He argued that comprehensive emergency management planning and proactive practices were needed to protect those at risk in unlicensed homes. These legally unlicensed residential care homes are exempt from licensure because they do not provide 24-hour supervision, though residents may be receiving intermittent skilled nursing care, and help with ADLs, medication administration, and social activities. . This became evident during discussions with informants in Pennsylvania and Georgia; it has also been reported in the literature, as we found in the environmental scan. Key informants for each site visit location included representatives of local public safety organizations such as law enforcement or firefighters, Adult Protective Services (APS) staff, and ombudsmen. Georgia: In one expose, the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local official, social service providers, and advocates, and then published an article on the status of affairs in unlicensed personal care homes. Also, Indiana state law requires legally unlicensed assisted living facilities to submit disclosure forms to the Family and Social Services Administration within the Division of Aging; thus, the state may be able to compile a listing of legally unlicensed facilities. One key informant in Allegheny County shared a list of seven current placement agencies that likely have registers of illegally unlicensed care homes. Unlicensed contracting is part of California's estimated annual $60 to $140 billion dollar underground economy. Key informants described the way the teams function. Without having a qualified, certified administrator on your team, none of the rest can follow. While we were specifically told by two key informants that the LME-MCO can only contract mental health services and supports to licensed group homes, these same key informants also shared specific examples of the LME-MCO unknowingly contracting services to unlicensed group homes. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. Available at http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Federal government websites often end in .gov or .mil. However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. Spencer, D., & Mimica, L. (2014). The North Carolina Office for Mental Health Licensure also licenses group homes for adults with developmental disabilities (5600B) and group homes for adults with substance abuse issues or chemical dependency. Key informants in two states confirmed that some hospitals there contract with placement agencies that, in turn, place individuals in unlicensed care homes, particularly individuals with limited resources and mental health issues. You can go online to quickly confirm an assisted living or residential care facility is licensed (cdss.ca.gov) under Find Licensed Care. Agencies have inadequate resources or authority. If the illegally unlicensed personal care home can be deemed unsafe, code enforcement has the authority to condemn the building and shut the illegal operation down. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. Health, Safety, and Sanitary Conditions. However, while SMEs reported variability in licensure requirements and the authority, responsibility and funding of ombudsmen agencies with respect to unlicensed homes, there is very little information available about legally unlicensed homes, including the characteristics of residents, their care and service needs, and their preferences. Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). A core pattern of exploitation described in interviews included the operator of unlicensed homes finding vulnerable individuals who need housing and supportive services (such as from hospitals or homeless shelters), requiring these individuals to transfer their SSI payments to the operator or one of the operator's agents in order to become a resident of the unlicensed care home, severely limiting the residents' ability to leave the facility, and relocating the residents to alternate locations to avoid detection. If the facility does not close, law enforcement (not the state licensure offices) fines the illegal operation $50 for the first offense and $500 for each additional offense. The cookie is used to store the user consent for the cookies in the category "Other. Medication is visible. While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. Sallah, M., Miller. In these cases, the hospital reportedly pays the placement agencies a fee to find a personal care home, and the placement agencies also receive monetary incentives from the personal care homes for referrals. Third, the findings suggest it is important to determine the nature and scope of abuse neglect and unsafe conditions experienced by people who have low incomes and physical and intellectual or cognitive disabilities. Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). Florida publishes a listing but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. Strategies for identifying illegally unlicensed care homes. General searchterms included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. Disability Rights California have investigated squalid conditions at a number of unlicensed room and board homes serving adults with psychiatric disabilities across the state. Indeed, several key informants in Allegheny County reported that the closure of Mayview Psychiatric Hospital led to an increase in the prevalence of illegally unlicensed care homes in the county. Maryland, Nevada, and Florida: The National Ombudsman Reporting System noted an increase in unlicensed care homes in these states, but no unlicensed care reports from any state provided evidence on the prevalence of unlicensed care. In the states we visited, a common theme across interviews was that addressing quality in illegally unlicensed care homes tends to focus on shutting down the operations. Some of these homes are legally unlicensed while others operate illegally. Anne Arundel County Fire Department, Millersville, Maryland. As such, they could be a key source for learning about currently unlicensed care homes. Qualitative Health Research, 14(4), 478-495. 3.5.2. From a county perspective, one ombudsman and housing officer estimated that perhaps there may be less than 20 lawfully unlicensed facilities and less than five illegally unlicensed, however Tobia's team found that there may be as many as 78 unlicensed care homes serving as many as 400 individuals in that county. In California, many types of facilities offer room and board, including hotels, universities, residential care facilities and privately owned residences. 5. Troubled group homes escape state scrutiny. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. Improper medication assistance and management were most commonly noted by key informants as problematic; informants were concerned that operators or staff of illegally licensed care homes may not be properly trained in medication management and administration. Who do I contact for complaints against Community Care Facilities? Providers of housing and care services that are licensed by the state, such as nursing homes and residential care facilities (RCFs), serve some of these individuals. According to one key informant in the state, moving individuals from institutions for mental illness with an inadequate plan for housing these individuals has contributed to an increase in the numbers of people available for unlicensed personal care homes to serve, thus motivating the opening of unlicensed care homes. Operators often gain control of residents' funds by becoming the representative payee for residents receiving SSI, a common payer source in unlicensed residential care homes. Interview questions were based on respondent expertise, and were tailored for each respondent. According to several key informants in the state, including APS and law enforcement officials, the property, which they referred to as a boarding home, was being rented by the operator, members of the church served as the representative payees for the residents, and the money was then pooled together and given to the operator. