New Push to Further Clarify Rules for Addiction Recovery Housing

Lilo H. Stainton | October 30, 2019 | Health Care
Existing regulations are largely geared toward boarding and rooming houses and not to helping those with substance-use disorders, advocates say
Credit: Twenty20
A group treatment session

Supporters of addiction recovery housing in New Jersey are hopeful that proposed new regulations will lead to more sensible oversight, as well as additional capacity that encompasses a truly effective system of support for those who have been treated for substance abuse disorders.

These hopes are codified in a bill that would create a credentialing process aligned with respected national standards and allow facilities here to become state certified under the program. While participation would be voluntary for the residences, the bill would eventually prohibit addiction treatment providers from referring individuals to sites that did not have this certificate.

The bill encompassing the new regulations cleared a Senate hearing in September and passed the full Assembly in December 2018. State Sen. Bob Andrzejczak (D-Cape May) called it a “top priority” and one leading advocate said she was “pretty confident” it would get final approval in the Senate in the coming months. (Lawmakers are scheduled to return to Trenton after the Nov. 5 elections for the remainder of the legislative session, which ends in January.)

Based on guidelines crafted by the National Alliance for Recovery Residences (NARR) — which form the basis for laws already adapted in at least nine states — the legislation would allow facilities to be regulated under a different system, as opposed to the current one that grew out of the state’s longtime law governing rooming or boarding homes. While new regulations adopted in January 2018 were designed to better support recovery programming in these homes, some advocates said more change is needed to allow them to flourish as true recovery housing.

The NARR standards strive to encourage a more home-like experience, while maintaining strict parameters on everything from business practices to the way staffers interact with clients to the use of urinalysis screenings to detect illegal drugs. They also require sites to have a space large enough for all residents to gather, encourage them to cook and eat together, and allow for non-clinical support services, like case management and work readiness programs.

‘Gold seal of approval’

“In the industry as a whole, there’s a tremendous amount of support for the NARR standards,” said Michael Santillo, who runs the recovery program at John Brooks Recovery Center in Atlantic City. In addition, studies show recovery homes are fairly effective at helping people abstain from substance abuse, he said. NARR’s model fully allows for the use of medication-assisted treatment, or MAT, which involves carefully calibrated doses of an opiate to control addictive behavior.

NARR certification is “a gold seal of approval,” agreed Terri Burns, president of the New Jersey Alliance of Recovery Residences, a state outlet of the national group. “It’s designed to raise the bar and be the best.”

Burns is also director of operations at the Hansen Foundation, which is about to open its tenth recovery residence in the Garden State, while locked in a now eight-year battle with state officials related to the current regulations.

In addition, NARR certification would help weed out operators that are providing substandard services, the advocates said. “Right now, you have good actors and you have bad actors,” Andrzejczak added. The bill (A-3607), is also sponsored by Sen. James Beach (D-Camden), Assemblymen Vincent Mazzeo and John Armato (both D-Atlantic), and Assemblyman Nicholas Chiaravallotti, (D-Hudson.).

A need for more recovery housing

There is a huge need for recovery housing in the Garden State, experts agree, especially for quality facilities that are committed to helping individuals address their addictions over the long term. Some experts suggest it can take 15 years to achieve the same level of happiness and self-esteem enjoyed by those without substance use disorders.

“One of the biggest problems we have is finding placement for people after they complete treatment” at the John Brooks inpatient facility, which has 120 beds, Santillo said.

In the coming weeks, John Brooks will open a new recovery home to help address the need, under a pilot program led by the state Department of Human Services, which is funding three such facilities across New Jersey.

“Recovery supports are an essential part of responding to the opioid epidemic,” said DHS Commissioner Carole Johnson. “We believe that initiating a recovery housing pilot will help us learn and build tools to strengthen our response in helping individuals find and sustain their path to recovery.”

New Jersey continues to struggle with a drug-use epidemic that has killed more than 2,000 people this year and prompts at least 70,000 people to be admitted to treatment annually in the state. For many, going home could prove dangerous, or even deadly. Advocates believe there are several hundred recovery homes of various models now in operation, but say more space is needed.

“We fill our beds immediately,” Burns of the Hansen Foundation said, “and we always have at least four to seven people on the wait list.”

Advocates see regulatory mismatch

The dispute between the state and the foundation stems largely from the problem the proposed regulations seek to address, the fact that so-called recovery houses fall largely under state rules governing boarding houses, and not regulations tailored toward providing support for people recovering from substance-abuse disorders.

The Hansen Foundation, founded in 2001 by recovering heroin addict Jennifer Hansen and her family, operates residential group homes in communities throughout South Jersey.  In 2012, the state Department of Community Affairs, which regulates housing facilities, visited one of their facilities and issued the first of what became multiple citations for violations of the boarding house laws, according to media reports, and led to a federal lawsuit that remains unresolved.

For years, recovery houses had to meet the same standards as boarding houses — which required commercial fire suppression systems and other safety features — or operate according to a national model that dates to the 1970s in which residents run the facility on their own. Federal lawsuits have found such so-called Oxford House sites exempt from certain local regulations and zoning laws.

Burns said complying with the boarding-house regulations would have been prohibitively costly for the nonprofit foundation and would have created other zoning conflicts that would hamper its ability to run a family-style residential facility. And many of their clients are not ready to run their own group home under an Oxford House plan, she added.

In January 2018 the state enacted a new category within the rooming-house statute, a Class F license dedicated to so-called Cooperative Sober Living Residences. While the change exempted these facilities from some of the group-home requirements, it also limited their capacity to 10 residents each and banned operators from providing food, laundry, transportation or other personal services that advocates said are essential for clients in recovery.

Santillo, of the John Brooks Recover Center, described the January 2018 change as “better than nothing” but said that advocates have long called for more appropriate guidelines, based on the NARR standards.

Burns, meanwhile, said the Class F licensing is not at all helpful to Hansen Foundation facilities, which need to shelter more than 10 people at each site to actually break even. Hansen charges residents a small program fee, which Burns said many struggle to pay on their earnings from minimum wage jobs.

Getting a Class F license requires several application forms, a criminal-background check for the operator, fees and a local code inspection, among other elements, according to the DCA’s Tammori Petty. So far, the state has licensed 66 facilities in this category, she said.

Regardless of recent changes, Andrzejczak said he has heard concerns about the DCA’s process from recovery home operators — and those seeking to open new facilities. His bill is designed to make it easier for people to open and run quality sites, he said.

“The accreditation process shouldn’t be as difficult as it is,” Andrzejczak said. As a state, “we’re dragging and we’re lagging behind” how others regulate these facilities, he added.