When police responded to a disturbance in Bienville Square the morning of Ash Wednesday, the 25-year-old special-needs woman they found there was unable to tell officers why she was naked or that she’d been forcefully raped outside of her hotel hours earlier.

When her family filed a lawsuit on her behalf, they claimed the woman was sexually assaulted after residents from Agape House — a group home in Axis — had allegedly been “uprooted” and put up in a room in a downtown hotel so the owners and staff “could party during Mardi Gras.”

While the facts about the events leading up to her assault are still disputed, the incident shed light on a system of adult care that has become the last option for many seeking mental health care in a state that continues to reduce funding for it.

“We have added additional group homes to our continuum of care indefinitely as a part of the downsizing and closure of Searcy Hospital,” AltaPointe Performance Improvement Director Sherrill Alexander said. “We have more group homes than we did before because we had to do that to meet the community’s needs.”

The Alabama Deparment of Mental Health regulates residential homes for mentally and developmentally disabled adults throughout the state. (ADMH)

While the term “group home” can be loose, Alexander applies it to those certified through the Alabama Department of Mental Health (ADMH), which has approved, reviewed and inspected hundreds of locations housing mentally or developmentally disabled patients throughout Mobile County.

Though it lost its certification in April — after the incident downtown — Agape House used to be included among them.

Because it isn’t a clinical hospital setting, patients in these homes have to meet a certain level of functionality to ensure they’re capable of cohabitation and don’t pose a danger to the communities they live in. For those who don’t, though, there are often few options left.

Many end up in local hospitals or in Mobile County Metro Jail, which has already expanded its capacity to handle mentally ill inmates. Others, however, find residence in unlicensed group homes that operate without any certification and with no oversight from the state of Alabama.

Licensed homes
According to ADMH, a certified group home can serve three patient populations — those with mental illnesses, those with developmental disabilities (formerly known as mental retardation) and those with substance abuse problems.

Combining all three categories, ADMH has performed more than 331 “community service provider” site inspections in Mobile County, 88 of which were for places serving mental patients.

A “community service provider” is a residential location that receives money from ADMH — often through Medicaid or Supplemental Security Income — for housing individual patients who fit one of ADMH’s three certification categories.

Prospective providers go through a multi-step licensing application process starting with a $10 certification orientation course outlining the process. After that, a lengthier, in-person orientation is required.

A printable “certificate” is offered for completing those courses, even though the authority to operate a group home still requires a background check, a site inspection, a review of qualifications and a $1,500 application fee.

A Lagniappe reporter received a printable certificate form the Alabama Deparment of Mental Health after completing a $10 orientation online. (Jason Johnson)

Eleanor Tolbert oversees all of the ADMH-certified homes serving developmentally disabled patients in Mobile County. She said the qualifications for staff members at those agencies can vary depending on the extent of services provided.

ADMH requires specific training for direct care staff who work with residents on a daily basis and for nurses employed by those providers.

In homes designated for the mentally ill, though, the requirements are more stringent — one of the reasons most of the certified agencies locally are operated or subcontracted through AltaPointe or Volunteers of America.

AltaPointe staffs and manages 22 group homes falling into that category, but also subcontracts to private owners who serve “seriously mentally ill consumers” in several residential locations. Alexander referred to those as “foster homes.”

Group homes like those are subcontracted through AltaPointe because of “the way the system is set up” in Alabama, according to Alexander, who said AltaPointe is essentially a “pass-through” for funding because it serves most of the area’s mental health patients, including those residents.

“ADMH would not give funding directly to those community providers,” she added. “It has to come through AltaPointe, as we are the [state licensed provider] for the community.”

Alexander said residents qualified to reside in those homes have “a serious mental illness” or “some area of confusion with daily living skills.” They also have to be willing to stay there, as all of AltaPointe’s homes are voluntary admission facilities.

“One of the main objectives is trying to keep them out of the hospital,” Alexander said. “Quite a large percentage of those consumers who live in group homes, if they’re not in a stable living environment, will end up in the hospital, which is a more costly level of care.”

Volunteers of America Southeast CEO Wallace Davis said, like AltaPointe, VOA contracts with outside agencies to provide services in some of its group homes, though it also runs several directly. According to ADMH data, VOA operates or subcontracts more than 25 locations, housing patients with mental illness or developmental disabilities in area homes and apartments.

“We have been providing services to individuals with developmental disabilities since 1980, and we’ve grown to become one of the largest, if not the largest, provider of services in residential settings in Alabama,” Davis said. “We’re proud of that.”

Unlicensed group homes
Given their prevalence, keeping up with licensed group homes is challenging enough, but tracking unlicensed group homes — commonly referred to as boarding homes — can be next to impossible.

Even when an unlicensed facility is identified, taking action can be an arduous process that often falls between the cracks of regulatory authorities and law enforcement. However, those in the industry say there’s no doubt several unregulated facilities are operating in Mobile.

