Pilot program to aid gravely disabled residents could improve housing, hospitalization rates

by University of California, Los Angeles

Credit: Unsplash/CC0 Public Domain

An evaluation of Los Angeles County's pilot program aimed at bolstering aid to gravely disabled homeless residents found the initiative could offer a promising framework to improve housing and health outcomes for this vulnerable population while also relieving overburdened psychiatric hospitals.

The UCLA Health-led study is published in the journal Psychiatric Services.

Led by the county and including a partnership of more than 40 different organizations and agencies, the outpatient conservatorship pilot program sought to offer wraparound housing, health care and social services to 43 homeless residents who had severe illnesses such as schizophrenia, delusional disorders, substance use disorders and other medical illnesses. Many of the residents had been homeless for more than five years.

Beginning in 2020, county officials prioritized offering voluntary services to these residents before referring any of them to an involuntary conservatorship, known as a Lanterman-Petris-Short Act conservatorship. For those referred to a conservatorship, the pilot program allowed the county's Homeless Outreach & Mobile Engagement team, known as HOME, to continue providing services to the resident in the least restrictive setting deemed appropriate, including street-based services in some cases, as the residents awaited their court proceedings.

At the end of the pilot program's first year, 81% of the 43 homeless residents were no longer unsheltered, according to the study. While the study did not include a matched cohort as a control group, the housing placement rates in the pilot program were significantly higher than those observed by the county in recent studies. In the year before the pilot program began, about 20% of all people served by Los Angeles County's homeless outreach had obtained housing placement within 12 months.

About 65% of the residents were placed under a conservatorship with most requiring treatment at a psychiatric hospital. More than half of these residents were able to leave these locked settings and transfer to licensed residential facilities earlier than would have been possible prior to the pilot program, according to study lead author and UCLA Health psychiatry professor Dr. Elizabeth Bromley.

"This pilot really shows that if you have a well-staffed, very assertive, expert team that is practicing with high intensity, they're able to both identify people who can benefit from conservatorship and they're able to build enough care continuity into the process to minimize the amount of coercion," said Bromley, who also serves as director of the UCLA-Los Angeles Department of Mental Health Public Mental Health Partnership.

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Pilot program to aid gravely disabled residents could improve housing, hospitalization rates

Credit union partners with Wayne State to fight financial exploitation

DETROIT — Michigan Legacy Credit Union has launched a pilot program with Wayne State University’s Institute of Gerontology to help protect its members from financial exploitation.

New members of the credit union, age 50 and up, are offered the Financial Vulnerability Survey (FVS), a short questionnaire to determine their risk of financial exploitation. The survey was developed by Peter Lichtenberg, PhD, director of the Institute of Gerontology.

Peters

“Older adult financial exploitation is at epidemic heights,” said Carma Peters, president and CEO of Michigan Legacy Credit Union. “Sadly, these crimes are often swept under the rug because victims are too ashamed to report them. We never want to see a credit union member manipulated and victimized. This pilot program provides resources to truly empower our staff and members.”

In September 2021, Michigan enacted the Financial Exploitation Prevention Act, requiring financial institutions to offer training and procedures to recognize financial exploitation and protect vulnerable clients from becoming victims. Michigan Legacy Credit Union staff have already used Wayne State trainings and tools to combat several cases of older financial exploitation.

For nearly two decades, Lichtenberg has done extensive research to develop and validate a variety of financial decision-making and vulnerability tools. The Financial Vulnerability Survey (FVS), a self-administered tool for older adults, is the most recent. The 17-question survey identifies older adults at increased risk of financial fraud and exploitation and suggests resources to help protect them.

Dozens of people have taken the FVS so far. Their scores are included in a database to help monitor accounts for abnormal financial activity. All credit union staff received training on the new survey and how to identify and discuss cognitive risk factors before exploitation occurs.

Lichtenberg

"The FVS is easy to understand and to complete,” Lichtenberg said. “It resonates with older people who are concerned about their financial decision-making. Finances are often a taboo topic for discussion, yet people are hungry for information about their own financial vulnerability level."

Persons at risk or who have already been financially victimized are referred to the Institute of Gerontology’s SAFE program for help.  SAFE (Successful Aging thru Financial Empowerment) offers counseling at no cost to help repair the damage of financial scams. Among other things, SAFE helps to recover funds, file police reports, and freeze credit reports as well as deepen client’s financial literacy.

