Two Flew Over the Cuckoo's Nest

Solange Lambert and Cosmo Salerno can't wait to take their love outside the walls of an adult home on Coney Island. But for now, they have to wait.

Solange has been watching all of this unfold from one side, listening politely with her hands folded and her head cocked, looking a little uncertain. As Shalom speaks to the young man, she gets up quietly and opens the back door to the parking lot, where she looks around for Cosmo. He is sitting on a wooden bench just outside the rec-room window, smoking a pipe. She sits down beside him; he cups her face in his hands and gives her a long kiss, then lights a cigarette for her. She leans her head against his and closes her eyes for a moment. Framed by the window, their heads together, they could be anywhere.

Living in Limbo

Like Solange and Cosmo, Surf Manor and the other adult homes exist in a sort of limbo, both because they're businesses, not hospitals, and because their residents are neither profoundly sick nor wholly well. Originally meant to house elderly or disabled people who could no longer live on their own, in the past three decades, adult homes in New York and many other states have largely replaced psychiatric hospitals as primary residences for the moderately mentally ill.

According to one census, there are about 7,200 psychiatric inpatients in New York at any given time, while 28,000 people are living in adult homes. An estimated 40 percent of all adult-home residents have been diagnosed with a psychiatric illness; at Surf Manor, the number is more like 100 percent. In the mid-1990s, the last time a large federal study was conducted, well over a million people in the United States lived in these facilities, about 25,000 of them in New York State.

"An adult home by definition is really not a bad place," says Davin Robinson of the CQC, the state agency that oversees services for the disabled. For some people who will likely always need a lot of help with basic things like taking their medications on time and even just washing their clothes, she says, adult homes are probably the best option for long-term care.

Emily Berl
Love in bloom: Solange Lambert and Cosmo Salerno
Emily Berl
Love in bloom: Solange Lambert and Cosmo Salerno

But for others, Robinson says, especially younger people like Solange, adult homes should function more like halfway houses, a stop between the psychiatric hospital and a return to independent living. "[An adult home] isn't meant to support someone to get a job or have any meaningful life in the community," she says. "For a temporary place, it's certainly better than being in the hospital. But it's just that, a temporary stop-gap." For many fragile people with little money or family support, places like Surf Manor become home for much longer than they might prefer. While there's no good data on the average length of stay in an adult home, some residents say they've ended up stranded in these facilities for months, years, and even decades longer than they had intended.

Technically, though, Solange and Cosmo are free to leave whenever they like, notes Matt Schatzel of the state Office of Mental Health, an agency that is one of the defendants in the DAI suit. "Nothing's preventing the adult-home residents from moving out right now if they want to," he says. "That's really their choice."

Attorney Sherrin, who since 1981 has represented Surf Manor and numerous other adult homes, says, "None of the adult homes are against the idea that people should move into the least restrictive setting that's most appropriate and safe for them. But what they do oppose is just taking people out under the theory that anybody living in an adult home who has mental illness would be better off in the community."

State law currently requires adult-home case managers to help residents who want to move out to do so. But that doesn't seem to be happening in many homes, including Surf Manor, says Jota Borgmann, a staff attorney for MFY Legal Services, which provided co-counsel for the disability advocates. "Adult homes are for-profit businesses, for the most part," she says. "So they are trying to make a profit. It's as if I said to my landlord, 'I want to move out, and you need to find me other housing.' What would be my landlord's motivation to do that?"

Most of Surf Manor's revenue comes from the rent residents pay out of their monthly Supplemental Security Income (SSI) checks, which is usual at for-profit homes; Surf Manor also generates additional money by renting a basement office space to New York Psychotherapy, which provides psychiatric services to many of the residents. Solange and Cosmo each receive $1,368 a month from SSI, and pay $1,190 of it—almost 90 percent—back to the home for room and board, the legal amount set for so-called Level 3 care facilities, the designation that covers virtually all adult homes.

They wind up with only $178 each, which isn't even enough to pay for all the other things—medical co-pays, clothing, and toiletries, for example—that the home isn't obligated to cover.

And it certainly isn't enough to save up to move out, Solange adds. "Most regular apartments want you to give a down payment, first month's rent, security," she explains. "We don't have the money to do that at all." At least they have each other.

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