Speaker numbers apply only to this recording. Names come from transcript evidence. “Possibly” marks uncertain attribution.
Chairperson Christina Henderson (At-Large, Committee on Health) convened a public oversight roundtable on October 15, 2026, to examine systemic gaps in the District's long-term care continuum for residents with overlapping health, behavioral health, and support needs. The roundtable focused on placement denials, fragmented agency responsibilities, and the declining capacity of Community Residential Facilities (CRFs). The sole government witness was Dr. Hannah Kaufman, the District's first Age-Friendly DC/Long-Term Care Strategic Coordinator.
Expert Panel (Virtual): Dr. Mark Salzer (Temple University) argued that community participation is a medical necessity for people with serious mental illness (SMI). Prof. Brian McGarry (University of Rochester) testified that nearly one in five nursing home residents have an SMI diagnosis but facilities lack specialized staff; he supported continued evaluation of DC's 2018 behavioral complex needs add-on. Mark Frederick (Elder Serve Health) described New York's health home and level two supportive housing models for SMI populations.
DC Long-Term Care Ombudsman Office: Nicole Belanis detailed accelerating CRF closures, noting 20 beds lost in 2025 and 55 beds lost through ten closures in 2026, with Supported Rehabilitative Residence (SRR) beds declining from 201 to 138 (2022-2026). Kimberly Walker testified that DBH failed to assess residents before closures, placing them at inappropriate levels of care, leading to mental health crises and homelessness. Holly Eaton criticized DBH for identifying homeless shelters as acceptable discharge destinations and recounted a resident who became homeless after a 7-day closure notice. State Ombudsman Mark Miller noted CRFs make up 12% of beds but generate 23% of complaints; DC has lost 30% of its CRF beds in ten years. The office recommended an independent comprehensive study of the DBH CRF system.
Advocacy & Associations Panel: Jacqueline Verner (Disability Rights DC at ULS) expressed concerns about physically inaccessible CRFs, inadequate housing voucher rental caps (set at 2011 rates), and slow progress on the McDonald v. DC nursing home transition injunction. Elizabeth Davis (DC Hospital Association) reported that in March 2026, 89 patients remained hospitalized beyond medical clearance, accounting for 4,862 excess days; 32 awaiting long-term care stayed an average of 103 additional days. Barriers included guardianship delays and staffing. Dr. Christy Kovax (Behavioral Health Solutions) argued the core issue is long-term care capacity, not just hospital discharge, and the behavioral add-on's 90-day authorization is too restrictive. Andrew Patterson (Legal Aid DC) stated approved PCA hours go unfilled due to staffing shortages and urged a 1915(j) state plan amendment for participant-direction. Kristen Ewing (DC Appleseed / DC Coalition on Long-Term Care) focused on workforce data gaps and the unimplemented Medication Aide Certified (MAC) credential; she offered six recommendations including a workforce gap analysis and funded training plans.
Provider & Resident Panel: Catherine Buell (Wellness Real Estate Innovations) shared personal dementia care costs exceeding $120,000 annually and advocated for memory care regulations and integrating health in the Comprehensive Plan. Dr. Benjamin Aderu (HCS) and Veronica Sharp (DCHCA) testified that the behavioral add-on ($82/day, 90-day authorization) creates a perverse incentive by rewarding documentation of disruptive behaviors over stabilization. Loreline Gregory (Service My Way representative) testified to severe communication delays and a six-month hiring process for PCAs. Sinique Lynn (Community Connections) reported operating CRFs at a 15% financial loss due to unfunded mandates and an absent reimbursement cap (30 days vs. 90-day required bed hold). Sister Melly Smith (Catholic Charities ACT) described a wheelchair-bound consumer with schizophrenia who was denied nursing home care within three hours, despite a waitlist. Judy Ashburn (Nuvaya/Samaritan Inns) highlighted a successful SUD therapeutic housing phase facing a sustainability funding cliff. Will Doyle (Pathways to Housing DC) stated the transition system is not working, noting "no wrong door often feels like no right door." Dr. Catherine Crossland (Unity Health Care) explained that a personal needs allowance of roughly $100/month causes people experiencing homelessness to decline assisted living placements.
