Very little discussion centered on improving the quality of unlicensed care homes. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. Areas for future research and potential data sources related to unlicensed care homes. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Currently at the state level, the primary strategy used in Georgia to identify unlicensed care homes is through complaints, including complaints from neighbors, residents, residents' family members, and hospitals serving residents of unlicensed care homes. Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. individuals with serious mental illness who require care and supervision as well as room and board. Retrieved August 6, 2015 from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/requirements-for-home-and-community-settings.pdf. One interviewee estimated that licensed personal care homes used to reserve 50% of their beds for individuals who only had SSI benefits and now this amount has decreased to fewer than 25%, leaving SSI recipients with fewer licensed options. First Responders: EMS, Firefighters, and Police. (2004). Some of these places are legally unlicensed, while others operate without a license illegally. Multiple key informants described unlicensed care homes as primarily serving persons with mental illness. Also, the information collected from newspapers, ombudsmen, APS staff, or other agency reports (by their very nature) skew towards negative events. While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. Future research examining the role of hospital discharge planners and strategies to prevent discharge to unlicensed care homes appear warranted. 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. Key informants also noted that unlicensed care homes may serve mixed populations within the same home (e.g., elderly residents as well as individuals with severe and persistent mental illness). More recently within the City of Atlanta, the gentrification of some neighborhoods has resulted in increased property values and rents, which has caused some unlicensed care home operations to relocate to less expensive areas. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. Miami Herald. You also have the option to opt-out of these cookies. Leases are for a fixed period of time-usually a month or longer. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. Two key informants mentioned that changes to the state's Medicaid Personal Care Services program had a direct impact on available funding for group homes that serve individuals with mental illness. A wide range of specific concerns about unlicensed care homes were identified in this study, including improper management of residents' medications; unsafe, unsanitary, and inadequate living environments; failure to adequately feed residents; and monetary theft of benefits. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. In several cases, the potential interviewees did not have direct knowledge on the topic of unlicensed care homes, and were not interviewed, but referred us to interviewees with more knowledge on the topic. It is now a misdemeanor to operate an unlicensed RCF. Residents may not have access to their personal identification cards due to the care provider retaining those items, which can limit the capacity of the resident to relocate. However, landlord and tenant laws typically only apply to individuals who meet the legal definition of a landlord or a tenant. One key informant from Pennsylvania spoke about the difficulty in handling reports of neglect or abuse in legally unlicensed care homes: "we will have repeated incidences, or alleged incidences [at legally unlicensed residential care homes] and we don't report to anyone [any agency or the state] either. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. Maximum employee meal and room costs are established under California Employment Law. Retrieved from http://www.state.gov/documents/organization/245365.pdf. New Jersey and Tennessee have a licensure category that specifies the maximum number of beds required for licensure, but not a minimum, which also implies that in these states some residential care homes may be legally unlicensed. From May 2015 through February 2016, Mr. Akinsete operated three unlicensed Room and Board homes in South Sacramento, luring gravely disabled elders and dependent adults into his homes with false promises of medical care, medication dispensing, transportation to and from medical appointments, food, and cleaning. Many residents in unlicensed care homes receive SSI, and some residents may qualify for waivers to provide long-term care services in HCBS. Not only will you be protecting the individuals who live in the care facility, you will be providing a service to your community. 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. Key informants in all three site visit states provided examples of how this might happen. For example, SMEs indicated that law enforcement investigators have discovered operators of unlicensed homes with scores of electronic cards for food stamp benefits that belonged to current and former residents. Having buildings that were infested with bedbugs, other insects, and rodents. Few of the investigations focus solely on financial exploitation. Both states use a penalty system to fine operators for illegal operations. ", 3.4.2. Positive Actions by States to Improve Oversight of Unlicensed Facilities. Schneider, C., & Simmons, A. Many interviewees mentioned monetary motivations of operators as one factor. For example, is it defined by the services the home offers, the services needed by residents, or the services provided to the residents in the unlicensed care setting. DISCLAIMER: The opinions and views expressed in this report are those of the authors. C., & Barry, R. (2011).Neglected to death, part 2: Assisted-living facility caretakers unpunished: 'There's a lack of justice.' Key informants in Pennsylvania speculated that owners of legally unlicensed care homes may have direct experience operating an illegally unlicensed home or know someone operating one, and therefore may be able to help identify unlicensed homes or their operators. Absent assistance from the ombudsman or other support in finding affordable licensed care options, unlicensed care homes may be the only option these individuals have. Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. They indicated that these unlicensed personal care homes are filling the gap left by the closing of licensed personal care homes. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. To address unlicensed care homes, states commonly use a strategy that includes penalty systems that fine operators as a way to try and close illegally unlicensed care homes. However, unlicensed care homes, which provide room and board and some level of personal care services, but are notlicensed by the state, fill some of the gaps in the availability of housing and services for these populations. Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). SME interviews primarily focused on federal and state policies that may impact the prevalence of unlicensed care homes. In other situations, a landlord must list the violation and allow a tenant to correct the violation only if feasible. It does not store any personal data. Several key informants mentioned that hospital discharge planners sometimes discharge patients to unlicensed care homes (described in more detail in Section 4), and as such they might be a potential source for compiling a list of these homes. However, even if the home continues to operate, the fines are rarely enforced or collected. One state key informant told us that the state licensure office is currently working on an amendment to add a graduated fine system which would increase fines overtime for those operators who are repeat offenders which could potentially serve as a deterrent to continuing illegal operations. By clicking Accept All, you consent to the use of ALL the cookies. A private residence, a care facility or an employer might offer room and board. The Texas Department of Aging and Disability Services (DADS) website (2015) states that the agency is aware of some unlicensed residential care homes and is either working to get the homes licensed and to comply with health and safety requirements or is in the process of closing them. However, we did not hear any specific examples of this from the state or local level. Legally Unlicensed Residential Care Homes, 6.2. These findings suggest that as states continue to move toward serving more of their Medicaid beneficiaries in the community rather than in institutions, consideration should be given to ensure appropriate safeguards are in place for these beneficiaries. Targeted searches of media reports in states with the lowest percentages (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield a higher number of reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). Savchuk, K. (2013). We also heard of operators not reporting the death of a resident to SSA so the operator could continue collecting the resident's checks from the government. One key informant stated that if a call comes in and the name of the care home that is being reported is unknown, then the next step is to call the state licensure office. Most state informants said legally unlicensed care homes did not fall under state regulatory purview, and thus were not monitored (or investigated unless there is a complaint). Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. 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Interview results indicate that the majority of unlicensed care homes investigated by state officials and local APS agencies involve situations in which residents are not being cared for properly. Although some SMEs and key informants provided a few examples of unlicensed care homes where residents receive what they categorized as good care, it appears that abuse, neglect, and financial exploitation of these vulnerable residents is commonplace. Findings from the interviews suggest that the majority of unlicensed care home residents in the metro Atlanta area have severe and persistent mental illness and are highly vulnerable to exploitation. No other coordinated agency efforts beyond the state licensure office, APS, and the LME-MCO were described by key informants. 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. Neglected to death, part 1: Once pride of Florida; now scenes of neglect. In 2012, the state mandated that large adult care homes (seven or more beds) housing only individuals with mental illness had to close because they were considered institutional settings. Thus, one implication of the study is that it may be worthwhile in one or more states or communities to test and evaluate other methods of detecting illegally unlicensed care homes. Key informants noted that the possibility for theft from residents and from government programs also exits with the practice of operators taking control of residents' monthly income from SSA. Moreover, the 1976 Keys Amendment to the Social Security Act requires states to assure that SSI recipients do not reside in substandard facilities, and states must annually certify that this is true. San Jose, California 95112 Toll-Free (800) 248-MHAP Fax (408) 350-1158 Telephone (408) 294-9730 TDD (408) 294-5667 . The state regulatory agency can send letters to illegally operating facilities and fine them $500. According to the key informant, these individuals were given one-way bus tickets out of the city under the stipulation that they never return. However, we did not focus on these populations in the interview. These cookies will be stored in your browser only with your consent. Some publish notices of how and where to