In addition to the FVS and SAFE services, other tools to assess financial decision-making, plus resources for professionals, caregivers and older adults, can be found at Lichtenberg’s website, olderadultnestegg.com. “We can now point members to olderadultnestegg.com for valuable training and resources,” Peters said. “Studies shows older adults who read the information are more likely to identify signs of financial exploitation before it happens.”

Peters and Lichtenberg will discuss the pilot project and financial exploitation protections with other credit unions at Audit Link’s “Conversations on Compliance,” May 25 in Grand Rapids, and on June 10 at the Michigan Credit Union’s Annual Convention and Expo at the Renaissance Center in Detroit. Michigan Legacy Credit Union also created a campaign during April’s Financial Literacy Month to encourage existing members and owners to take the FVS and have their scores uploaded to the credit union’s database.

“Ideally, this pilot program will be used throughout the state of Michigan, and nationally, to help combat this epidemic and provide another tool to protect older adults from financial fraud,” Peters said.

Aonymous data from the project will be analyzed by Lichtenberg and his team to expand research insights into vulnerability and improving safeguards for older adults.

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Credit union partners with Wayne State to fight financial exploitation

Lawmakers propose plan to treat mentally ill people without their consent

Bill plans pilot program placing people who are incapacitated in executorship, appoint guardian 

by Leona Vaughn

People unable to care for themselves due to mental illnesses could be subject to receiving treatment, even without their consent, if Washington state legislators pass a law to establish executorships for people who are incapacitated.

“Our mental health and addiction system of care is failing, in my view, the most vulnerable,” said the proposed bill’s primary sponsor, Sen. Steve O’Ban, R-Pierce County.

If passed, Senate Bill 6109 will initiate a four-year pilot program in King, Pierce, and Snohomish counties, effective Jan. 1, 2021.

Each county would be responsible for treating 10 persons during the pilot.

The bill places people who are incapable of caring for themselves because of a mental health disorder in an executorship, and requires that the counties provide services, such as housing and treatment. The executorship may be renewed after one year if a petition is made to do so.

According to the Centers for Disease Control and Prevention, there were almost 45,000 suicides in the U.S. in 2016 and 46 percent of suicides are committed by those with a known mental illness.

“We are losing hundreds, probably thousands, of our young people,” O’Ban said. “They’re our sons and daughters, and they could live lives of dignity, of creativity, and of service. The enormous waste of human potential is tragic.”

Jerri Clark, founder of Mothers of the Mentally Ill, lost her son when he took his own life last March. He suffered from severe bipolar disorder and made several suicide attempts before he succeeded, Clark said during a press conference held Friday, Jan. 31.

Instead of receiving effective treatment, he cycled in and out of hospitals, homeless shelters and jails, Clark said.

“He was forced into the margins of society by a system that not only refuses to help, but actually requires violence and destitution before help of any sort that is reasonable is available at all,” Clark said at the press conference.

Several people who suffer from a mental health disorder also experience anosognosia, a condition in which someone is unaware that they are suffering at all, according to the National Alliance on Mental Illness.

“They do not have the ability to take care of this illness on their own because of the illness itself,” Clark said.

A person who has had “at least five detentions in the most recent 12-month period” is eligible for the executorship, according to the Senate Bill Report. An investigation is conducted by a court appointed resource executor officer who determines if an individual is incapacitated.

The bill defines a person as incapacitated when they are at a significant risk of personal harm based on their inability to care for their own health, housing, or safety. The person who is incapacitated will receive guardianship, the extent and duration of which is decided by the court.

Some mental health advocates worry that an incapacitated person may lose several of their rights to their guardian. A person may lose their right to, “marry, divorce, or enter into a domestic partnership; vote; enter into a contract, or make or revoke a will; have a driver’s license and drive; buy, sell, own, or lease property; consent to or refuse medical treatment; decide who will provide care, and; to make decisions,” under this guardianship, according to the Senate Bill Report.

“Guardianship is a complete loss of civil rights,” said Melanie Smith, a representative for the National Alliance on Mental Illness Washington and who testified in opposition of the bill at a public hearing held Jan. 31.

David Lord, director of Public Policy for Disability Rights Washington, suggested implementing a supported decision-making agreement instead of appointing a guardianship, which is outlined in Senate Bill 6287, at the Jan. 31 hearing.

The agreement is a “legally recognized strategy where people identify supporters, and then they’re able to make a plan,” Lord said.

The bill currently waits to be passed out of committee, and will move on to the Senate floor if it does.

