As New York Boosts Residential Treatment, Regulators Turn a Blind Eye to Conditions

Cruz lives in a residential program for adults with behavioral health issues, but has also battled health complications and addictions to heroin and cocaine. He said he has abstained from both for about two decades.

Thousands of New Yorkers live in residential programs like Cruz’s — effectively apartments with extra services, like managed healthcare and monthly welfare stipends. The residential program that Cruz lives in is regulated by the state Office of Mental Health, which funds programs that can house 42,000 people. Another agency, the Office of Addiction Services and Supports, reported 14,000 admissions last year to residential treatment services it oversees.

The residential treatment system has become a key plank of the state’s response to the crises of addiction and mental illness. And it’s slated to expand: The state allocated funds this year to open 3,500 new residential units through OMH, while OASAS plans to ratchet up spending on residential treatment services each year, totaling $681 million from 2023 to 2027.

As New York pushes for more beds, a patchwork of regulations leaves people living in residential treatment programs vulnerable to abuse, putting the state’s goals of increased capacity at odds with its ability for oversight.

In interviews with New York Focus, lawsuits, and testimony to state agencies, experts and residents of such programs have reported that they are subject to the whims of their providers and landlords, and that regulators have often looked the other way.

The most recent guidelines from OASAS and OMH say that people who reside in their programs should have at least the same legal protections as anyone in regular housing. But in practice, service providers sometimes ignore those rights for their residents — some of the state’s most vulnerable.

In Cruz’s case, the housing provider Promesa — a subsidiary of mega-provider Acacia Network — appears to have violated OMH guidelines. New York prohibits landlords from evicting tenants without a court order, but New York Focus could not find any eviction case filed against Cruz in state court records. According to Cruz, he received no warning before the men showed up at his house. He said he was then told that his eviction was happening because his wife and stepdaughter had moved in with him.

“OMH is committed to ensuring that providers under our supervision comply with all regulations and provide service recipients with safe, affordable housing and the support they need to thrive in their community and in their recovery,” wrote a spokesperson for the agency in a statement to New York Focus. “Any provider that does not do so is held accountable.”

Acacia declined to comment on Cruz’s case.

Cruz, who shared pictures and videos of the eviction attempt with New York Focus, was ultimately able to keep his apartment. He said police intervened and told the movers that they had to go through housing court.

Not everyone gets to bring their bags back in from the curb.

A legal directive OASAS issued in 2015 gave service providers the green light to remove people from certain residential programs without going through housing court. Even though they can live in their apartments for months, the state reasoned that the residents are clients of a treatment program, not tenants. Judges have split on whether such evictions are legal.

Asked about the directive, a representative from OASAS said that programs are converting to a new model for care. But a searing 2021 audit from the state comptroller revealed that OASAS allowed programs to flaunt the agency’s rules for recertification during the transition.

Among other failings, the comptroller found that by declining to complete necessary reviews and “disregarding the requirements in the Regulations,” OASAS had “increased the risk that deficiencies would go unidentified and not be addressed in a timely manner.”

With state agencies already straining to regulate existing residential services, it’s unclear what will happen as the programs grow.

Amid questions about the evictions’ legality, the state sided with the providers.

“Individuals who are temporarily residing in an OASAS-certified supportive living service are substance use disorder treatment clients, not tenants,” Mark Boss, the OASAS attorney, wrote to a Samaritan executive in a 2015 memo obtained by New York Focus. In other words, clients had no tenants’ rights.

Samaritan declined to comment for this story via a representative.

“OASAS has them living outside of the law,” Grinthal said. “It wasn’t a hypothetical or an on-paper problem. Our clients were getting evicted.”

Grinthal was able to delay further removals via settlements with Acacia and Samaritan. But eventually, the programs shut down, and many of the people still living in the buildings were displaced.

A spokesperson for Acacia said that the provider was just following the state’s instructions.

“Acacia Network fulfilled the objective of the court transition agreement, which was to temporarily operate [the programs] in accordance with licensing oversight while transitioning clients to new placements,” the spokesperson said in an email.

OASAS spokesperson Evan Frost told New York Focus that most providers have transitioned away from supportive living programs to residential care, but did not specify how the new regulations are more protective of residents’ housing rights.

As OASAS has pushed programs to make that transition, oversight has fallen by the wayside. The agency gave numerous redesignated programs a pass on inspection requirements — and only enforced its own regulations when a government watchdog intervened.

In 2021, State Comptroller Thomas DiNapoli’s office issued an audit report of OASAS’s residential services programs. While written in the muted prose of government auditors, its findings were scathing.

The report examined 76 randomly selected programs. Certifications had lapsed for every single one of them, with some going uninspected for years. More than half had been out of compliance since before the Covid pandemic.

“This lack of oversight and action poses an increased risk to the safety and security of the conditions of Programs and the vulnerable populations served,” the report read.

Across 25 programs, OASAS had identified 243 deficiencies during recertification. The programs didn’t say how they would address 40 percent of those deficiencies, nor did OASAS ask for proof that they’d been resolved. Ten of the 25 programs didn’t even receive an on-site visit from OASAS during their recertification period.

OASAS marked one program as non-compliant, requiring them to follow up six months later in June 2018. Nearly two years later, regulators still hadn’t visited the program.

The report concluded that OASAS had flouted its own regulations by extending the recertification period in order to entice providers to move to supportive living — a process that remains ongoing. There are still 18 supportive living facilities in operation statewide.