In addition, many unlicensed care homes operate as family businesses in single family dwellings allowing shifting of residents to avoid detection by regulators (Tobia, 2014). 3.5.3. 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. A Homes for the Aged (HFA) provides 24-hour room, board, and supervised personal care to: 21 or more unrelated, non-transient individuals 55 years of age or older. Some states allow them to assist with medication storage but not with ADLs. 5:00 pm PST6:00 pm MST7:00 pm CST8:00 pm EST. First Responders: EMS, Firefighters, and Police. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. One key informant stated this posted information, as well as general education sessions out in the community; for example, in senior centers or nursing homes, leads to some complaints that can generate investigations into personal care homes that may be identified as illegal operations. In 2005, Pennsylvania state regulations for personal care homes were changed, reducing the minimum number of residents a personal care home could serve from seven to four. In addition, one key informant stated that penalties for operating unlicensed care homes are similar to only a Class C offense, which is "equivalent to fishing without a license." We completed 17 interviews with SMEs. Several examples of unlicensed personal care homes were described by key informants during the site visit. National Association of Medicaid Fraud Control Units. (c) "Assisted living facility" means an unlicensed establishment that offers community-based residential care for at least three unrelated adults who are either over the age of 65 or need assistance with activities of daily living (ADLs), including personal, supportive, and intermittent health-related services available 24-hours a day. &qcfcO%P>s]w auN y6+@ pP ^aAIT6d\cl?` -9'gr61,=.X YW={r23bK(L+k These challenges include differences in laws and regulations pertaining to care homes across states, and the lack of cooperative arrangements across states to facilitate tracking residents or operators who traverse state borders. 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. (2015). State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety, or appropriateness of those other environments. Some residents were also described as transitional or homeless, while others were described as persons with substance use disorders. HOUSTON - KPRC 2 recently reported on Blessed Hands Independent Homes, an unlicensed group home operating in southeast Harris County. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. There were no reports of varying frequencies of unlicensed facilities between urban and rural areas. A phone number is provided if someone has a question about the licensure status of a facility. Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. Using information from a HHS Administration on Aging report, provided by the National Ombudsman Reporting System (2009-2013), we identified reports regarding unlicensed facilities in five states: Maryland, Michigan, Nevada, Florida, and Georgia, as well as the District of Columbia. Perils in personal care homes. Instances or allegations of physical and psychological abuse and neglect of residents were reported by SMEs and key informants and highlighted in the environmental scan. U.S. Department of Health and Human Services 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. Several informants reported that it is common for the operator of an unlicensed care home, or representatives designated by the care home operator, to serve as the representative payee for the residents. Of the approximately 1,400 complaints received by APS each year, an estimated 20% pertain to unlicensed personal care homes. 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. In either case, while states regulate and provide some level of monitoring and oversight of licensed care homes, state and local oversight of unlicensed care homes can be minimal or non-existent, and these facilities provide questionable care and services. 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). Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes. We hypothesized that states that do not have well-funded HCBS programs may have a higher incidence of illegally unlicensed homes than states with more robust HCBS programs. States with concerns about the prevalence of unlicensed care homes may wish to examine their licensure regulations, as these may influence the supply of and demand for unlicensed care homes, either because the complexity of some regulations makes them hard for operators to understand, or because they might contain loopholes that operators can easily exploit. . Assisted living provider resources: Unlicensed facilities. In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. One of the SMEs shared comments from ombudsmen that the numbers of unlicensed homes in some states are increasing, while in other states, they reported that they had not heard about unlicensed care homes. 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. Key informants described the way the teams function. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. 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. Advocates reported a growing number of unlicensed facilities and difficulties distinguishing them from boarding homes or other types of RCFs. Based on the findings from this exploratory study, unlicensed care homes appear to be widespread in some areas within some states. What concerns are there about the quality of care and safety in unlicensed care homes? Based on our exploratory research, we found that a number of factors may have an effect on the demand for unlicensed care homes. 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. For example, a care home with three persons with at least one personal care need might also house three people with personal care needs whose community housing arrangement is covered by the U.S. Department of Veterans Affairs. This key informant also emphasized that unlicensed care home operators tend to work with a network of collaborators who support moving residents between homes to avoid detection by legal authorities, and also help with re-recruiting residents and reopening a care home after an unlicensed care home is closed down. In addition, investigations by Georgia law enforcement officials indicated that there is considerable fraud with respect to SSI, Social Security, residents' personal needs allowances, Medicare and Medicaid, and the food stamp program. Some legislatures made it a felony to operate an unlicensed care home. Complaints can also be received by fax, letter, or email. SMEs and key informants discussed a number of factors that may have an effect on the supply of and demand for unlicensed care homes. State investigators from the Bureau of Licensing and Regulatory Affairs inspected the home in October and found that Carter was violating the law. 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. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. Reporters from the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local officials, social service providers, and advocates, and then published a series of articles on the status of affairs in unlicensed residential care homes (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). Troubled Group Homes Escape State Scrutiny. If you have a story for Heather Catallo, please email her at hcatallo@wxyz.com or call 248-827-4473. 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. On the other hand, grey literature--that is, reporting databases, blogs, and media reports--produced more results about unlicensed care homes. He said, well youre supposed to and I can name several violations right off the top, said Klavinger. We targeted site visits in communities that varied according to whether the state: (1) has legally unlicensed care homes; (2) has a list of unlicensed care homes; and (3) ranks among the highest or lowest in HCBS waiver expenditures. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. The following acronyms are mentioned in this report and/or appendices. They noted that the following may have heightened the demand for unlicensed care homes: The admission and discharge policies of licensed care homes. As described earlier, some of our key informants noted that hospital discharge planners knowingly discharge these individuals to unlicensed care homes to alleviate the immense pressure they are under to facilitate quick patient turnover, and some hospitals reportedly will pay unlicensed care homes to admit these individuals. Fraud reports have been filed with the U.S Department of Housing and Urban Development for the misuse of funds to send users from Puerto Rico to unlicensed rehabilitation centers in the United States. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. Glover-Hogan said going forward, she will do more research, and she said often when she initially places wards, she does not have access to any of their funds yet, which can make placement extremely difficult. The Bureau supervises the states 4200 licensed group homes. The PCRR team shares the complaints they receive about potential illegally unlicensed personal care homes between the AAA, APS, Disability Rights Network, code enforcement and state licensure office. As a result, we also examined HCBS expenditures in a select number of states. As with health and safety concerns, the environmental scan and interviews conducted with SMEs and key informants revealed myriad concerns about abuse, neglect and financial exploitation. This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. Many key informants regarded the closing of Mayview State Psychiatric Hospital in 2008, which was located in Allegheny County, as an important factor contributing to the gap of services and affordable housing available for individuals with mental health diagnoses. In other types of residential care, if the care is arranged or managed by the owner, manager, or staff of the building, home, or community, then the facility must be licensed. Most of the literature and media reports reviewed focused on the pitfalls of unlicensed care homes and the poor quality and safety provided in these settings. Additionally, interviewee discussions revealed a lack of ombudsman involvement in unlicensed care homes, which is another area for future research. 4GEMS ADULT FOSTER CARE. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. Multidisciplinary PCRR teams were then formed at the county level to address the relocation of residents to licensed facilities and to investigate illegally unlicensed personal care homes in coordination with the state licensure office. What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? Several key informants expressed concern about neglect of the health needs of residents because of too few or inadequately trained staff, particularly in regard to the care of residents who have severe and persistent mental illness and need monitoring of their conditions and reactions to medications. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. m'C{:4hQ*7/^=5"}}XOiE04>f{3c y `'#U#"+ezaC T%YXJ4&l-!~?# ,5gvHRD3|LcGZ@' L=$bo-}w={&vT-)>/bcSG{K1DCIqEV8w $Ts7 .&S`1MSaqI&Q:NY3p v)ybUB@H K,q(.U w^t{N Thus, future research might be warranted to determine the characteristics of residents in unlicensed care homes and whether they differ across legally and illegally unlicensed homes. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. Almost all adult care home operators receive $2,608 per month. Given the types of key informants interviewed for this study, and the limited viewpoints captured, more information is needed to understand the characteristics of unlicensed care homes and the residents they serve. In addition, states differ in whether they provide additional funds to the ombudsman program, over and above the federal funds from the Older Americans Act. Monitoring and Improving Quality in Legally Unlicensed Care Homes. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. In 1999 legislation (PA 99-80) passed, authorizing trained, unlicensed personnel to administer medication to elderly people in residential care homes (residents must be ambulatory and generally less frail than those in nursing homes). Retrieved from http://www.miamiherald.com. Hawes, C. & Kimbell, A.M. (2010). The team conducted brief vetting calls with the second subset of SMEs to determine their appropriateness for an interview; if they were not deemed appropriate, they were asked whether they knew of any other potential interviewees. Desperate, Plummers family hired an attorney. In one state, Pennsylvania, three bed residential care homes are legally unlicensed. Her e-mail addresses is: Emily.Rosenoff@hhs.gov. The environmental scan and SME interviews informed state selection for site visits. In general, the FHA provides group homes, their residents and developers with important protection. Although a coordinated, multidisciplinary effort appears necessary to comprehensively address unlicensed care homes, several key informants discussed the lack of ombudsman jurisdiction to access residents in unlicensed care homes. You may need to be personally licensed as a Certified Administrator of Group Homes, for instance. An earlier study by Perkins, Ball, Whittington, & Combs (2004) provided these reasons from the perspective of one small unlicensed care home operator: Regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential homes. When discovered, investigators said, 37 people were living . Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. Each interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. One key informant described the selling of residents from an unlicensed care facility located in a house. States with concerns about vulnerable adults' access to housing with services may wish to examine their admission and discharge requirements for licensed care homes. But several judges in metro Detroit like to appoint Public Administrators as professional guardians for adults who are considered legally incapacitated.. Before 2005, Pennsylvania allowed residential care homes with 1-8 individuals to be legally unlicensed. 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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. %PDF-1.7 My goal, is make sure they have a roof over their head, they have heat, they have electricity, they have water and they have food, said Glover-Hogan. The guardian later moved Plummer to a licensed facility, but according to state records, Glover-Hogan still has one ward inside the Warren group home. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. However, we did not hear any specific examples of this from the state or local level. Pennsylvania DPW highlights safety and care regulations at personal care homes. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. For example, one ombudsman report from Florida noted the difficulty in identifying an unlicensed care home due to the quantity and quality of evidence needed to obtain a search warrant in order to enter the home and positively identify a place as providing unlicensed care or housing residents who must be cared for in a licensed facility. 48317. As noted by one SME, unlicensed care homes that provide good care and a safe environment may intentionally not be brought to the attention of state agencies nor be reported by these agencies when they learn of these homes: "We do receive reports, about 6 months ago someone wrote to me about their mother who was getting care in an unlicensed homeshe was getting wonderful care, she wasn't going to report it. Abuse and Neglect. Some states allow legally unlicensed facilities to assist with ADLs and administer medication, but do not allow them to provide 24-hour supervision. For many of these individuals, their only option may be unlicensed facilities. 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. 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