good cop bad cop

NYC has been sending public health mixed signals!

A recent Post article notes an unexpected trend: a reduction in the number of uninsured people in NYC over the last several years. According to the article, of the 2.7 million New Yorkers enrolled in a public health insurance program (Medicaid, Child Health Plus, Medicare...) approximately one million of them first received benefits since 2002. Moreover, 90% of the city's children are insured, even if one includes the children of undocumented immigrants. So, according to the article, NYC is about halfway there: 1 million down, 1.3 million to go.

On the other hand, a Brooklyn judge recently ruled that the state has discriminated against thousands of mentally ill residents by placing them in "adult homes" instead of "supported housing". The New York Times reports the suit was brought by Disability Advocates, a nonprofit legal services group, under the auspices of the Americans with Disabilites Act. The judge ruled that these adult homes were "segregated settings"that did not provide residents with appropriate opportunities to cultivate daily living skills and personal independence. Interestingly, the cost per resident associated with an adult home is about $7,000 greater per year than the cost per resident in a supportive housing facility. ($47,936 vs. $40,253).

I work in such a supportive housing facility, and I think it strikes an excellent balance for its residents. Medical care is provided by a GP and a psychiatrist, both of whom come in weekly, and medication administration and monitoring is performed by myself, an RN, who is in twice a week. Moreover, each resident has a social worker to help them with a huge number of issues: government benefits and the associated paperwork, bills and financial management, part time work, and coordinating medical care when it goes beyond the on-site staff. Meanwhile, the residents maintain a high level of independence and self-sufficiency. Overall, it's great.