Overall, key informants were able to provide little information about the prevalence of illegally unlicensed care homes (henceforth referred to as unlicensed care homes); informants we spoke with at both the state, local licensure office and APS reported that they do not currently systematically monitor or track unlicensed care homes. He argued that comprehensive emergency management planning and proactive practices were needed to protect those at risk in unlicensed homes. From a county perspective, one ombudsman and housing officer estimated that perhaps there may be less than 20 lawfully unlicensed facilities and less than five illegally unlicensed, however Tobia's team found that there may be as many as 78 unlicensed care homes serving as many as 400 individuals in that county. Strategies for Addressing Issues in Legally and Illegally Unlicensed Care Homes, 3.6. A few interviewees agreed that in cases such as this, the operators are motivated by their desire to care for people; they are just not aware of the licensure requirements. One SME from an advocacy organization in Pennsylvania shared that they use an Excel spreadsheet to track illegally unlicensed care homes identified as a result of a complaint. Informants noted that unlicensed care homes vary in their appearance and condition. Additionally, several SMEs and key informants noted that in many cases unlicensed homes are the only option, other than homeless shelters or living on the streets, for some of these residents. While we were specifically told by two key informants that the LME-MCO can only contract mental health services and supports to licensed group homes, these same key informants also shared specific examples of the LME-MCO unknowingly contracting services to unlicensed group homes. If ombudsmen become aware of such discharges, they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified. The Allegheny County PCRR has sent letters to hospitals and their discharge planners informing them about known illegally unlicensed personal care homes to which they should not discharge patients; however, according to two key informants, discharges to these homes have continued. Legally Unlicensed Residential Care Homes, 6.2. This cookie is set by GDPR Cookie Consent plugin. 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. Social Security Administration. Hospitals and hospital discharge planners are responsible for the safe discharge of individuals into the community, but some hospitals may have policies that incentivize the discharge of individuals to unlicensed care homes. 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. Study staff screened each of the collected articles, blogs, and reports to identify relevant material for review. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. The state and local agencies mostly rely on complaints from the general public and county agencies. Perkins, M., Ball, M., Whittington, F., & Combs, B. Abuse and Neglect. The 10 study States were: California, Florida, New Jersey, Oklahoma, and Oregon in the extensive regulatory stratum and .
PDF OFFICE OF DEVELOPMENTAL PROGRAMS BULLETIN - Provider Alliance 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. There were several reports of false imprisonment of residents who were kept locked in residential homes, sometimes deprived of their identification papers in Florida, Georgia, Indiana and Texas. Two of our three site visit states aimed to enhance awareness of poor and inadequate unlicensed care homes by increasing education for the public and key stakeholders: Pennsylvania held a statewide education and marketing campaign to inform the public about unlicensed care homes, and Georgia conducted training sessions to educate law enforcement and first responders about these homes. Conditions (including quality and safety) of unlicensed care homes. Stop elder abuse petition. Ombudsmen reported increasing numbers of RCFs operating without a license in both Maryland and Nevada. There was not much attention paid to the original sources who identified an unlicensed facility, but in some articles or media reports, the case came to light due to a death that occurred in the facility that had to be investigated, neighborhood complaints of numerous vans, ambulances or police cars at the home, or calls from concerned family members about the status of a resident. Some of these places are legally unlicensed, while others operate without a license illegally. One key informant in Allegheny County shared a list of seven current placement agencies that likely have registers of illegally unlicensed care homes. For many of these individuals, their only option may be unlicensed facilities. Study findings should be viewed in light of these limitations. Retrieved from http://www.miamiherald.com. Troubled residents languish in flophouses. You must fill out a separate complaint form for each physician or other healthcare provider you wish to file a complaint against. 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. These calls spur investigations that sometimes result in the identification of unlicensed care homes. (2013). 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. Also, new HHS Centers for Medicare and Medicaid Services (CMS) policies on waivers and where waiver services may be provided may alter the prevalence of legally and illegally unlicensed care homes across the nation. Currently human trafficking is defined as "the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts" (U.S. Department of State, 2015), however, one SME recommended expanding this definition to include the situation in which an administrator for the unlicensed care homes seize and maintain control of vulnerable individuals in order to maximize revenue by taking the public benefits that the individual may be receiving. It is important to learn if such abuses and frauds are limited to a small number of communities or if they are more widespread. If your concerns are still not addressed and you believe that . 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. Most of the literature we found referenced problems in and the prevalence of unlicensed residential care homes prior to 2009, or addressed abuse and exploitation of adults living in licensed facilities. If the SSA implements this requirement, it could become a potential source for identifying unlicensed care homes. In a licensed facility, medications should be locked in a central location and disbursed at the appropriate time to the residents. 