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). 52ND STREET HOME. At the local level, one key informant estimated that members of the Allegheny PCRR, along with the state licensing office, have investigated approximately five illegally unlicensed personal care homes in their specific geographic region over the past two years. Once an unlicensed care home is identified, the PCRR team works closely with the both the state and regional licensure offices to take the necessary steps to deal with the home. In the first half of 2013, 37 other unlicensed homes had been identified. Interview findings indicate that many residents of unlicensed care home are Supplemental Security Income (SSI) beneficiaries. Lax enforcement in personal care homes. Informants consistently emphasized the critical need for collaboration between multiple agencies, including law enforcement, APS, ombudsmen, the Department of Behavioral Health, and HFR, in order to address the potentially unsafe environments in unlicensed care homes, ensure the needs of the residents are met, address the criminal acts of the operators, and attend to the buildings themselves. The same held true, with one exception (Georgia), for the top ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island, Alabama, Tennessee, Georgia, New Hampshire, Massachusetts, and Delaware. One woman was marketing heavy to the hospitals, and taking them to the licensed facilities, and then moving them to the unlicensed facilities, in result to those types of facilities. An individual thats incapacitated that needs a higher level of service, the likelihood is that that type of facility would require a license, said Larry Horvath, the Director of Michigans Bureau of Community and Health Systems. The Department of Public Welfare also can take action against boarding homes and similar facilities that house four or more people if they are providing personal care services because they are considered illegally unlicensed. 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. Some of these housed mainly older residents. Though it is outside the time period of our environmental scan, the case study describes how regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential care homes. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Compendium of residential care and assisted living regulations and policy, 2015 edition.Prepared for U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Understanding Supplemental Security Income SSI benefits, 2015 edition. 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. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. Some states allow them to assist with medication storage but not with ADLs. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. 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. 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. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. One key informant specifically mentioned a 10% cut to state funding for mental health in 2012 while another key informant mentioned block grants as a potential contributor to lower funding amounts for mental health services and supports. Neglected to death, part 1: Once pride of Florida; now scenes of neglect. Informants noted that interagency, multidisciplinary teams at state and local levels are imperative to the success of shutting down unlicensed care homes, and to address the various issues involved in such closures, such as meeting the housing and services needs of residents, addressing any criminal behaviors of the care home operators, and ensuring the safety of the house or facility and neighboring properties. The aging housing stock in Allegheny County was also a cause of concern for a few key informants, as it relates to the number of pre-existing buildings that cannot meet the state regulatory building code requirements for licensed personal care homes. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. For example, in Georgia it recently became a misdemeanor to operate an unlicensed care home,therefore we aimed to speak with law enforcement officials who had been involved in the process of investigating unlicensed care homes. It is now a misdemeanor to operate an unlicensed RCF. State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. Key informants from Georgia and Pennsylvania reported that hospitals and hospital discharge planners (or their contractors) often place patients in unlicensed care homes (described in more detail in Section 4). 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. endobj Key informants described the way the teams function. The following are some examples of financial exploitation depicted during interviews; these examples are discussed at greater detail below: Operators of unlicensed care homes collecting the residents' medications and selling the medications on the street for cash. However, the effectiveness of these strategies in monitoring or otherwise addressing the prevalence of unlicensed care homes is unknown. In addition to the aging population, many key informants agreed that the lack of affordable supportive housing options for individuals with a mental health diagnosis is also a concern for Allegheny County and surrounding counties. Massachusetts exempts small private-pay homes from licensure. 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. (2015). At least one administrator, on-site manager, or responsible person must be on duty 24 hours per day, seven days a week, and all staff must be trained as personal care workers within 60 days of hire. Frustrations continue among licensure agencies and advocates with unlicensed care homes, and residents are largely unprotected by licensing agencies (Hawes & Kimbell, 2010). Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. Demographic trends are placing an increasing number of older persons at-risk for needing residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. Site visit findings were largely consistent with those of the environmental scan, and despite increased attention to unlicensed care homes in some states, key informants highlighted issues of safety, abuse, and exploitation. One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. 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. Providing unsafe housing conditions, including overcrowding of resident rooms, housing many more residents in bedrooms than is allowed by state licensure regulations, housing residents in storage sheds, basements, and attics that were unsafe, unsanitary, and made egress difficult for frail or disabled residents. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. In addition to legally unlicensed residential care homes, there are a variety of places that operate illegally. After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. (2012b). Study staff screened each of the collected articles, blogs, and reports to identify relevant material for review. Some illegally unlicensed facilities deny services are being provided. The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices. 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. At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. He said, well youre supposed to and I can name several violations right off the top, said Klavinger. From our review of the regulations, we identified that North Carolina likely has legally unlicensed care homes (e.g., boarding homes serving 4-5 residents who do not require 24 hour supervision), and we suspect that illegally unlicensed care homes also exist. Another interviewee suggested that it is becoming more difficult to recruit individuals to be Dom Care operators because of the competing demands on their time. Those are just a few of the guardianship problems 7 Investigator Heather Catallo has . The Bureau supervises the states 4200 licensed group homes. Three reports are worth noting separately. You can file your complaint against an assisted living facility and AFC home the same w. restriction of group homes, both their siting and operation. Available at https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. 