This is part 19 of a series. To go back to the very beginning, start with part one. To go back to the start of this section, start with part fifteen.
While employees at government agencies around New Jersey were debating where to send people living in institutions, researchers at Columbia University were studying Geel. The office of the Caregiver Space is practically on the Columbia University campus, so I can tell you that these two places are not far apart. I walk a few minute’s from my dad’s house to the Asbury Park NJ Transit station and take that into Manhattan. At Penn Station I transfer to the one uptown. It’s not a commute I want to do on a daily basis, but people do.
It’s not as if New Jersey would have been the first to create a boarding-out system in the US. Most of the US had informal boarding-out programs. In the 1860s, Massachusetts debated rebuilding the outdated Worcester Asylum to replicate Geel. The plans were approved, then overturned. They still moved forward with a formal boarding-out program as a pilot program:
“In 1886, 34 patients were boarded-out in Massachusetts. This rose to 175 in 1892, before declining to 129 in 1896. In making the following remarks, Mitchell observed that in his opinion, there was a general misunderstanding of the real purpose of the boarding-out system, and that some difficulties had been created unnecessarily and greatly magnified. To him, the experiment was never on anything more than "a quite insignificant scale."
The experiment ended and was not extended or expanded, despite noting that “It is a significant fact that the demand for insane boarders invariably exceeds the supply.” The reason why families were eager to host and why the asylum directors didn’t support the program were the same: the patients who boarded-out were those who were able to do useful work. Sending them to live with families increased the cost of running an asylum.
Lunacy Commissioner Mitchell faulted Massachusetts for selecting hosts with hospital training and barring families with young children from participating, as this created an asylum like setting rather than a proper home life and denied boarders the connection they can have with children.
There are hints that people were fostered by families at places besides Geel into the modern era, like in this report from 1905 on how asylum inmates were dropping like flies due to TB:
"Examination of the statistics of other countries shows a death rate amongst the insane comparable in magnitude to our own; everywhere this marked contrast obtains between the mortality in closed asylums and that of family colonies."
So, it’s clear that the idea of placing stable patients with host families wasn’t unfamiliar. When government agents in New Jersey decided not to return patients to their communities or origin, why didn’t they take the opportunity to create a program modeled on Geel? All of these Americans were studying Geel in order to learn what made it work so well, yet they don’t seem to have put any of those lessons into practice.
Ocean Grove and other former camp meeting towns would have been an ideal location. Ocean Grove is a tight knit community with an organization – the Ocean Grove Camp Meeting Association – that could have matched boarders to families. Like Geel, the construction of the town was guided by the goal of creating a retreat to meet people’s spiritual needs. It’s an incredibly safe community where all of life’s necessities are within walking distance. At the time of deinstitutionalization it was still enmeshed into a dense network of public transit. Even now there’s reasonable bus service and the train to Newark and Manhattan. As much as it's an insular community in some ways, in other ways it’s open to the world and accepting of people who live differently.
Ministers and innkeepers
In the story of Saint Dymphna, it is the innkeeper who foils her escape. Dymphna had established a new life in Geel, where she and her entourage were living godly lives of contemplation and good works. When her fathers men reach the area, the innkeeper mentions that she’s seen their foreign coins before. She’s given away Dymphna’s location without realizing what she’s doing. Soon after, Dymphna’s father tracked her down and murdered her.
I can’t say for sure why the state chose to make agreements with innkeepers rather than working with the OGCMA to place boarders with families. I do have an inkling of the work involved in placing people with families, since my mother volunteered with AFS for many years, placing exchange students with host families for a school year. Families and kids aren’t always a match – and even when they are, the adjustment can still be quite difficult.
Given the timeline New Jersey institutions had to find new homes for the mad, the intellectually disabled, and other people who had been living in residential institutions, it’s easy to see why they went the route of dumping people in inns. It allowed people to get out of institutions and into communities as quickly as possible. Developing systems modeled on those used for children in the foster care system and exchange students would have taken time and required ongoing support.
The state of New Jersey, and governments everywhere, want programs that scale. They want simple to understand metrics. Placing people in boarding homes by the dozens generates clear metrics.
