This is part 17 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.
The Brinley Inn fire wasn’t the only tragedy to take the lives of boarders in New Jersey.
The phrasing in an article about another fire a year later, at the Beachview Rest Home in Keansburg, suggests how I could have gotten the impression that former residential care patients simply ended up in old Jersey Shore inns by chance, rather than being placed there, their care paid for and overseen by government agencies:
“Since the state embarked 10 years ago on a policy to allow many mental patients to return to their communities, thousands have drifted into old housing in central cities and in shore resort areas.”
They weren’t sent at the convenience of state agencies, they drifted.
That fire saw 31 of 100 boarders die. There were no violations in the boarding house, which had been converted into a “rest home” in 1966. The state ombudsman for the institutionalized elderly, John J. Fay Jr., stated:
''As long as we allow elderly people, many of them requiring sedation, to be housed in old wooden hotels and in tenements, fires that might be expected to claim one or two lives will continue to become major tragedies.''
Indeed, some boarders took sleeping pills and other sedatives. They also relied on glasses and hearing aides. Others had dementia. There were two more fires in Jersey Shore boarding homes within that year, with a total of 64 deaths.
Stouffer’s Inn, which was not participating in state programs for boarders, saw 26 guests die in an 1980 fire, suggesting that the potential for fatal fires existed for all inns, regardless of who was staying there.
A 1995 article makes it clear that placing dozens of boarders in boarding homes didn’t end after the fires:
“In Asbury Park and neighboring Ocean Grove, such homes have become notorious for housing the mentally ill — people with schizophrenia, manic depression and other disorders who spend much of their time wandering the streets.”
By then there were far more patients living in the communities along the Jersey Shore. SSI payments had increased to around $500 a month. As of 1992, the Housing and Mortgage Finance Agency had made 147 loans, for a total of $24.5 million, for innkeepers hosting boarders to upgrade their facilities.
Deinstitutionalization began with the National Mental Health Act of 1946. New Jersey passed the Community Mental Health Services Act in 1957. It was passed at the national level with the Community Mental Health Act of 1963. The federal government created the supplemental security income program in 1974, providing income and medicaid benefits to indigent aged, blind, or disabled individuals.
The out-patient support promised by federal and state agencies never materialized. What support existed was suitable for crisis intervention, not long-term management and daily support.
There were three types of homes that could house boarders in New Jersey:
Sheltered boarding homes, also known as sheltered care homes, licensed homes, or residential health care facilities. These were overseen by the Department of Health.
Boarding homes, also known as single room occupancies (SRO) or unlicensed homes. They were licensed as boarding homes by the Department of Community Affairs, not licensed to perform sheltered care services by the Department of Health.
Family care homes. This included anywhere housing less than three boarders. Family care homes were not regulated by the Department of Health or Department of Community Affairs. They were regulated by the municipality and each had its own policies.
The law extended tenant protections to boarders, meaning they could not be evicted without following eviction proceedings. Aside from these and a few other minor tweaks, it’s not clear that the act improved life for boarders. Nor does it appear that the act was concerned with the wellbeing of boarders. As the Community Mental Health Law Project explained:
“The Rooming and Boarding House Act was designed to correct problems and abuses that existed in the boarding house industry while ensuring that residents' needs would be met. It was not designed to be a panacea for all the social ills befalling the indigent, vulnerable, dependent, often elderly, friendless and family-less population which inhabits the boarding facilities through this state.”
High hopes indeed. As long as no one was burning to death they were assuming these friendless, hopeless lost souls were living the best life they could. No one seems to have considered that they could deter people from loitering by offering them day programs, gym memberships, educational opportunities, opportunities to volunteer, job placement programs, bikes, and transit passes.
