LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. Group homes generally charge less than larger assisted living communities, in . These are Alaska, Arizona, Arkansas, Connecticut, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New York, North Dakota, Ohio, Oregon, South Dakota, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. It is important to note that we do not know whether the types of financial exploitation and abuse described by the SMEs and key informants occur in both legally and illegally unlicensed care homes, or how commonplace they are. Though outside the scope of our focus, some of the searches also produced media reports and grey literature about concerns in licensed care homes; however, reports about unlicensed care homes and the quality of care described therein was sometimes worse than those for licensed care homes. Group Child Care Home (GCCH) License The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. It is now a misdemeanor to operate an unlicensed RCF. During each site visit we interviewed state licensure agency staff to obtain a broad perspective on the regulations surrounding residential care in each of the states. Please note a group home for adults may require a Home for the Aged or Adult Foster Care Home license if the level of care provided at the facility meets the licensing requirements of one of these license types, see the Department of Licensing & Regulatory Affairs, Bureau of Community & Health Systems. But several judges in metro Detroit like to appoint Public Administrators as professional guardians for adults who are considered legally incapacitated.. As part of this study, we sought to identify potential data sources or listings of unlicensed care homes that may be useful in efforts to understand how widespread unlicensed care homes might be, and whether these settings can be identified for future research purposes, both in the states we visited and in other states. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. 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. If you have a story for Heather Catallo, please email her at hcatallo@wxyz.com or call 248-827-4473. Three states (District of Columbia, Maryland, and Mississippi) have no minimum bed size for licensure, implying that some residential care homes can be lawfully unlicensed. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. 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. You can: Use the online form to file your complaint. 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. A local ombudsman and APS supervisor lead the PCRR team and maintain lists of both known illegally operating homes and those that are potentially illegal operations. Several key informants discussed the role hospitals and hospital discharge planners potentially play in referring patients to unlicensed care homes. Some of these ideas may be relevant for agencies other than or in addition to ASPE, such as the National Institute of Justice, CMS, or ACL. The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. Box 30664 Lansing, MI 48909-8164 1. These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. 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. Estimates of the prevalence of unlicensed residential care homes are lacking for most states. And regardless of whether states have regulations concerning unlicensed homes, many operators choose to operate illegally unlicensed homes. 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. The SME noted that this approach misses individuals who are representative payees for fewer than 15 individuals and as such may miss operators of small unlicensed residential care homes. 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. Key informants included representatives from several agencies, including the state Healthcare Facility Regulation (HFR) and APS offices, local fire departments, local and state law enforcement and ombudsmen, and a church-affiliated provider of day services used by individuals who live in unlicensed care homes. Additionally, agencies such as The National Disability Rights Network's Protection and Advocacy Agency (NDRN P&A) could potentially use representative payee data to identify unlicensed care homes. Pennsylvania lists the number of enforcement actions taken against illegally unlicensed residential care homes in their annual report on personal care homes, but this information may not be representative of how many complaints about unlicensed care homes are made (see the state summaries in Appendix A for more details). The first, a six-state study on elder abuse in RCFs conducted by Hawes & Kimbell (2010) for the U.S. Department of Justice found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Some states allow them to assist with ADLs, but do not allow them to administer medication. 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. 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 Pennsylvania, facilities providing or arranging for housing, food service, and one or more personal care needs for four or more unrelated adults must be licensed as personal care homes. Safety issues affect local fire departments. SMEs and key informants discussed a number of factors that may have an effect on the supply of and demand for unlicensed care homes. SMEs and site visit key informants noted that individuals being served in unlicensed care homes are very vulnerable adults. These fines ($50 for a first offense in North Carolina and $500 for a first offense in Pennsylvania) become more severe if criminal activity or a resident's death is involved. To reduce abuse, several informants indicated that state officials should target closing unlicensed care homes. Please note a group home for adults may require a Home for the Aged or Adult Foster Care Home license if the level of care provided at the facility meets the licensing requirements of one of these license types, see the Department of Licensing & Regulatory Affairs, Bureau of Community & Health Systems. At least two states have demonstrated that coordinated efforts can effect changes to laws and policies and create at least initial disincentives or barriers to the operation of illegally unlicensed care homes. Some SMEs and key informants noted that if lists could be obtained from these organizations, they could then be compared to state licensure lists to determine whether the residential care homes are unlicensed. Thirty states require residential care homes to be licensed if they have at least one bed.7 Massachusetts exempts small private-pay homes from licensure. This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. Texas Department of Aging and Disability Services. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' State key informants emphasized that they could not make estimates about the scope of abuse and exploitation issues because unlicensed care homes are not systematically monitored. Desperate, Plummers family hired an attorney. As noted in Section 3.4.1, one SME from an advocacy organization in Pennsylvania noted that they log specific information concerning names and dates into an Excel spreadsheet once a complaint has been lodged against an illegally unlicensed care home. 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. Unlicensed care homes commonly will accept these individuals and many market themselves to discharge planners. 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. 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. Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). Informants expressed other specific concerns about unlicensed care homes, including improper management of residents' medications; unsafe, unsanitary, and uncomfortable living environments; theft of utilities from neighbors; and fraudulent collection of government payments (e.g., not reporting residents' deaths and continuing to collect their SSI payments). Key informants described the regulatory agency's ability to work with an operator of an illegally unlicensed personal care home to help facilitate the home obtaining licensure. 20 or fewer individuals 55 years of age or older that is operated in conjunction with and as a distinct part of a licensed nursing home. 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. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. 200 Independence Avenue, SW In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. 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 concern expressed by some of the individuals interviewed was that even those unlicensed homes that were clean or free of neglect and abuse, commonly have safety hazards and do not meet the fire safety codes required of licensed facilities. Estimates of the number of unlicensed RCFs, as detailed in this report, were in the hundreds in two states: one state estimated more than 200 unlicensed homes in contrast to their 400 licensed facilities; and the other state estimated more than several hundred unlicensed homes but noted there was no reliable count. Some illegally unlicensed facilities deny services are being provided. While the information herein is not generalizable--it is based on a targeted scan and a limited number of interviews--it does highlight the fact that unlicensed care homes appear to be a problem in at least some states. One key informant in Allegheny County shared a list of seven current placement agencies that likely have registers of illegally unlicensed care homes. nmpV[0VM.T1B2L3qHY' w|Z?paTjSy`6GEk1BL67d.VX7dNO!7hj. endobj Although limited in scope, the findings of this exploratory study provide important foundational information about current conditions in some unlicensed care homes, factors that may influence demand for these homes, and strategies to identify them and address their quality. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. State informants did not provide information on the services provided in the unlicensed care homes stating that that the sample of unlicensed care homes they see is too small to make an accurate approximation of the conditions. 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. Findings from this study are necessarily limited by the number of experts we identified and states we visited. Assisted Living Facility (ALF) - Residence for at least 3 unrelated adults, at least 80% of whom are age 55 or older. He said, well youre supposed to and I can name several violations right off the top, said Klavinger. One key informant suggested that lists of available housing maintained by a local homeless housing assistance program may include illegally unlicensed personal care homes. Funds are being allocated to relocate residents out of unlicensed residential care. 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. Further, receipt of a complaint was the most commonly cited method to spur identification of an unlicensed care home. Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. As such, they could be a key source for learning about currently unlicensed care homes. Qualitative Health Research, 14(4), 478-495. Full of natural beauty, historical importance, and a talented, resourceful population, Michigan has it all. 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. They can also be found in document form on the LARA website. State licensure offices primarily depend on complaints via phone calls3 that come first to a local county APS or regional licensure or monitoring office. Having buildings that were infested with bedbugs, other insects, and rodents. We heard stories from SMEs and site visit informants of operators recruiting vulnerable individuals from psychiatric wards of hospitals, from acute care hospitals through the hospital discharge planners, from homeless shelters, and directly from the street, similar to those we found in media reports (see Appendix B for details). The state investigates the types of services that are provided to residents on site in order to determine if a license is required. Study staff screened each of the collected articles, blogs, and reports to identify relevant material for review. Corporations, Securities & Commercial Licensing Bureau. However, our key informants (including representatives of adult protective services, ombudsmen programs, and police and fire departments) were informed about unlicensed care homes only in response to complaints or emergencies, which may have biased their views of these homes. Another specific example included a resident moving from a home where the operator was their representative payee and the operator continued to collect their SSI check. 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. (Hawes & Kimbell, 2010). In another report, a representative of the Arizona Department of Health Services stated that unlicensed assisted living facilities were not a problem because licensed operators monitor the industry and report illegal activity (Arizona Department of Health Services, n.d.). Health, Safety, and Sanitary Conditions. In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. Miami Herald. 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. 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. <> In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements or other rooms, given buckets for toilets, and had their benefit checks taken from them. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified ten states that spent the highest percentage of their LTSS expenditures on HCBS and those that spent the least. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. Retrieved from http://www.thisamericanlife.org/radio-archives/episode/554/not-it. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. In response to media stories and a congressional request about abuse and neglect of developmentally disabled residents in group homes, OIG launched a series of audits that found that these residents often experienced serious injuries and medical conditions that resulted in emergency room visits. Homes for individual residential care are licensed to provide food, shelter, assistance, and supervision for no more than two persons who are aged, . Group Home: Individuals can choose to reside in a licensed or unlicensed group home with 2-5 other individuals. 3.5.3. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. According to key informants from APS and law enforcement, care home operators and residents crossing state borders poses several challenges that make it difficult to ensure the safety of residents and address the criminal activities of the operators. Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. Alabama's APS agency estimated that there were more than 200 unlicensed homes in the state, in contrast to their 400 licensed facilities. Nevada stated that no interagency procedures were in place to handle complaints about unlicensed board and care homes in a timely and efficient manner (Ryan, personal communication). 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. 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." 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. . For that reason, this outline will begin by reviewing those basics. One key informant estimated there are approximately 526 Dom Care operations in the state. 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