Okay, good afternoon. I'm calling this public oversight roundtable to order. Today is Thursday, October 15th, 2026. We're in room 412 of the John A. Wilson building, and the time is 1.39 p.m. I'm at large councilmember Christina Henderson, chair of the committee on health. Today's roundtable will examine two related challenges within the district's long-term care continuum of care. First, the district's long-term care, health care and behavioral health system often operate separately, leaving residents with overlapping needs without appropriate placement. Individuals with serious mental illness, substance use disorder, cognitive impairment, complex medical conditions, and other intensive support needs, may be ready to leave the hospital or an institutional setting, but unable to transition safely to a nursing facility or another community-based or long-term care placement. The committee wants to understand how placement denials, workforce and training limitations, inadequate reimbursement, service gaps, and fragmented responsibilities across agencies, hospitals, managed care organizations, and providers contribute to this problem. Second, we will examine also examine the district's uh community residential facility system. CRFs uh serve individuals with mental health needs who require support but do not need hospitalization and be may be working towards greater independence. Concerns have been raised about the quality of services, inadequate transition planning, residents remaining in facilities longer than necessary, and facilities failing to use treatment plans to guide residents' care and progress. At the same time, rapid facility closures and declining CRF capacity threatens to leave residents with either fewer appropriate options. The purpose of today's roundtable is not simply to document these longstanding problems, but to truly get at identifying solutions. We want to be able to determine how the district can improve coordination, strengthen care and transition planning, stabilize its provider network, and ensure that residents receive appropriate services and settings that support their safety, recovery, and independence. We purposely did not invite all of our agency leaders to testify today on behalf of the government. Our one government witness today, Dr. Hannah Kaufman, is serving as the district's first age-friendly DC/slash long-term care strategic coordinator. The Committee on Health funded this expanded position in the FY26 budget with the express purpose of having someone with a dedicated role sitting within the Deputy Mayor for Health and Human Services, who has a purview to track long-term care services provided by health and human service agencies throughout the cluster and to help develop and improve long-term strategies on this end. Should they arrive? Before we get started, I do want to review our testimony guidelines for our public witnesses. So aside from our first panel, all of our witnesses will have three minutes to speak. We have clocks here. It is not because we don't want to hear all that you have to say. It is because we're trying to hear what everyone has to say today. With that, I'm going to turn to our first panel, which is all virtual. We have Dr. Mark Salazar, who's a professor at Temple University. Professor Brian McGarry, who's an associate professor at the University of Rochester School of Medicine, and Mark Frederick, who is the Vice President of Social Work and Community Services for Elder Serve Health. And I think they're almost all online. So I see Dr. Salzar, so we'll start with him. Thank you for being here with us today. Great. Thank you for having me. My name is Mark Salzer. I'm a psychologist and professor in the College of Public Health at Temple University. Since 2003, I've served as principal investigator and director of the Temple University Rehabilitation Research and Training Center on Community Living and Participation of People with Serious Mental Illnesses, which is funded by the National Institute on Disability, Independent Living and Rehabilitation Research. I'd like us for a second to think back to the early days of the pandemic. Work, school, worship, coffee shops, gyms, volunteering, and even time with family and friends all disappeared. It was hard on every one of us. Now imagine that it was not a moment in time, but your everyday life. For many people with serious mental illnesses, including those diagnosed with schizophrenia, bipolar disorder, and major depression, it is everyday life. Community participation is a medical necessity. Work, education, faith, volunteering, and relationship shape our physical, cognitive, and mental health and wellness. That is true for everyone, including people with serious mental illnesses. Mental health treatments, including medications and therapy matter, but as Professor Charlie Rapp, a pioneer of strengths-based case management put it, people don't need more referrals to mental health services. We already do a pretty good job in that area. They need referrals to life in the community.