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). 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. Miami Herald. The state's annual Personal Care Homes Report provides the number of illegally unlicensed personal care homes that result in enforcement actions and details the historical trend of the number of enforcement actions taken against illegal unlicensed personal care homes. Failing to have safety equipment available, such as smoke detectors and fire extinguishers. In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. Ombudsmen. 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. Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping" by the operator. As described by the majority of key informants, the primary motivation to maintain an unlicensed care home is to maximize profit. Some publish notices of how and where to report unlicensed care facilities. Below are examples from the environmental scan that provide some estimates of the number of unlicensed care homes: Maryland: A representative of the licensure agency estimated 500 unlicensed illegal assistive living facilities and noted the fine line between a boarding home and assisted living. Site visit locations were based on the information gathered in the environmental scan, SME interviews, and a review of residential care regulations. How do states address unlicensed care homes, and if states or other organizations maintain lists of unlicensed care homes (legal or illegal)? Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. The latest thing with hospitals, not only discharging to substandard places, the hospital is paying for the first month because it's cheaper than an expensive hospital bed.". While no comprehensive nationwide list of unlicensed care homes exists, the environmental scan identified one state (Florida) and one city (Houston, Texas) that maintain listings of unlicensed care homes. 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. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. State licensure offices primarily depend on complaints via phone calls3 that come first to a local county APS or regional licensure or monitoring office. Each of these factors is discussed in more detail in the sections that follow. 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. There have been limited prosecutions by the legal system. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. 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. Key informants included representatives from the state licensure office. 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. 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. However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. Failing to consistently provide running water and electricity, or having unsafe or illegal electrical wiring. Clarifying this definition will be critical to understand the prevalence of unlicensed residential care homes, as well as the characteristics of residents in these homes. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. 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). Therefore, the purpose of this project was to conduct exploratory research on unlicensed care homes to understand more about their prevalence, factors contributing to their prevalence, their characteristics (including their overall quality and safety), and the types of residents they serve. Key informants were also concerned about a lack of specific services inside illegally unlicensed personal care homes. 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. The following section presents individual research topics and identifies the related questions that might guide future research on unlicensed residential 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. First Responders: EMS, Firefighters, and Police. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. She had on the same clothes every day, it was for a week, said Klavinger. 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. In multiple interviews, unlicensed care home operators were described as being involved in human trafficking, and also were specifically noted by APS and law enforcement officials to traffic residents across state lines, specifically into Florida and Alabama, to avoid legal action in Georgia. In many cases, the cost of care in other settings is too high for what individuals with severe and persistent mental illness can able to afford on their SSI stipend. stream The inability or unwillingness to provide appropriate care for residents at an affordable cost also was noted by key informants as a motivator to not pursue licensure. 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. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. 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. A 2010 report from the Pennsylvania BHSL noted that enforcement actions against illegal personal care homes had increased from four homes in 2009 to 27 in 2010 (most were located in the Philadelphia area). AS800397501. 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. Tobia's report (2014) described residents of unlicensed facilities as vulnerable older adults with "hard to place" mental health and paroled individuals who are warehoused. 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. Retrieved from http://www.ajc.com. An Online Resource for Skilled Immigrants. As noted above, placement agencies work with Allegheny County hospitals and discharge planners, therefore these agencies may also have lists that include illegally unlicensed personal care homes. In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. One SME, who was a firefighter and paramedic who has responded to calls from several unlicensed care homes, stated that he often had more comprehensive listings of unlicensed care homes than the local ombudsman. One prominent case required more than 40 people in law enforcement and social service agencies to investigate and close a home, find placements for the residents being displaced, and prosecute the violators. Operators seizing the residents' food stamps and selling them for cash. They speculated that there may not be enough licensed mental health group homes available to care for persons with mental illness, and that unlicensed group homes can potentially fill that gap. However, we did not focus on these populations in the interview. 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. Similarly, by nature of their jobs, many of our interview participants, including APS staff, ombudsmen, police, and fire department personnel, typically hear about care homes when there are complaints or emergencies. Adult residential licensing, 2010 annual report: A report on licensed personal care homes. One key informant indicated that this reduction is due to the increasing numbers of HCBS waivers giving potential Dom Care residents the option to live alone in apartments. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. Some key informants described illegally unlicensed personal care homes as filthy and potentially filled with rodents and insects; they also noted that these homes are unsafe structures that could be condemned. Vetting calls, we can not assess the generalizability of these findings and concerns sent to hospital discharge planners discharge. Phone calls3 that come first to a local county APS or regional licensure or office. 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