The other issue is the American obsession with oversight. It’s easy to demand the right to inspect an inn, a bed and breakfast, group home, asylum, or hospital at any time. It’s easy to make lists of requirements for the way every little thing must be done. It’s not so easy to control what’s going on in people’s homes.
Of course, part of the problem of boarding-out in New Jersey was that agencies failed to actually enforce the regulations and conduct inspections. Residents and local agencies worked together to enforce the right to inspection, regulations, and penalties only against boarding homes where abuse, neglect, and illegal behavior on the part of innkeepers and boarders was obvious. Agencies couldn’t keep up with inspecting boarding homes, so there would be no way for them to even pretend to be conducting regular inspections of host families.
More importantly, people object to having government agents in their home. This is not the local AFS coordinator, who you probably already know, coming by for coffee and to explain what to expect as a host family for an exchange student. We all recoil with horror at stories of welfare recipients having agents barge into their homes at night, looking for evidence of a man in the house in order to cut off benefits. Family caregivers turn down visiting nurses, home health aids, and other support services because they don’t want to have government agencies examining their financial documents, evaluating their housekeeping, and telling them how to behave in their own homes.
The thing about a small town is that oversight is different. You don’t need government agents snooping around or conducting surprise visits. You don’t need Geel’s disquieting system of transporting boarders to bathhouses, where they were scrubbed down by asylum employees carefully taking notes. Ocean Grove’s homes are so close together you can barely walk between the houses. There are far too many eyes on the street for there to be secrets.
With a full boarding house, we can flatten the innkeeper, the staff, and the boarders into statistics. That seems sufficient for newspaper articles and reports. Yet with foster families we know that we are dealing with people. When placing boarders with families, we automatically deal with them as individuals rather than lists of names.
Boarders
Geel has never tolerated disruptive behavior. The things that the residents of Ocean Grove objected to – public urination, petty theft, aggression, panhandling – have always been unacceptable in Geel. Anyone who was disruptive was either not placed in Geel or was placed in hopes that under the care and supervision of a family they would integrate into the community. Boarders who did not conform to community norms were returned to asylum care. The threat of being returned to incarceration within a closed asylum was always there.
In the early 1800s, entire asylums were emptied out into Geel. Those who were disruptive were shackled, locked in their rooms, or held in the “hostel” attached to Sint-Dimpnakerk. Those asylums weren’t meant to be emptied permanently; they were being renovated by Guislain and Triest. Once the renovations were complete, patients who couldn’t live peacefully within the community were returned to the newly renovated asylums.
New Jersey emptied entire asylums into communities without the careful screening and ongoing support provided to boarders and host families in Geel. New Jersey innkeepers were not allowed to lock people in their rooms. No one was there to require boarders took their medication. The only threat was incarceration, which would require more than being an unpopular neighbor. Ocean Grove went from a town where there was no running on Sundays to a place where you could do anything you wanted.
While the OGHOA did prevent the creation of a community service center, that was after many years of government agencies ignoring the concerns of residents – while the OGCMA faced seemingly endless lawsuits stripping it of power over the community. At that point they had been battling state agencies for years and were afraid resources for boarders would justify the placement of more boarders in the tiny town.
It’s impossible to know how things might have been if representatives from state agencies had started by reaching out to the OGCMA in order to establish a partnership. Instead, the OGCMA was stripped of the right to decide who was part of their community and enforce community norms – and then hundreds of mental patients arrived.
The rise of the single family home
Part of why the OGHOA was so successful was that their tactics were on trend. Ocean Grove was hardly the only community dealing with problems – like today, downtowns were full of people in distress. Communities across the country were removing public amenities and affordable housing in order to discourage certain types of people from coming and staying.
Contrary to the idea of families being settled in one place for generation, it was once common for families of all classes to live in boarding homes. Boarding homes had always been popular among the elderly, students, and busy workers because they provided meals, laundry, and cleaning services. Anyone who’s read novels set in the nineteenth and early twentieth century has encountered people living in hotels, inns, and boarding houses for months and years, something these books treat as so unremarkable as to not warrant an explanation.
Prior to the 1950s, most people living alone were living in shared company housing or boarding houses. As families fled cities for the suburbs, they left behind affordable urban apartments. Living alone may not be good for us, but most of us prefer it when given the chance. People who could afford to live in nice boarding homes could now afford to live in their own apartment instead. While there had always been cheap boarding homes, this shift led to a decline in the character of boarding homes across the board.