“The cycle must end of refusing treatment, followed by hospitalization or jail, followed by refusal of treatment, followed by hospitalization or jail,” O’Ban said at the Jan. 31 press conference.

“The cycle must end.”

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Lawmakers propose plan to treat mentally ill people without their consent

9NEWS investigation inspires lawmakers to help at-risk adults

A 9Wants to Know investigation is getting attention at the State Capitol. Lawmakers are trying to solve the problem of at-risk adults who are abandoned and end up stuck in hospitals for months.


DENVER- State lawmakers say they were inspired to push for a new state guardianship program after 9NEWS exposed the hidden epidemic of at-risk adults stranded in local hospitals.

As part of it’s reporting on STRANDED, 9NEWS found the current Office of Public Guardianship has failed to help one adult because of a lack of funding. Lawmakers are currently pushing to hit the “reset button” on the program to get it started as a pilot.

t’s estimated 5,000 Colorado adults could use a state guardian program.

The 9NEWS investigation was referenced several times during a House Judiciary Committee meeting on Thursday afternoon. Lawmakers voted to move a bill forward for potential appropriations to a pilot program.

“It really motivated me on why I wanted to bring this bill and why I’m so concerned with addressing this growing problem,” said Representative Marc Snyder, a democrat from Colorado Springs. “

A few people testified against the program, saying Colorado needs to establish oversight regulations for guardians so they don’t exploit at-risk adults.

“Currently guardians are allowed to ruck amuck unregulated and unsanctioned,” David Cassidy said.

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9NEWS investigation inspires lawmakers to help at-risk adults

Assembly passes Stern’s bill aimed at helping ‘the most vulnerable’

An effort to help Californians most in need, authored by Sen. Henry Stern, D-Canoga Park, passed the Legislature on Thursday, and is now headed to Gov. Jerry Brown for a signature.

Senate Bill 1045 would establish a five-year pilot program authorizing San Francisco, Los Angeles and San Diego counties to create a conservatorship focused on providing critical services and housing to the most vulnerable, who suffer from mental health and substance abuse issues, and who cannot care for themselves.

“Currently, local governments’ hands are tied when gravely disabled Californians experiencing homelessness refuse services,” Stern said. “The old model of conservatorship doesn’t give us the flexibility we need to address the crisis.”

A conservatorship is a court case where a judge appoints a responsible person or organization, called the “conservator,” to care for another adult, called the “conservatee,” who can’t care for himself or herself or manage his or her own finances, according to the Judicial Council of California’s website.
The bill, which was also supported by Scott Wiener, D-San Francisco, essentially expands and strengthens existing California conservatorship laws. 

“People who can’t help themselves are dying on the streets, and our communities suffer with them,” Stern’s office said in a news release. “This law will give our local leaders the power to update and modernize our antiquated and inhumane conservatorship system.”

The five-year pilot program would focus on housing with wraparound services to care for those who are mentally ill or otherwise unable to care for themselves. Under the bill, a county’s Board of Supervisors would have to opt in to the program by a vote via resolution, as is the case under Laura’s Law, and ensure that no resources dedicated to voluntary services and programs are curtailed or diverted in order to support this conservatorship.

Once a county votes to establish such a program, in order for an individual to be considered for conservatorship, an individual must be suffering from serious mental illness and substance use disorder, such that those co-occurring conditions have resulted in frequent detentions under a 5150 hold, or frequently being held for psychiatric evaluation and treatment.  

Los Angeles County officials, through 5th District Supervisor Kathryn Barger’s office, said Thursday they brought forth competing legislation, AB 1791, which was held on the Assembly floor due to concerns over amendments that were added to the bill in the Judiciary Committee, according to Eric Matos, Barger’s deputy in charge of health and legislative affairs.

Matos said both bills work to address issues surrounding conservatorship that have been brought to officials, “particularly, around (the term) grave disability, the concern where individuals who are in need of treatment and they’re having chronic issues, they’re not qualifying for a conservatorship because the current definition lacks the clarity needed.”

The current law is subject to interpretation, Matos said, noting the qualifications for someone to need a conservatorship state an inability to provide one’s self with food, clothing and shelter, however, the definition of shelter, i.e. a home and a lean-to under a freeway underpass could both be considered shelter, as an example.

The bill by Stern and Wiener also requires San Francisco, Los Angeles and San Diego counties to form working groups to assess the effectiveness of this new conservatorship, including collecting data that would be used to determine the effectiveness of the five-year pilot program. 

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Assembly passes Stern’s bill aimed at helping ‘the most vulnerable’