There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. Unlicensed care homes are not required by law to open their doors to the state licensure office because the state licensure office does not have the legal authority to enter them. A six-state study conducted by Hawes & Kimbell in 2010 for the U.S. Department of Justice, National Institute of Justice, found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Finally, as noted in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or unnecessarily institutionalized. (2013). APS professionals there estimate three reports or complaints about unlicensed personal care homes every month in the metro Atlanta area, and about one complaint or report about unlicensed personal care homes every three months in rural areas of the state. Monetary theft of benefits is not uncommon. These steps include site visits to suspected illegally unlicensed care homes, during which an ombudsman may inform residents of their rights, APS may conduct abuse or neglect investigations, licensure staff may assess whether the residents should be in a licensed care home based on the level of service needs, and code enforcement staff may determine if the home meets regulatory code requirements. This key informant also noted that the residents frequently transition in and out of the home, as is often the case with illegally unlicensed personal care homes. The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option, the types of individuals who reside in them, their characteristics including quality and safety and the policies that influence the supply of and demand for these homes. While North Carolina's licensure offices do not have this same authority, key informants in North Carolina did note that most unlicensed care home operators allow them entry even without legal authority. We found little published information about unlicensed residential care homes; in fact, the scan revealed that most of the literature about conditions in RCFs covered licensed residential care or were about unlicensed care staff. Key informant interviews focused on local context, state and local policies that may impact or affect the demand for unlicensed care homes, and informants' direct experiences with unlicensed care homes. Findings from this study are necessarily limited by the number of experts we identified and states we visited. No Legally Unlicensed Residential Care Homes Are Allowed in Some States. One key informant estimated that approximately 25 cases are investigated annually, with about half that number determined to be illegally unlicensed personal care homes. Family care homes serve 2-6 residents and adult care homes serve seven or more residents; both can choose to serve only elderly persons (55 years or older or any adult who has a primary diagnosis of Alzheimer's disease or other form of dementia) or to serve a mixed resident population. Savchuk, K. (2013). 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. He noted that residents with disabilities in unlicensed homes were at risk during fires and natural disasters such as tornados, hurricanes, and severe storms. Having a license attempts to ensure the home has met minimal health and safety requirements placed upon it by the State of California. Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. A paper by Tobia (2014) describes the state of unlicensed residential care in one county in Maryland, where as many as 78 unlicensed care homes may be serving as many as 400 individuals. 5. 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. Which agencies get involved when addressing unlicensed care homes? For further information regarding the . Florida can impose fines of up to $1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). CCLD Complaints - California Department of Social Services 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. To address the issues surrounding quality and safety in unlicensed care homes, key informants described a process involving the investigation of complaints by visiting the home and interviewing residents and staff (which may necessitate getting an inspection warrant if denied entry upon arrival), then providing a written cease and desist letter if the investigation results indicate that the home should be licensed, issuing fines of $100 per day per resident, and prosecuting the operator. Government Owned Pharmacy (PHE) (PDF) Hospital Pharmacy/Drug Room (PDF) Renew Online (HSP/DRM license Only) NOTE: If the facility . 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). Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Although we heard about a range of conditions in illegally unlicensed homes, including neglect, abuse, and financial exploitation, it is unclear whether this is the norm or whether the findings are skewed because of the types of key informants we interviewed. For complaints against Health Care Facilities, please contact the California Department of Public Health, Licensing and Certification Division. 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. In addition, the reports of financial abuse also may represent considerable financial fraud of federal programs including SSI, food stamps, and the programs paying for resident medications (i.e., Medicare and Medicaid). The study by Hawes & Kimbell also provided reasons operators do not seek licensure, including: inability to meet fire safety codes (e.g., installing sprinklers), lack of state supplemental payment for SSI residents or Medicaid waiver funds (which can be restricted to licensed facilities), and avoidance of inspections and sanctions/fines for not meeting state regulation. One way to collect this information to develop a frame of unlicensed care homes and conduct a small scale study of unlicensed care home operators. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). League of Women Voters to moderate school board candidate forum Often these homes serve very vulnerable populations, such as individuals with serious mental illness or older adults with functional limitations and limited financial resources. Interviewees had varying opinions on the causes for Dom Care homes closing. States have a variety of options for reducing the prevalence of both legally and illegally unlicensed residential care homes, such as changing regulations and coordinating across agencies to address these homes. Multiple interviewees suggested that it was important to quickly involve code enforcement and local health departments in efforts to close an illegally unlicensed personal care home. Multiple key informants spoke about the significant impact of the closure of this hospital in Allegheny County and the western part of the state as it relates to the possible continued proliferation of illegally unlicensed personal care homes. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. While experts may speculate on changing market dynamics, we do not have a reliable estimate of the unlicensed care home market prior to these policies taking effect, so we do not know what the market would have been without such policies. Multiple key informants expressed concern about other state policies related to reductions in funding for mental health services and supports as potential contributors to a gap that illegally unlicensed personal care homes can fill. If the homes are closed and the residents' identification cards and personal paperwork are not able to be retrieved, this poses challenges for residents to get SSI payments and medications. Many interviewees mentioned monetary motivations of operators as one factor. 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. Thus, although our findings consistently highlight concerns about safety and quality, we cannot assess the generalizability of these findings and concerns, and our findings only minimally address unlicensed care homes that are safe and provide quality care. Analytical cookies are used to understand how visitors interact with the website. Even with relatively low payment rates, operators can make profits by cutting corners in housing and services and trafficking in the federal benefits they seize from residents. This site can provide up to five years worth of information on a facility. Health Management Associates. A 2010 annual report from the Department noted that the number of illegal residential care homes had increased from four homes in 2009 to 27 in 2010, most of them located in the Philadelphia area (Pennsylvania Department of Public Welfare, 2011). The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. This cookie is set by GDPR Cookie Consent plugin. Retrieved from http://www.miamiherald.com. Based on the findings from this exploratory study, unlicensed care homes appear to be widespread in some areas within some states. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. One of our study states made it a crime to operate an illegally unlicensed residential care home, and some states have the capacity to penalize unlicensed care homes with monetary fines. Although this regulation reduced the number of legally unlicensed care homes and reduced their capacity to three or fewer residents, many key informants in Pennsylvania noted that this had the unintended consequence of spurring many more illegally unlicensed care homes to open. "The California Room & Board Advisory Coalition is committed to enriching the quality of life of those in the communities we serve while maintaining the highest level of advocacy for providers and consumers. We found a number of publications and media reports in both Florida and Texas (e.g., the Miami Herald newspaper series in Florida, and the U.S. Department of Justice report in Texas), and a few media reports and a research report on unlicensed care homes in Maryland; however, these states were not selected as site visit states. Troubled residents languish in flophouses. 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. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. State of California. For example, some states have adopted policies including licensure regulations that allow legally unlicensed care homes to operate. Oversight was spread across several agencies and depicted as convoluted and overstretched. Adult residential licensing, 2010 annual report: A report on licensed personal care homes. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. This was described as limiting the capacity of the resident to relocate. 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. Operators forcing the resident to name the operator as the representative payee for government payments, such as SSI, and controlling the use of that money. They deny services such as assistance with medication are being provided to residents, or assert they are only providing housing for alcoholics, ex-convicts or people with mental health issues to avoid having to become licensed. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). You also have the option to opt-out of these cookies. 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. It is not unusual for them to be involved in other illegal activities as well. The NDRN P&A reportedly has suggested that SSA require representative payees to self-identify if they own a residential care home (licensed or unlicensed). We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants. 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. Necessary cookies are absolutely essential for the website to function properly. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. Interview findings also suggest that research is needed on the best strategies for identifying unlicensed care homes and effectively closing them down. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. There is no systematic information about the actual nature or range of conditions in legally unlicensed homes (e.g., safety, quality of care, issues of abuse and neglect), or provision of services and care through Medicare or Medicaid home health, private attendants, or HCBS waivers. Not all states license all residential settings with as few as one resident, as Georgia does; therefore many states, such as Pennsylvania, legally allow some unlicensed care homes to operate. Both the information we collected about unlicensed homes in the literature review and that which we collected through interviews mostly paint a negative view of these settings. 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. One key informant explained how North Carolina regulations restrict ombudsman activity in unlicensed care homes, stating "our structure is pretty clear as far as the accountability," implying that the regulations make ombudsmen unaccountable for residents in unlicensed care homes. Connie's Room and Board Independent Living 2 3333 Hickerson Drive San Jose CA 95127 Connie Reyes 408-649-6452 or 408-518-2088 txt conniesroomandboard2 Downtown Independent's 7@gmail.com Home 1188 East Santa Clara St San Jose CA 95112 408-849-8404 Complaints The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. Strategies for Identifying Legally and Illegally Unlicensed Care Homes, 3.5. An operator with this population mix can avoid licensure because each agency is only responsible for the residents that are enrolled in their program or waiver. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. Regardless of what they are called, this study focuses on places that provide room and board and sometimes provide personal care to two or more unrelated individuals, but whose operators are not licensed or certified by the state. In addition, as one ombudsman report noted, it is often difficult to determine whether a place is an illegally unlicensed residential care home because of the difficulty of obtaining access to the suspected home to make the determination. Please read and acknowledge the disclosure below: CRBC makes no representation or guarantee regarding the outcome and confidentiality of information provided through complaint process, whether in person, via phone or in writing. (n.d.).Retrieved from http://www.agingavenues.com/topics/assisted-living-facilities-in-indianapolis-indiana. Retrieved from http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/p_011015.pdf. As noted in earlier sections, many unlicensed care home residents receive federal SSI benefits, and many unlicensed care homes receive these benefits directly through the SSI representative payee program. Failing to consistently provide running water and electricity, or having unsafe or illegal electrical wiring. 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. These individuals do not pay taxes, have insurance or bonds. 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. Room and Board Homes - California Room and Board Advisory Coalition It is now a misdemeanor to operate an unlicensed RCF. They provide room, board, housekeeping, supervision, and personal care assistance with basic activities like personal hygiene, dressing, eating, and walking. Most key informants stated that many unlicensed care home operators receive the income from the SSA directly, either in the name of the resident or by requiring the resident to name the operator or someone else as a representative payee. Spencer, D., & Mimica, L. (2014). Cross-state human trafficking is another area for future research. Tracking Public Benefits and Representative Payees. Several SMEs and key informants noted that individuals who had only SSI to pay for care have few options for housing and care, and often end up in unlicensed care homes. Some violations may not be cured, such as ongoing illegal activities including drug abuse, abusive behavior or threats of violence. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. Based on our exploratory research, we found that a number of factors may have an effect on the demand for unlicensed care homes. Savchuk, K. (2013). Another key informant suggested that it would be key to involve the LME-MCO because they cover a four county area and must receive calls that are about unlicensed care homes. The enactment of state laws or penalties and fines related to the operation of illegally unlicensed care homes is a strategy that states can use to address illegal unlicensed care homes. In addition to serving the elderly, personal care homes can exclusively serve persons with serious mental illness and/or intellectual and developmental disabilities, on condition that the home is appropriately staffed and is capable of providing the needed care within the scope of its license. Government staff lack of respect for the care provided in small residential care homes by non-professional licensed staff. In Durham County we interviewed key informants from APS, Group Care Monitoring Services, a local hospital discharge planner, a local ombudsman, and one local law enforcement official, who also serves on a crisis intervention task force. As a resident of a licensed residential care or unlicensed room and board facility, you have all the rights guaranteed by the Constitution of the United States and by the State of California. One potential strategy suggested by an interviewee for proactively identifying unlicensed care homes is to hold community meetings to inform community members about unlicensed care homes, including ways to identify them and how to notify APS and licensure officials if they suspect an unlicensed home operation. Candidate forums provide an opportunity for the public to learn about the candidates and their views on the issues. An oral agreement may be legally binding for short terms of less than one year. 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. By clicking Accept All, you consent to the use of ALL the cookies. She has practiced in the field of financial planning and investment management since 2000.