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' Informants noted that unlicensed care homes vary in their appearance and condition. Similar to the information summarized in the environmental scan, interviews with key informants revealed that unlicensed care homes make money off of residents in sophisticated and profitable ways. However, site visit key informants and SMEs we interviewed were unaware of any such lists of unlicensed homes and could not identify existing methods for tracking them. These homes often serve very vulnerable individuals such as individuals with serious mental illness or other disabilities, or older adults with functional limitations and limited financial resources. Another state-level key informant was unable to estimate how many calls the agency receives that result in investigations of unlicensed group homes for persons with mental illness. Findings from the environmental scan highlighted issues of safety, abuse, and exploitation in unlicensed care homes; however, the source material, including media reports, tend to highlight negative and sometimes sensational stories, which may or may not represent the norm in unlicensed care homes. This results in different payment streams and different regulatory agencies that have responsibility for different residents in the same residence. Many publications also focused on quality of care or other issues related to unlicensed care staff. (2015). The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. Many residents in unlicensed care homes receive SSI, and some residents may qualify for waivers to provide long-term care services in HCBS. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. While this may be a promising source of unlicensed homes only in Allegheny County, Pennsylvania, similar tracking mechanisms may be used or developed for use in other communities as well. The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices. Individuals who are poor, experiencing homelessness, or individuals with a mental illness who cannot return home orhave no home to return to after being discharged from the hospital are a source of clients for unlicensed care homes. Detecting, investigating and addressing elder abuse in residential long-term care facilities. In contrast, in North Carolina (and other states not included in our site visits) ombudsmen have no authority in or responsibility for residents in unlicensed care homes according to state regulations. Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). Atlanta Journal-Constitution. According to the key informant, these individuals were given one-way bus tickets out of the city under the stipulation that they never return. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. However, even with those limitations, we know that in the communities we visited, there were significant health and safety concerns for residents, as well as concerns about financial exploitation and government fraud. In 2005, Pennsylvania changed the regulations so all residential care homes with four or more individuals had to be licensed by the state, but 1-3 bed residential care homes still could be legally unlicensed. A few key informants suggested cross-referencing different agency lists as another potential source for identifying unlicensed care homes. Hancock, L. (2007). (Producer). Pennsylvania's BHSL and the North Carolina Adult Care Licensure Office and Mental Health Licensure Office will offer to work with unlicensed residential care homes to help facilitate licensure. One key informant described a recent (2015) case of human trafficking in which a care home operator who was closing a home was explicitly selling residents for $100 each to other personal care home operators. Although such issues are not restricted to unlicensed care homes, as they are known to occur in licensed care facilities as well, future research might examine and describe the mechanisms states use to detect, investigate, and resolve allegations of abuse or neglect in unlicensed residential care homes and how they compare to the mechanisms used to identify and resolve instances of abuse and neglect in licensed care homes. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes. The regional and state licensure offices are closely involved in this process. One-bed and two-bed residential care homes are lawfully allowed in several states. Retrieved from http://www.azdhs.gov/als/hcb/index.htm. Most key informants noted that hospital discharge is a critical juncture at which individuals can be directed to, or end up in, unlicensed care homes. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. This cookie is set by GDPR Cookie Consent plugin. One key informant estimated that approximately 25 cases are investigated annually, with about half that number determined to be illegally unlicensed personal care homes. A follow-up story revealed that these unlicensed rehabilitation centers may have been selling the identities of the victims on the black market for as much as $2,500. If the facility is providing licensable services in an unlicensed setting, the state then sends a cease and desist letter, copying the LME-MCO and the local APS. For example, some states have adopted policies including licensure regulations that allow legally unlicensed care homes to operate. CALIFORNIA-DSS-MANUAL-CCL Based on the information gathered, we determined key criteria for site visit location selection, including having good leads/contacts for identifying key informants in the state, and having geographic variation across states. One key informant in North Carolina indicated that fines for the operation of unlicensed care homes have little impact on closing the homes, are rarely collected, and are not enforceable by their agency because the operation of an unlicensed care home is considered a criminal offense, and thus under the purview of law enforcement. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. Multiple key informants also stated that interviews with small licensed personal care home operators may result in learning more about the motivations for operating an illegally unlicensed personal care home. Because an owner/operator does not provide care and supervision to tenants they are not required to possess a license to operate their facility. The state regulatory agency can send letters to illegally operating facilities and fine them $500. Boarding homes are allowed to provide the following services beyond room and board: light housecleaning, transportation, money management, and assistance with self-administration of medication, but no personal care service. Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. State of California. We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limit the scope of our findings. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. In contrast, most key informants agreed that some operators start out with a smaller one to three bed legally unlicensed home and gradually end up caring for more residents, not realizing that doing so requires the home to be licensed. However, you may visit "Cookie Settings" to provide a controlled consent. Except for special circumstances, complaints must be filed in writing. One example, described by multiple key informants, looked like a nice physical environment and was affiliated with a local church, but the operator of the home was taking the residents' money while abusing, imprisoning, and exploiting them. In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. Additional key informants participating in interviews during site visits included local hospital discharge planners (North Carolina), representatives of organizations providing services to residents of unlicensed care homes (Georgia), and local advocacy organizations including National Alliance on Mental Illness (NAMI), Disability Rights North Carolina and Disability Rights Network of Pennsylvania. A local ombudsman in Maryland stated that they had no authority to inspect an unlicensed home and therefore did not have reliable knowledge about whether unlicensed care homes exist, how many individuals are living in such homes or what level of care or assistance those residents needed (Tobia, 2014). Safety issues affect local fire departments. They indicated that these unlicensed personal care homes are filling the gap left by the closing of licensed personal care homes. Characteristics of Residents and Unlicensed Care Homes. 3.4.4. With regards to the safety of unlicensed care homes, the majority of key informants agreed that the lack of clean and safe housing was a primary safety concern.
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