report unlicensed care facilities. He recommends additional research, enhanced coordination and cooperation among local agencies, education for first responders about unlicensed group homes and how to identify at-risk individuals, and stronger advocacy for risk reduction strategies to prevent fires that involve large loss of life (Tobia, 2014). The primary motivation for most care providers to maintain an unlicensed home is to maximize profit. Key informants also commonly described the conditions in unlicensed care homes as abusive, financially exploitative, and neglectful of residents' basic needs, and depicted situations that involved false imprisonment of the residents and repeatedly moving the residents from one facility to another, both within and across states, to evade law enforcement. In more extreme cases, other personal care homes have stopped accepting any persons whose sole source of income is SSI. (2011). According to findings from these interviews, there are a few different pathways into unlicensed care homes, including unlicensed homes receiving residents directly from hospital discharges, representatives of unlicensed homes picking up residents from homeless shelters, and owners of licensed facilities taking residents to unlicensed homes. licensed board and care beds in California. Informants noted that unlicensed care homes vary in their appearance and condition. Strategies to Address Unlicensed Care Homes. Hawes, C. & Kimbell, A.M. (2010). The new regulations were implemented to monitor and provide oversight of personal care homes with four or more residents, while reducing the number of homes that legally did not require licensure. Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit. LeasesandRentalAgreements Leases state the amount of rent and the rights and duties of the landlord and tenant. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. Based on the collective feedback of a diverse group of key informants, unlicensed personal care homes appear to be prevalent and problematic in the state. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. KCMH currently links clients with approximately 30 homes ranging from 1-21 beds, usually 2 persons/room. This section explains how consumers, building officials and legitimate licensed contractors can report unlicensed activity. Licensure staff only learnabout the unlicensed residential care homes when someone reports them. The facilities are homelike environments that offer adult mental health clients and supervised group living experience. The majority of key informants interviewed cited emotional abuse including intimidation and neglect as the most common forms of abuse observed or reported in unlicensed care homes. In California in the early 1970's, the Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. From our review of states' regulatory information on licensed residential care categories during the development of the sampling frame for the 2014 National Study of Long-Term Care Providers, and our review of ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy (2015), we found that 30 states require residential care homes to be licensed if they have at least one bed. But there are homes providing room, board, and personal care that either fall outside the bounds of the state licensure requirements or are deliberately avoiding state licensure requirements. Georgia was selected as a state for our site visit because of the state's actions surrounding unlicensed care homes described during interviews with SMEs, and the numerous news reports about unlicensed care homes in the state. 3.5.3. Additionally, some of what we heard about policies that affect demand for and supply of unlicensed care homes was based on the opinions of the individuals interviewed and may not be representative of others' views, and we do not have data to support these viewpoints. Stop elder abuse petition. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. Pennsylvania Department of Public Welfare. The majority of examples of mistreatment included resident physical and emotional abuse, neglect, or financial exploitation. 1. Finally, in some states, SMEs and the environmental scan identified legally and illegally unlicensed residential care homes that were referred to as boarding homes or board and care homes. In response, the legislature has appropriated $260,000 to relocate residents identified as living in unlicensed care homes. As noted, jurisdictional disagreements exist as to whether licensure agencies or APS agencies are responsible for the illegally unlicensed facilities. The nature of health and safety concerns described by key informants were wide-ranging and often included neglect and the risk of death to residents. Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. With regard to recruiting residents from hospitals, we also heard of unlicensed care home operators receiving payments of up to a month's fees from hospitals anxious to discharge the residents to free up hospital beds. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental issues to community-based care settings, such as legally unlicensed care homes. National Association of Medicaid Fraud Control Units. The landlord may also issue a three-day notice immediately to a tenant who uses his room for illegal activities. ", 3.5.5. Tracking Public Benefits and Representative Payees. Unlicensed care homes--which provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state--fill some of the gaps in the availability of housing and services for these populations. Residents in need of medical assistance such as nursing care can pay for such care from an outside provider, and the facility does not have to be licensed as "assisted living." Similarly, APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. Lax enforcement in personal care homes. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort.