BRIEF REPORTS THE APARTMENT PROGRAM: A COMMUNITY-LIVING OPTION FOR HALFWAY HOUSE RESIDENTS Marilyn
Edith Naomi
Kresky,
M.S.
W.
M. Maeda, O.T.R. D. Rothwell
#{149}Woodley House, a private, nonprofit psychiatric halfway house in Washington, D.C., offers ex-patients and outpatients a residence during their transition from the hospital to autonomous community living. The house is designed for those who choose to live under a workincentive plan that encourages individuals to become self-supporting. Those who do become self-supporting pay the lowest fee for room, board, and 24-hour staff supervision. In 1971 Woodley House staff prepared a prospectus that described plans for an apartment program particularly for those who had been long-term residents of halfway houses or hospitals. The proposed apartment program was in response to a demand for an alternative to halfway house living for individuals who had chronic psychological problems and who also needed an economical living plan. On the basis of the prospectus, seed money was provided by the Eugene and Agnes Meyer Foundation in Washington, D.C. The Area A Community Mental Health Center in Washington paid the salary of a fulltime director for the program. Woodley House agreed to supervise the apartment program staff and to provide office space and a meeting place for participants in the program. The program started in 1971 with a single apartment and three residents; it now includes nine two-bedroom apartments, in several different buildings, housing 36 residents. Five of the nine apartments are occupied by women and the other four by men. Ages of the residents range from 18 to 70 years. Approximately 100 individuals have participated in the program; the average stay has been about ten and a half months, in Ms. Kresky is the director of the apartment program. Her mailing address at Woodley House is 2711 Connecticut Avenue, NW., Washington, D.C. 20008. Ms. Maeda is the executive director of Woodley House and Ms. Rothwell is a member of the board of trustees.
comparison with a six-and-a-half month average stay in Woodley House. The leases on the apartments are held by Woodley House. Residents pay the actual rent plus ten or 20 per cent, depending on whether they are on welfare or Social Security or are financially independent. All residents are expected to have a plan for therapy and an activity in the community, such as a paid job, volunteer work, or attendance at school or at a day hospital. Currently two full-time staff members operate the program. The director is a trained social worker who had previously been a member of the halfway house staff. The director’s assistant is a Spanish-speaking paraprofessional who not only assists in the entire program but also provides information, consultation, and referral services to the Spanish-speaking community of the District of Columbia. The two staff members alternate being on call 24 hours a day. There are weekly evening meetings of staff and residents, usually at Woodley House but occasionally at one of the apartments. The meetings are for discussions, problem-solving, and socializing. Issues involving the emotional or irresponsible behavior of individual residents frequently are confronted during the group meetings. At these formal meetings the residents are encouraged to hold similar meetings in their own apartments in order to resolve other problems. A major goal of the program is to help the ex-patient gain greater independence and assume responsibility for his own life choices. Therefore all residents pay their own rent and get their own food stamps. Those who are eligible for Medicaid or Medicare secure and handle those benefits. The residents plan their daily routines and develop their activity programs according to their personal needs and goals. Another major goal of the program is to foster the resident’s skills in cooperative living. Residents make their own decisions about shopping, cooking, and cleaning, and they otherwise organize their apartment life through group decisions. Residents’ lengths of stay in the apartments are not limited. Therefore, they have a greater sense of security in the program than they might elsewhere in the community. When an apartment does have a vacancy, staff screen candidates, and the residents select their new roommate from the acceptable candidates.