“That’s a continuous thing all the time,” Alexander said. “Some of these boarding homes may not necessarily have people residing there who are mentally ill, or they may be mixed in with mentally ill people in some cases, but there’s a lot going on out there.”

Dr. Walter Geary, director of health bureau standards at the Alabama Department of Public Health (ADPH), said the issue is complicated because so much of what is or isn’t legal depends on what services a boarding home offers.

Facilities with mental patients fall under the purview of ADMH and require a license. Facilities that — like nursing homes — assist with residents’ medication, feeding and grooming require a license from ADPH. Geary said figuring out what services an unmonitored facility offers is “an enormous effort,” often requiring surveyors to obtain a search warrant just to get started.

“In most states, it’s the police that go after them, but not in Alabama. Police here are only interested if there’s crime or theft of substantially more money than residents are paying in room and board,” Geary said. “We have to find time for our surveyors — which there are only seven of for 30-plus licensed facilities — to stop investigating complaints so we can send them out to a suspected unlicensed facility to start an investigation.”

Despite the challenge, ADPH has successfully shut down facilities under laws governing the operation of hospitals in Alabama. The most recent case involved a facility in Clarke County that was shut down last July, though a local facility was driven out of business as recently as 2008.

Cuddle Sitting Care, which was operated by Felisha N. Wright in Irvington, was shut down amid an ADPH investigation after the state fire marshal ordered its closure and removal of residents when “serious violations of fire safety rules” were discovered.

Other than the fact that hundreds of legally operated facilities spend the time and money to comply with the requirements of maintaining a state license, Geary said unlicensed facilities can pose an immediate danger to residents, even when their owners’ intentions are good.

A particular case that stuck with Geary occurred in St. Clair County, where ADPH filed a lawsuit to shut down a group home housing nine elderly patients in two trailers. Because the owner’s lawyer was the son of the judge who wound up hearing the case, it was initially delayed.

A hearing was rescheduled in front of a new judge, but two weeks before that date, April 27, 2011, a statewide tornado outbreak hit St. Clair County — killing four residents, the owner, his daughter-in-law and his 7-year-old grandchild.

Despite the concern over group homes dodging state regulations, Geary said he understands that many of their residents have few resources and few options.

“There is a terrible need for assisted living facilities for those who can’t afford $3,500 to $4,000 a month to live in a licensed facility, but you have to have locks on the doors. You have to have fire alarms,” he said. “Some of these unlicensed places, they charge $650 a month or whatever a person gets from Social Security and they’re done.”

“Right now, I don’t have an answer for people who only have $600 or $700 a month,” he added.

It’s unclear how many unlicensed facilities there might be in Mobile County today, but a basic Google search will turn up a number of “group homes” with no history of licensure. However, a Lagniappe investigation recently revealed one private operator in Mobile never obtained a license from the state before setting up multiple group homes in residential areas.

By Faith Independent Living or By Faith Living Transitional Housing is owned and operated by Meoshi “Shonta” Nelson. Based on Nelson’s posts on social media, she opened her first home in 2013 after completing the ADMH “prospective community provider certification orientation.”

Sharing a picture of the printable “certificate” ADMH provides, Nelson wrote, “I’m certified and been through my training.” As stated earlier, though, those certificates only indicate the completion of an ADMH orientation course — a one-hour online primer and a six-hour, in-person orientation.

Yet, posts to Nelson’s public Facebook account and a since-deleted account for the business indicate at least nine homes were being operated under the By Faith name as recently as May, though Alexander said this month there could be “as many as 11.”

In her own posts describing the services By Faith offers, Nelson wrote that the homes specialize “in the mentally ill and elderly” and those with “behavior disabilities.” She has also mentioned a “total care house” serving patients that need some assistance with “bathing” or “medication.”

Through property tax records and court files, Lagniappe was able to identify five addresses associated with Nelson’s homes; according to ADMH, it hasn’t provided authorization to operate a facility at any of them. By Faith is also not listed among the licensed assisted living or specialty care facilities regulated by ADPH.

One of the only available records pertaining to Nelson’s business activities is a license for a By Faith Cleaning Service LLC filed with the Alabama Secretary of State’s office in 2010. That business was also central to federal fraud charges that Nelson pleaded guilty to in 2015.

In a plea agreement, Nelson admitted to fraudulently claiming lost income from By Faith Cleaning after the BP oil spill and to at least assisting with other fraudulent claims submitted in the names of her daughter, sister, sister-in-law and former husband.

She was sentenced to five years’ probation and ordered to pay $122,900 in restitution.

Nelson declined multiple requests to speak with Lagniappe about the nature of her business, and when reached by phone said, “I would prefer you not to publish anything.”

“There are some facilities that seek her out, but AltaPointe is not one of them,” Alexander said. “I think the majority of [those patients] may be mentally ill or have intellectual disabilities, but if it’s a boarding home, she does not have certification through ADPH.”

AltaPointe, like other licensed medical facilities, can actually run into trouble if they knowingly discharge patients into the care of an unlicensed facility, though that’s a relatively new regulation for Alabama.

Currently, Alabama Act 2008-389 prohibits licensed inpatient hospitals from knowingly discharging patients to such unlicensed assisted living facilities or nursing homes and prohibits hospices and home health agencies from providing care to their residents.

While ADPH does receive “complaints” about unlicensed facilities from paramedics, hospitals and physicians, Geary said they most often come from home health and hospice employees who make an initial visit and find their new patient in a home with several others residents.

“In that case, we get in touch with Adult Protective Services through the Department of Human Resources since we can’t do anything right away to remedy the complaint until a judge has ruled in our favor in a case with supporting evidence showing that person is operating an unlicensed health care facility,” Geary said.

One proactive step ADPH has taken is producing a quarterly list of all the approved facilities the department is aware of that’s sent out to every registered agency including area hospitals like Mobile Infirmary and Springhill Medical Center.

Lagniappe reached out to local hospitals inquiring about their policy for placing and referring patients to long-term care facilities.

In a brief statement sent through a member of the communications staff, Springhill President and CEO Jeff St. Clair said: “We refer to state certified homes.”

Mobile Infirmary’s Director of Marketing Lauren Giddens said the same is true at their facilities, which “adhere to the [ADPH] rules regarding unlicensed homes.” However, she did acknowledge that hospitals don’t always have a say in where former patients decide to seek care, which can often come into play with patients who are homeless or don’t have any family.

“Some of these patients lack the social support and resources to live on on their own,” Giddens said. “Homeless patients who are physically handicapped or have mental illness, they may end up in a boarding home, but it’s not by our doing. We’re certainly not referring them.”

Trouble in the neighborhood
While the sexual assault of the Agape House resident may have been the most high-profile recent incident involving a local group home — licensed or otherwise — others have occurred this year.

On Feb. 23, less than a week before the reported sexual assault, a group home resident ran away from her caretakers during a doctor’s visit on Springhill Avenue. The Mobile Police Department identified the resident as Natasha Williams, a “mentally challenged” 29-year-old who “suffers from a personality disorder and is prone to hurting herself.”

Williams was found the following day, though MPD declined to release the name of the facility that was caring for Williams at the time and couldn’t confirm whether or not it was licensed.

The Mobile County Sheriff’s Office had its own run-in with a local group home in April when, according to MCSO, staff members from Bayou Oaks Foster Care Facility in Satsuma dumped several used medical items into an MCSO prescription drug drop-off bin.

MCSO spokesperson Lori Myles said DEA guidelines require certain protocols for disposing of medical waste that were not followed by the staff, and that personal information about residents had been dropped into the box including “patient care charting sheets,” prescription information and “one patient’s explanation of Social Security benefits with the amounts highlighted.

“Also in the bags was medical waste such as used face masks, gloves, gauze, used diabetic lancets and three used syringes,” Myles added.

Intended for the disposal of unused prescriptions, the drop-off was built inside an old bank deposit slot, which deputies reach into in order to remove the contents. Myles said it puts their staff at risk when something like a used syringe is improperly placed in the box. Myles said correspondence was sent to AltaPointe, which subcontracts Bayou Oaks to manage at least two of its foster homes, and there hasn’t been a similar incident since.

When asked, Alexander downplayed AltaPointe’s involvement the incident.

“The people in those homes are not AltaPointe employees,” she said. “They’re responsible for that home. They hire the staff, provide all services and provide for customers that live there.”

However, the amount of liability agencies like AltaPointe have when incidents occur in their subcontracted group homes is one of the key issues in the lawsuit filed over the March 1 sexual assault reported after Mardi Gras.

While the suit accuses Agape House and owners Rodney and Shetecia Chastang of “negligence” and “wantonness,” it also names as defendants AltaPointe — the victim’s case manager — and VOA, which subcontracted services from Agape House.

According to the ADMH website, Agape House LLC was certified through VOA in 2008 following a “deemed” visit, which occurs when “DMH accepts a certification, license or accreditation issued by another recognized state or national organizations in lieu of an additional review through the DMH certification process.”

In April, the Mobile County District Attorney’s office launched a criminal investigation into “the entire situation” including the sexual assault and whether there was any criminal liability on the part of the victim’s caregivers.

While no charges have been filed, the civil suit is still pending. Representatives for AltaPointe and VOA declined to comment on the lawsuit as did attorneys for Agape Ministries Inc. and the victim’s family.

Updated at 10:08 a.m., June 29, to include information about local hospitals’ policies regarding unlicensed assisted living facilities and nursing homes.