Sandoval has had a rocky track record on mental health during his two terms. In 2013, the Sacramento Bee exposed the state's practice of bussing mentally ill clients out of state when they were discharged from the psychiatric hospital in Las Vegas.

In 2014, Sandoval opted to significantly expand Medicaid coverage, which enabled many more people with a mental illness to obtain care from private providers. After that decision, Sandoval proposed deep cuts to state-provided mental health care, saying it was no longer needed if private providers were filling the gap.

Lawmakers rejected the bulk of Sandoval's proposed cuts.