Pennsylvania, home to a large percentage of the country’s opioid epidemic, is itself starting to have to deal with insurance marketplace realities that addiction treatment is not being provided with the same type of critical care that other medical healthcare issues are, with housing of people while in treatment and post-treatment being a major concern.
As reported yesterday in the Pittsburgh Post-Gazette, market observers are starting to (finally) recognize that sober living housing has proliferated due to the opioid epidemic, bringing in short-term tenants.
While the Fair Housing Act otherwise prohibits regulations for these homes (other than zoning limitations that apply to all housing equally), no one anticipated how insurance carrier’s refusal to pay for necessary housing commensurate with treatment, coupled with no state oversight agency, would create a battlefield of good vs. bad providers, fighting over the care of people in recovery.
Some have house managers, mandatory drug testing and other requirements, while others leave tenants to their own devices.
Among hundreds of recovery homes thought to operate in Pennsylvania, there is no data to determine whether these homes actually offer support to their residents, or are simply “boarding houses” in neighborhoods for which the “social model” of therapeutic co-habitation is lacking.
Separately, the Pittsburgh City Council has urged state lawmakers to regulate the residences. Councilwoman Natalia Rudiak said the group homes have been a “problem” in her district, which includes Carrick, Brookline and Beechview.
“They are simply warehousing those who are struggling with addiction and trying to remain sober,” Ms. Rudiak said of troubled recovery homes with few amenities. She said tenants arriving there from more structured halfway houses are “basically entering a free-for-all” by comparison.
William Davison, 28, of Allentown lived in a recovery home in Ms. Rudiak’s district about three years ago. He said that five recovering addicts shared a single bathroom in the Brookline home, where a house manager left to watch over another home, he said. [A property operator identified by Mr. Davison reported no immediate recollection of his having been a tenant.]
“Some people started using [drugs] in the house here and there,” said Mr. Davison, a recovering heroin addict. He said he “lasted about four months — and then I started using again.”
His friend Gus DiRenna, 57, who works with addicts, said some operators may fit more than a dozen people into a three- or four-bedroom home. Monthly prices typically run about $450 apiece, at times delivering fat profits for those property owners who skimp on tenant services, Mr. DiRenna said.
The time when recovering addicts leave the structure of inpatient centers or halfway houses is often a make-or-break period, he said. A poorly managed three-quarter-way home can undermine months of progress.
“At that point, I think, is where you make the difference to keep these kids alive. That’s where we’re losing them,” said Mr. DiRenna, of Whitehall. “We’re not losing them in the treatment centers. We’re not losing them in the detoxes. It’s right afterwards, when they get out of those places and it’s time to start over.”
Allegheny County recorded at least 300 drug overdose deaths through November, according to OverdoseFreePA.org.
Mr. DiRenna advocated eliminating the profit motive for operators of recovery homes. A state certification program, he said, could set minimum standards for many facilities, along with a mechanism to gauge — and perhaps reward — their successes.
To that end, two recent state bills would establish baseline requirements for recovery homes that receive federal or state support. State Rep. Tina Davis, a Bucks County Democrat, said she will reintroduce her legislation this year.
However, in Florida, there are NO recovery residences which receive any federal or state support. It simply does not exist.
Similar to recent efforts in Florida, the Penn. Department of Drug and Alcohol Programs, or DDAP, by early 2017, is considering new safety recommendations that a task force issued in July.
The suggestions include drug and alcohol testing for owners, employees and operators of recovery homes. Those workers also should not involve themselves romantically with residents, should not pay commissions to encourage referrals from health care providers and should not provide therapeutic interventions unless they’re licensed to do so, according to the recommendations.
Additionally, the task force suggested that major appliances and utilities be in good condition and that any crimes, deaths or overdoses be reported to the state. The standards would apply only to those recovery homes certified to receive state money or referrals from state-licensed treatment programs.
At the nonprofit Recovery United Pittsburgh, president John Miller said such regulations are necessary. While his group recovery homes follow internal rules such as curfews and drug tests, he said, other outfits have essentially no structure.
He expects state regulations could put many out of business. But the facilities are not a cure-all, Mr. Miller said.
“It’s up to the person who’s trying to get their life together to fix themselves,” he said. “It’d be great if they came in, and I waved a wand and said, ‘You’re done; you’re cured.’ Unfortunately, that’s not what happens.”
A relative handful of recovery homes in Pennsylvania already face review. State drug officials estimate that more than 50 are contracted at the county level. Inspections are mandatory for those that receive state money, according to the DDAP.
Allegheny County contracts with two recovery housing providers, each monitored every year. And the Philadelphia-based Pennsylvania Association of Recovery Residences has certified around 150 homes through its own process, largely in eastern Pennsylvania.
Taken together, the dwellings represent a fraction of the 800 to 1,000 recovery homes estimated statewide by Fred Way, the association’s executive director. He figured around 1 in 12 of the home operators is a bad actor.
Most are helping people, said Mr. Way, who served on the DDAP task force.
“It’s about being holistic with their recovery and making them better men and women,” he said. He supports making independent bodies, such as his association, responsible for issuing state-recognized certifications.
Back in Western Pennsylvania, recovery-home owner Leo Hutchison is working to form a regional chapter of the state recovery residence association. He got into the business after seeing unscrupulous practices elsewhere in the field, he said.
His residents in Beechview and Carrick must show progress in a 12-step recovery program, among other expectations. Though he follows other guidelines, such as stocking fire extinguishers and allowing a specific number of beds per square foot, he’s heard of other facilities that are more lax.
“I don’t know if they’re going to want to stay in this business,” Mr. Hutchison said, “with less of a profit margin.”
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