VOLUME
27
NUMBER
3 MARCH
1976
153
The program has several advantages. First is the effective use of staff; we have found that two staff members can handle the program. They minimize the need for their intervention by encouraging residents to save requests for help until the weekly meetings. That gives staff time to carry out their other duties, which include screening prospective residents, locating and furnishing apartments, coordinating the program with landlords and therapists, training students, and encouraging other professionals to initiate similar programs. A second benefit of the program is a more effective use of halfway house facilities. Before the apartment program began, some residents stayed in the halfway house longer than necessary simply because there were no satisfactory alternative living arrangements. As long as the residents were in the halfway house, they made no progress toward independence, and they occupied space that might have been used more advantageously by individuals needing close supervision on a shortterm basis. The apartments provide a setting for those who need a long-term stay in a semisupportive environment. Furthermore, the apartment program offers the low-income client a viable alternative to institutionalization or foster care. The most impressive advantage of the program is the relatively low cost to the individual and to the community. In fiscal year 1974-75, one day of hospitalization at St. Elizabeths Hospital cost the District of Columbia government about $24.53 per patient. One day in the apartment program for an individual on public assistance costs the district government $4.87. When the savings are multiplied by the number of patients ready for discharge from St. Elizabeths (about 1000 patients according to the Mental Health Law Project), the advantage of the program becomes obvious. The resident receiving public assistance and Social Security and using food stamps and medical benefits discovers that the program, with fees ranging from $70 to $98 per month, is one of the most economical posthospital living situations in Washington, D.C. The program has had problems. It originally depended on the city government for the director’s salary. With the city government’s uncertain budgets and allocations, there have been repeated financial crises, and Woodley House has had to pay the salary on an emergency basis. Secure salary funding is still a problem; however, the United Way fund currently is making up most of the deficit. A number of problems that staff anticipated have occurred; they include residents’ nonpayment of rent, smoking in bed, drinking, disruptive behavior, and one suicide attempt. In any group of 100 individuals, however, such occurrences would not be unusual. The Woodley House apartment program has shown that it is possible for a private agency to provide a viable and economical alternative to prolonged hospitalization. It provides a diverse group of chronic and low-income psychiatric clients of varying ages and racial, ethnic, and socioeconomic backgrounds a chance for a productive life in the community.
154
HOSPITAL
& COMMUNITY
PSYCHiATRY
A GERIATRIC PROGRAM FAIR: STATE HOSPITAL AS AN AGENT FOR COMMUNITY INTERACTION
THE
Sandra
Lewis,
M.F.A.,
0. T.R.
USince January 1974 staff of the occupational therapy department of Norristown (Pa. ) State Hospital have been providing geriatric consultation services to private residential centers, boarding homes, and nursing homes. During one consultation session at a local nursing home, an activities worker asked about the possibility of having a central meeting place where agencies, institutions, organizations, and individuals concerned with the needs of the elderly could exchange ideas and information. Within two weeks the suggestion evolved into a Geriatric Program Fair, scheduled for the following November in the hospital’s cornmunity center building. Work on the fair began in earnest in August 1974. The hospital printer prepared flyers inviting agencies and clients to participate in the exchange of ideas and descriptions of programs and achievements. Mailing lists of agencies and organizations were obtained from every known source, and 75 phone calls to potential local participants were made during the three months of preparation. The author and several members of the occupational therapy department also canvassed various meetings concerned with aging to enlist participants’ support. The phone calls, usually followed up by flyers, proved to be the most successful means of getting support. In addition to contacting agencies and organizations, we also contacted senior citizens themselves. During a fair such as this one, it is important not only that the elderly learn what services are available to them, but that agencies get ideas from the elderly about the kinds of services they need and want. Both staff and patients helped in organizing the fair. Two weeks before the event, the hospital’s public relations officer notified the media of the purpose, date, time, and place of the fair. One of the patients, a former advertising artist who had expressed interest in helping, painted promotional signs during occupational therapy sessions. The signs were distributed to community libraries, grocery stores, and community centers, and placed at various locations on the hospital grounds. Some patients decorated name cards during occupational therapy sessions, while others volunteered to act as hosts and hostesses. At the fair itself, a reading table with literature concerning the aged was set up, and copies of significant legislation were distributed. There were 31 exhibits from the community and 18 from the hospital. A total of 230 persons, including 75 exhibitors, attended the fair. No fees were charged. The hospital absorbed the Mrs. ment
Lewis is geriatric supervisor of Norristown State Hospital,
of the occupational therapy Norristown, Pennsylvania (Continued
on
depart19401.
page
159)
Edith Naomi
Kresky,
M.S.
