Sex Offender Placement in Adult Family Homes in Lakewood

A news story from City of Lakewood.

The City of Lakewood opposes the placement of high-risk sexual predators into residential adult family homes intended for vulnerable persons. The City also objects to the placement of potentially violent patients into distant communities in which they have no history or support network.

In late August, the City of Lakewood was notified by the Department of Social & Health Services (DSHS) that a Level III sex offender released from Eastern State Hospital was to be placed in an adult family home in Lakewood. The patient has an extremely violent record and a diagnosed propensity to reoffend. Among his many crimes, his most recent was failure to register as a sex offender.

The City of Lakewood was gravely concerned about this particular placement, but also about the general practice of placing potentially violent psychiatric patients into adult family homes with vulnerable residents. The City enlisted the help of Representative Mari Leavitt, Representative Dan Bronoske, and Senator T’wina Nobles, who successfully negotiated with DSHS to cancel the placement. The City is thankful for their leadership on behalf of the residents of Lakewood to prevent this placement.

The City of Lakewood objects to two current practices related to the placement of Level III sex offenders:

1. Placement of Level III offenders into adult family homes; and
2. Placement of Level III offenders into distant communities without a support network and against “fair share” principles.

Placement of Level III offenders into adult family homes

Adult family homes are important community assets. They shelter and care for our community’s most vulnerable residents. Long-term care workers perform difficult and admirable work caring for their residents.

129 adult family homes (as of September 2021), one assisted living facility, and one nursing facility operate in Lakewood – the City does not oppose residential care facilities.

Adult family homes are residential care facilities for up to six non-related residents. They provide shelter, supervision, and assistance with activities of daily living and personal care. Residents of adult family homes may include the elderly, individuals with developmental disabilities, and other health issues.

Adult family homes are not known to specialize in treatment of sexually violent patients. No specialty licensing or certification is required for an adult family home to host these patients. Workers at adult family homes must complete a “70-Hour Long Term Care Worker Basic Training”. Specialty training is required before a home may admit a patient with mental illness, dementia, or developmental disability. Mental health specialty training introduces workers to care for a broad spectrum of mental disorders, but does not specifically qualify workers for the challenges and risks of caring for sexually violent residents.

The City of Lakewood contends that these settings are incompatible with sexually violent patients. Adult family homes do not offer the close supervision and specialized care that high-level sex offenders may require to rehabilitate, or to protect fellow residents and the surrounding community.

Placement of Level III offenders into distant communities without a support network and against “fair share” principles.

The City of Lakewood objects to placement of sexually violent patients into communities where they have no known support network, family, or history. This also defies “fair share” principles outlined in SB 5163 2021-22, although that particular law applies only to conditional releases, not unconditional releases.

However, few providers are willing to accept patients with a history of sexual violence. A potential predator is then imported to a distant community by a provider willing to take them. Outlier adult family homes then serve as magnets for difficult-to-place patients. A high risk tolerance seems to be the primary qualification; there is no special certification that would indicate an adult family home’s expertise in the treatment of sexual predators.

By the time a patient is released to a community care setting, the patient would have completed a criminal sentence or forensic commitment and would have some agency to select where they wish to live. Recognizing the patient’s agency and the importance of support networks to positive outcomes, the City opposes the export of potential predators from their home communities.

Where should mentally-ill Level III sex offenders live?

Release of sexually violent psychiatric patients into adult family homes is not unprecedented, nor unusual. The DSHS Special Commitment Center on McNeil Island provides specialized treatment for civilly-committed sex offenders who have completed their prison sentences. Patients released from this facility are often placed into adult family homes.

These offenders need a place to live. By the time the state would consider residential placement after psychiatric treatment, they would have already completed any criminal sentence or forensic commitment. These individuals are free, and do have influence on where they wish to live.

However, by virtue of Level III status, these offenders may pose a chronic risk:

“These offenders pose a potential high risk to the community and are a threat to re-offend if provided the opportunity. Most have prior sex crime convictions as well as other criminal convictions. Their lifestyles and choices place them in this classification. Some have predatory characteristics and may seek out victims. They may have refused or failed to complete approved treatment programs. Fewer than three percent of all registered sex offenders in Pierce County are classified as Level 3 offenders.”

Accordingly, high-risk offenders with ongoing psychiatric needs may require greater supervision and specialized care than is typical within an adult family home.

Enhanced Services Facilities might be more fitting, and the City is open to other care models.

“An Enhanced Services Facility (ESF) is a small, community-based residential setting for up to 16 individuals who have complex personal care and behavioral health needs. These individuals require additional support and services from trained caregivers and professional staff, but do not require the level of care found in an institutional setting or mental health treatment facility.”

Enhanced Services Facilities are rare in Washington State; only six yet exist. A seventh has been permitted in Lakewood – the facility may be operational as soon as 2022. More of these specialized facilities should be built to house potentially dangerous patients that have demonstrated enough improvement within a psychiatric hospital to be considered for residential placement.

What is the City of Lakewood doing about this?

The City of Lakewood has previously litigated against the release of sexual predators into residential care settings. In 2018, the Pierce County Superior Court denied a City motion, ruling that the City had no regulatory authority over state-sanctioned care or placement practices.

The City of Lakewood is now preparing suggested legislation with the goal of ensuring proper supervision for high-risk behavioral health patients and the wellbeing of vulnerable residents of adult family homes. The City will also propose legislation to ensure “fair share” principles are followed in the placement of potentially violent patients near their area of origin.

The City will continue to work with legislators and with the State of Washington to improve the behavioral health model and to protect Lakewood residents.

Background Reading

• Pierce County Sex Offender Registry, Pierce County Sheriff’s Office
• Enhanced Services Facilities, DSHS ALTSA
• “Enhanced Services Facilities (ESFs): A New Residential Setting Type”, DSHS ALTSA
• Adult Family Homes, DSHS ALTSA
• “Choosing Care in an Adult Family Home or Assisted Living Facility”, DSHS ALTSA

Pertinent Legislation

• Senate Bill 5163
  • Conditionally Released Sexually Violent Predators – Placement and Treatment
• WAC 388-112A-0490:
  • What are the specialty training requirements for applicants, resident managers, administrators, and other types of entity representatives in adult family homes, assisted living facilities, and enhanced services facilities?
• WAC 388-112A-0495:
  • What are the specialty training and supervision requirements for long-term care workers in adult family homes, assisted living facilities, and enhanced services facilities?
• WAC 388-112A-0450:
  • What must mental health specialty training include?