Boarding homes remained popular in seaside towns past when they stopped being seen as acceptable housing for the middle class. Boarding homes in Ocean Grove were mostly run as family businesses, with a handful of elderly singles as year-round tenants. Boarding homes also remained acceptable accommodations for students and young workers.
This was the same time that the push to get people into single-family homes began. Over the next fifty years, boarding homes came to be associated with immigrants and the poor. In the early 1900s, reformers “grew hysterical about the dangers of boarding and lodging, once respectable middle-class practices...Progressives promulgated new zoning laws and building codes prohibiting working class-families from sharing quarters. Welfare agencies spent as much time and resources establishing habits of privacy among their ‘clients’ as they did providing material assistance; they withheld aid to families who clung to older habits of sociability and economic pooling...As late as the 1970s, food stamps were automatically denied to any poor family or individual who did the sensible thing and shared cooking facilities with others.”
Boarding homes had been entangled with medical care before the deinstitutionalization movement. Early surgery happened at home, but this became a challenge as surgeries became more complicated and more people moved to urban apartments. “To accommodate desires for privacy and fears of the hospital, many surgeons first moved their operations to private ‘medical boarding houses,’ which provided hotel services and nursing.” It was only in the 20th century that prejudice against treatment in hospitals died out.
With time, the boarding home was replaced with distinct institutions: assisted living, nursing homes, student dormitories, worker dormitories, and group homes. Cities nationwide prevented the creation of new boarding houses while making it more expensive and difficult to keep existing ones in operation.
Where do displaced boarders go?
There are still boarders in New Jersey today. There are simply fewer of them. A 2011 article explained:
“Many of the 2,800 people in the 125 "class c" boarding homes suffer from illnesses such as bipolar disorder, schizophrenia and severe depression. Some are former psychiatric patients and others have a history of drug abuse. Some homes only house seniors and people with dementia. While not nursing homes, these boarding homes provide an element of medical supervision.”
At the time, there were 168 licensed boarding homes and an additional 84 licensed residential health care facilities. The majority of patients being discharged from mental health facilities were no longer being placed in boarding homes, they were more likely to be sent to group homes.
The remaining boarders in New Jersey are still not well distributed. In 2014, one facility in Toms River had 251 boarders.
Inns are faulted for not providing supervision, only providing a weekly change of linens, and providing meals containing low cost ingredients. They are being faulted for providing the level of care the state contracts allow them to provide. They can’t legally provide less than this level of care and they can’t legally provide more than this level of care. Facilities are faulted for residents who loiter outside nearby businesses, behave inappropriately in public, and create traffic issues by walking in places not meant for pedestrians.
The other fate of former or would-be boarders is to be without housing. Many end up living in encampments. For the past fifteen years there has been an encampment with a number of seniors in Toms River supported by a religious organization called Destiny’s Bridge. Their aim is to build a tiny house community with support services funded through a farm and workshops.
The issue of people with disabilities ending up without adequate housing isn’t unique to New Jersey or the United States, as a recent article on the challenges faced by developmentally disabled adults in British Columbia, Canada. In BC, people on social and assistance now receive $500 a month for shelter, which was recently increased from $350. The average monthly rent for a one-bedroom apartment in BC is $2,163.
The United Kingdom also filled up the inns of seaside towns with the disabled:
“The disabilities of chronic schizophrenics did not melt away when the hospital gates closed behind them. In many parts of Britain community care has remained an empty slogan; the homeless populations of big cities have risen at the same rate as hospital closures, and "bag ladies" have become a prominent feature of many seaside towns. Increasingly, too, patients' organisations like the National Schizophrenia Fellowship and journalists like Marjorie Wallace have successfully focused public attention on the plight of former psychiatric patients adrift in an uncaring, uncomprehending society-and on the appalling burdens imposed on their families.”
The thing about problems like this – huge problems facing so many individuals, families, communities, and countries – is that there are many different people and organizations working to address them. We can support people without a beheaded incest victim, the chaos of multiple revolutions, or dozens of academics falling prey to motivated reasoning. The situation in Ocean Grove was a collection of missed opportunities – there are other places where people saw opportunities and used them to enrich their communities.