W.
M. Maeda, O.T.R. D. Rothwell
#{149}Woodley House, a private, nonprofit psychiatric halfway house in Washington, D.C., offers ex-patients and outpatients a residence during their transition from the hospital to autonomous community living. The house is designed for those who choose to live under a workincentive plan that encourages individuals to become self-supporting. Those who do become self-supporting pay the lowest fee for room, board, and 24-hour staff supervision. In 1971 Woodley House staff prepared a prospectus that described plans for an apartment program particularly for those who had been long-term residents of halfway houses or hospitals. The proposed apartment program was in response to a demand for an alternative to halfway house living for individuals who had chronic psychological problems and who also needed an economical living plan. On the basis of the prospectus, seed money was provided by the Eugene and Agnes Meyer Foundation in Washington, D.C. The Area A Community Mental Health Center in Washington paid the salary of a fulltime director for the program. Woodley House agreed to supervise the apartment program staff and to provide office space and a meeting place for participants in the program. The program started in 1971 with a single apartment and three residents; it now includes nine two-bedroom apartments, in several different buildings, housing 36 residents. Five of the nine apartments are occupied by women and the other four by men. Ages of the residents range from 18 to 70 years. Approximately 100 individuals have participated in the program; the average stay has been about ten and a half months, in Ms. Kresky is the director of the apartment program. Her mailing address at Woodley House is 2711 Connecticut Avenue, NW., Washington, D.C. 20008. Ms. Maeda is the executive director of Woodley House and Ms. Rothwell is a member of the board of trustees.
comparison with a six-and-a-half month average stay in Woodley House. The leases on the apartments are held by Woodley House. Residents pay the actual rent plus ten or 20 per cent, depending on whether they are on welfare or Social Security or are financially independent. All residents are expected to have a plan for therapy and an activity in the community, such as a paid job, volunteer work, or attendance at school or at a day hospital. Currently two full-time staff members operate the program. The director is a trained social worker who had previously been a member of the halfway house staff. The director’s assistant is a Spanish-speaking paraprofessional who not only assists in the entire program but also provides information, consultation, and referral services to the Spanish-speaking community of the District of Columbia. The two staff members alternate being on call 24 hours a day. There are weekly evening meetings of staff and residents, usually at Woodley House but occasionally at one of the apartments. The meetings are for discussions, problem-solving, and socializing. Issues involving the emotional or irresponsible behavior of individual residents frequently are confronted during the group meetings. At these formal meetings the residents are encouraged to hold similar meetings in their own apartments in order to resolve other problems. A major goal of the program is to help the ex-patient gain greater independence and assume responsibility for his own life choices. Therefore all residents pay their own rent and get their own food stamps. Those who are eligible for Medicaid or Medicare secure and handle those benefits. The residents plan their daily routines and develop their activity programs according to their personal needs and goals. Another major goal of the program is to foster the resident’s skills in cooperative living. Residents make their own decisions about shopping, cooking, and cleaning, and they otherwise organize their apartment life through group decisions. Residents’ lengths of stay in the apartments are not limited. Therefore, they have a greater sense of security in the program than they might elsewhere in the community. When an apartment does have a vacancy, staff screen candidates, and the residents select their new roommate from the acceptable candidates.
VOLUME
27
NUMBER
3 MARCH
1976
153
The program has several advantages. First is the effective use of staff; we have found that two staff members can handle the program. They minimize the need for their intervention by encouraging residents to save requests for help until the weekly meetings. That gives staff time to carry out their other duties, which include screening prospective residents, locating and furnishing apartments, coordinating the program with landlords and therapists, training students, and encouraging other professionals to initiate similar programs. A second benefit of the program is a more effective use of halfway house facilities. Before the apartment program began, some residents stayed in the halfway house longer than necessary simply because there were no satisfactory alternative living arrangements. As long as the residents were in the halfway house, they made no progress toward independence, and they occupied space that might have been used more advantageously by individuals needing close supervision on a shortterm basis. The apartments provide a setting for those who need a long-term stay in a semisupportive environment. Furthermore, the apartment program offers the low-income client a viable alternative to institutionalization or foster care. The most impressive advantage of the program is the relatively low cost to the individual and to the community. In fiscal year 1974-75, one day of hospitalization at St. Elizabeths Hospital cost the District of Columbia government about $24.53 per patient. One day in the apartment program for an individual on public assistance costs the district government $4.87. When the savings are multiplied by the number of patients ready for discharge from St. Elizabeths (about 1000 patients according to the Mental Health Law Project), the advantage of the program becomes obvious. The resident receiving public assistance and Social Security and using food stamps and medical benefits discovers that the program, with fees ranging from $70 to $98 per month, is one of the most economical posthospital living situations in Washington, D.C. The program has had problems. It originally depended on the city government for the director’s salary. With the city government’s uncertain budgets and allocations, there have been repeated financial crises, and Woodley House has had to pay the salary on an emergency basis. Secure salary funding is still a problem; however, the United Way fund currently is making up most of the deficit. A number of problems that staff anticipated have occurred; they include residents’ nonpayment of rent, smoking in bed, drinking, disruptive behavior, and one suicide attempt. In any group of 100 individuals, however, such occurrences would not be unusual. The Woodley House apartment program has shown that it is possible for a private agency to provide a viable and economical alternative to prolonged hospitalization. It provides a diverse group of chronic and low-income psychiatric clients of varying ages and racial, ethnic, and socioeconomic backgrounds a chance for a productive life in the community.
154
HOSPITAL
& COMMUNITY
PSYCHiATRY
A GERIATRIC PROGRAM FAIR: STATE HOSPITAL AS AN AGENT FOR COMMUNITY INTERACTION
THE
Sandra
Lewis,
M.F.A.,
0. T.R.
USince January 1974 staff of the occupational therapy department of Norristown (Pa. ) State Hospital have been providing geriatric consultation services to private residential centers, boarding homes, and nursing homes. During one consultation session at a local nursing home, an activities worker asked about the possibility of having a central meeting place where agencies, institutions, organizations, and individuals concerned with the needs of the elderly could exchange ideas and information. Within two weeks the suggestion evolved into a Geriatric Program Fair, scheduled for the following November in the hospital’s cornmunity center building. Work on the fair began in earnest in August 1974. The hospital printer prepared flyers inviting agencies and clients to participate in the exchange of ideas and descriptions of programs and achievements. Mailing lists of agencies and organizations were obtained from every known source, and 75 phone calls to potential local participants were made during the three months of preparation. The author and several members of the occupational therapy department also canvassed various meetings concerned with aging to enlist participants’ support. The phone calls, usually followed up by flyers, proved to be the most successful means of getting support. In addition to contacting agencies and organizations, we also contacted senior citizens themselves. During a fair such as this one, it is important not only that the elderly learn what services are available to them, but that agencies get ideas from the elderly about the kinds of services they need and want. Both staff and patients helped in organizing the fair. Two weeks before the event, the hospital’s public relations officer notified the media of the purpose, date, time, and place of the fair. One of the patients, a former advertising artist who had expressed interest in helping, painted promotional signs during occupational therapy sessions. The signs were distributed to community libraries, grocery stores, and community centers, and placed at various locations on the hospital grounds. Some patients decorated name cards during occupational therapy sessions, while others volunteered to act as hosts and hostesses. At the fair itself, a reading table with literature concerning the aged was set up, and copies of significant legislation were distributed. There were 31 exhibits from the community and 18 from the hospital. A total of 230 persons, including 75 exhibitors, attended the fair. No fees were charged. The hospital absorbed the Mrs. ment
Lewis is geriatric supervisor of Norristown State Hospital,
of the occupational therapy Norristown, Pennsylvania (Continued
on
depart19401.
page
159)