Even basic statistics about boarders in New Jersey vary dramatically. This seems to be due to uncertainty among the licensing institutions:
“The Department of Health presently has jurisdiction over 192 residential health care facilities, plus 56 other homes that have a residential component…The Department of Community Affairs has licensed 170 facilities on a permanent basis and 705 temporarily. It is aware of over 1,400 homes falling within their jurisdiction, however, and estimates that possibly twice as many are in existence throughout the state. Determining the existence of homes involves much work. The Department of Human Services' Division on Public Welfare, county welfare agencies, and local officials have all assisted in attempting to determine the existence of unlicensed boarding homes in New Jersey, but a large number of boarding homes remain unlicensed.”
Given the state of record keeping by licensing agencies, it is not a surprise that information on boarders placed in homes with three or fewer boarders is virtually nonexistent. Each town was responsible for developing and enforcing its own regulations for family care homes. I doubt this was a priority for most towns and in my experience, things that don’t have appropriate regulations are often simply not allowed.
Still, there is a legal pathway to place boarders with a foster family in New Jersey and always has been.
The New York Times wrote that in 1981 there were 3,500 licensed boarding homes in New Jersey. Supposedly four of five boarding home residents were formerly institutionalized in mental hospitals. In 1992, boarders made up 10% of Ocean Grove’s population. By 2001, many of the boarders had been relocated by the state. Several boarding houses had been demolished. By 2003, most of the boarding houses in Ocean Grove were gone.
People are eager to pin blame for the disaster of community mental health care on the innkeepers. It’s said they were negligent in providing support for the boarders. They were just in it for the money.
Looking at the documents, it seems that innkeepers were meeting the standards set out for them. Boarding houses were paid to provide three meals a day, provide weekly linens, distribute medication for boarders to take, and provide housing that met the standards of the Hotel and Multiple Dwellings Law. The amount of money they got for each boarder wasn’t particularly enticing – the money for room and board came out of various government programs for the indigent, hardly programs known for their generosity. Summer vacationers pay exponentially more.
Defenders of innkeepers tell of the activities and day trips they organized for boarders. They mention support services which were neither required by nor paid for by the government, such as organizing nurse visits, room cleaning, help with bathing and dressing, transportation to medical appointments, and assistance with money management.
Going the extra mile to provide for boarders was illegal, as they were not licensed to provide personal care or supervision. Anyone who has worked with a home health aid or personal care assistant knows that there are strict rules about who can do what if they’re paid to provide services.
These services people reasonably assume the innkeepers should have been responsible for providing were supposed to come from a host of agencies. Formerly institutionalized mental patients were placed in housing and funding was secured by the Bureau of Transitional Services. Mental health care was provided by the Division of Mental Health and Hospitals in the Department of Human Services. The Bureau of Housing Policy and Development monitored housing. Services for those 60 years or older was overseen by The Office of the Ombudsman for the Institutionalized Elderly. County welfare agencies were responsible for investigating allegations of abuse. Prior to the creation of SSI, welfare agencies were responsible for contacting each boarder annually to ensure they had housing. After SSI was instituted, they were not required to do this and boarders needed to reach out to them.
In 1981 Reagan passed the Omnibus Budget Reconciliation Act, repealing federal funding for the few community mental health centers that had been built, reducing federal aid by using block grants, and made it easier for states to use funding that had been earmarked for community care for other things.
In 1984 a Mobile Outreach Clinic Program was created, run by the Visiting Nurses Association, which operated a clinic in Asbury Park. Today The Boarding Home Outreach project, run by the State Division of Mental Health and Addiction Services, offers weekly transportation services from boarding houses to community wellness centers. It sounds a lot like a duct tape and paperclips version of the Assertive Community Treatment Model practiced today by OPZ Geel.
Reporters and lawmakers obsessed about abuses within the system and the lack of regulation. Headline after headline points fingers and nitpicks over technicalities. Whatever abuses may have occurred seem besides the point to me. The level of services provided to boarders – bed, board, spending money, someone to hand them their medication – is so obviously inadequate as to be neglectful.
Inspections and enforcement of woefully insufficient care aren’t a solution, they’re a bullshit jobs engine that does nothing to provide human beings with what we need. The loudest voices were from people who cared about box checking and avoiding liability, not about people.