Slums or Salvation?

Unlicensed boarding homes for the mentally ill draw scrutiny

Some people call them "necessary evils," while others call them "rat traps." In any case, unlicensed boarding homes for the mentally ill—which, since they are simply boarding houses, don't require governmental licensing—are beginning to draw attention.

The number of unlicensed boarding homes in Tucson is estimated to exceed 50, based on information from several sources.

According to data from the Arizona Department of Health Services, there are 26 somewhat similar, but licensed residential facilities in town. These homes, which typically house a dozen people or less, provide extra care and are therefore subject to both stringent city and state regulations.

Carter, not his real name, has lived in boarding homes his entire adult life. He estimates he's been in 15 of them over the past three decades.

"The homes I lived in were (mostly) slums," Carter remembers. "Some are run properly, but some are shipwrecks."

He says he receives approximately $600 per month from Social Security, and $500 goes toward room and board. Despite his lack of cash, Carter complains that staff members at many boarding homes have badgered him for money, cigarettes and sodas.

He also refers to the meals that are served—like rice and beans, soups and peanut-butter-and-jelly sandwiches, with water to drink—as "slop."

Neal Cash leads the Community Partnership of Southern Arizona (CPSA), an agency responsible for "the coordination of publicly funded behavioral health treatment and prevention services."

CPSA contracts with three provider organizations—CODAC, COPE and La Frontera. Each of these agencies has their own licensed residential facilities and also has clients living at the privately operated boarding homes.

"If we hear complaints," Cash says of the unlicensed facilities, "we put the word out to the providers." He adds that these facilities can't all be painted with the same broad brush, because there are indeed some good ones.

"I've always supported certification and licensing of these facilities," Cash adds, "but the flipside ... is that will drive costs up, and some of them will go out of business."

CPSA works with the Pima County Human Rights Committee on issues concerning the mentally ill. Susan Hyder is vice-chair of the group and indicates they have a subcommittee making site visits to unlicensed boarding homes.

"They'll make a report," Hyder says of the subcommittee, "and depending on the situation, the information will be passed on to appropriate parties. The full committee will then follow up."

Calling boarding homes an issue of "great concern," Hyder says the unlicensed facilities range in quality—with some of them being "out-and-out money-grabbing operations."

"This population," Hyder observes of the mentally ill, "are often extremely vulnerable to being taken advantage of."

Francine likes the boarding home she currently occupies—after being in three where she wasn't comfortable.

"The house managers didn't enforce boundary rules," she says about privacy at the earlier establishments. But at her current location, she says everyone gets along.

"I want to stay there," Francine says.

Clarke Romans is executive director of the National Alliance on Mental Illness of Southern Arizona (NAMISA).

"Most of the complaints we get are about unlicensed homes," he says, estimating that NAMISA gets about 25 complaints a year. He calls some of the facilities "junkyards."

Romans acknowledges that many concerns are raised only after a person has left a particular facility. Plus, he adds: "The providers (like CODAC, COPE and La Frontera) don't check the way they should"—an allegation they deny.

Despite this criticism, Romans understands why the providers have problems.

"Fundamentally," he says, "most problems arise, because case managers have way too many (80 to 100) clients. Each client gets less than one hour of attention per month, so there's no way they can go see where people live."

Dan Ranieri, CEO of La Frontera, thinks more affordable housing for the mentally ill is vital. He indicates that because of regulations, the apartments his agency operates can only charge a person one-third of their income. "The boarding home has no such restriction," he says.

Ranieri says La Frontera has clients in about 30 boarding homes and calls them "a mixed bag." He believes finding jobs for those living in these homes is a key. "That's a big focus of ours," he says.

The head of CODAC, Mark Clark, agrees. As for the current situation, he observes: "People are forced by the market to live in a place where the quality is not what you'd wish it to be."

For his part, Tom Donovan, the interim CEO of COPE, says his agency now has 57 clients living in boarding homes.

"They're a necessary evil," Donovan says, "but our strong preference is to put people into independent-living situations."

For two years, Janet has been in a facility operated by one of the providers, and she enjoys it immensely. Previously, she lived in a series of boarding homes, and says, "I never want to go back there."

"It was a nightmare," Janet says about her last boarding-home experience. "There wasn't enough food or privacy. There was only one meal a day, so people were starving. Plus, they didn't have toilet paper for weeks."

Janet also says she was afraid of the other tenants. "They looked like they were severely mentally ill, and they would fight and argue."

From his perspective, Clarke Romans sees the lack of housing options as a major problem.

"If the rat traps are required to have licenses, they'd go out of business. Then the folks (who live in them) would have no place to turn," he says.

Susan Hyder says that boarding homes need to be licensed.

"A secure, safe and supportive environment is critical," she says.