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 same message was also sent to hospital discharge planners and to rehabilitation discharge planners. The state made bridge funding available to those group homes impacted by this funding change, but one key informant said that according to a recent report, very few group homes accessed this bridge funding. Although the residents who were moved out of this hospital may have been relocated to licensed facilities when the hospital closed, the fact that such institutional settings are no longer an available option may have encouraged unlicensed care homes to open. Health and safety concerns for residents were a major topic of interview discussion. This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. Populations Served and Conditions in Unlicensed Care Homes, 3.3. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. Texas Department of Aging and Disability Services. Safe food handling and storage and nutritionally balanced menus. (2007).Personal care homes in Pennsylvania: A guide for advocates. Presumably, this led to an increase in need for LTSS for these populations. If you are seeking more information on a facility than is provided on this site, call your local Regional Social Services office. One key informant noted that the state or the LME-MCO can conduct follow-up to assess whether a facility that received a cease and desist letter does, in fact, close down. A facility that advertises or represents via verbal communication that it provides personal assistance is required to make personal services available to its residents. For example, in Allegheny County, Pennsylvania, informants noted that the closure of Mayview Psychiatric Hospital in 2008 resulted in the displacement of persons with mental illness. 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. Residents in R&Bs and independent living facilities are able to care for themselves, live independently on a fixed income, and do not need around the clock care or supervision their landlord. How do states address unlicensed care homes, and if states or other organizations maintain lists of unlicensed care homes (legal or illegal)? The first and most important step is to find a certified administrator. As a direct result of this regulation change, many personal care homes in Pennsylvania became illegally unlicensed and either shut down, became licensed, or continued to operate illegally. 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. In response, the legislature has appropriated $260,000 to relocate residents identified as living in unlicensed care homes. Areas for future research and potential data sources related to unlicensed care homes. These individuals do not pay taxes, have insurance or bonds. We did not find any report where a government agency was proactive and discovered the case on its own initiative or because of routine monitoring of unlicensed residential care homes. Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. In contrast, most key informants agreed that some operators start out with a smaller one to three bed legally unlicensed home and gradually end up caring for more residents, not realizing that doing so requires the home to be licensed. 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. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. 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. Hancock, L. (2007). What populations do unlicensed care homes serve? 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. During interviews, informants talked about situations in which the operators of unlicensed care homes continue to be the representative payee and continue collecting the SSI checks of residents even after the resident moved out of home. Illinois: A story released on the This American Life radio podcast described a scam where individuals with substance use disorders were sent from Puerto Rico to supposed rehabilitation centers in Chicago where they were to be provided with housing, food and counseling services, only to find themselves in crowded, unlicensed rehabilitation centers, their passports and other identifying information taken from them. More information exists about licensed RCFs than unlicensed care homes, thus knowledge of the unlicensed care homes is limited. Key informants recommended several tactics to address poor quality in unlicensed care homes, but the overall strategy consistently discussed was to shut down these homes. A private residence, a care facility or an employer might offer room and board. Key informants noted that it is important to know the history of Pennsylvania's personal care home regulation changes in order to understand why and how the state has addressed illegally unlicensed personal care homes. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. Sometimes the care providers require residents make the care home operator their representative payee for Supplemental Security Income (SSI) from Social Security. Along with funding to cover relocation of residents, this legislation empowers state and local multidisciplinary teams to collaboratively plan and coordinate efforts to identify, investigate, and pursue any necessary regulatory enforcement or legal action against unlicensed facilities. (2015). If states have reduced funding for HCBS needed by low-income elderly and disabled individuals, thenlicensed care homes, which may have higher rates and fees than unlicensed homes, may no longer be an option for these individuals, or they may be faced with a potentially longer waiting list for licensed care homes. Assisted living provider resources: Unlicensed facilities. In contrast, one key informant stated that one repeat illegally unlicensed facility had housed residents who had thrived there and had benefited from living in the home. Interview findings indicate that many residents of unlicensed care home are Supplemental Security Income (SSI) beneficiaries. Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. State regulations appear to vary widely in regards to ombudsman jurisdiction. Some publish notices of how and where to report unlicensed care facilities. In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. Many key informants and SMEs suggested that discharge planners face difficulty placing residents in licensed care homes because these homes often do not accept patients who only have SSI (or otherwise have little money), and they often will not accept individuals with a history of mental illness, substance abuse, or those who are homeless. Further details on findings from the environmental scan can be found in Appendix B. These cookies ensure basic functionalities and security features of the website, anonymously. She specializes in intellectual property, copyright and trademark law. CALIFORNIA-DSS-MANUAL-CCL Key informants in two states confirmed that some hospitals there contract with placement agencies that, in turn, place individuals in unlicensed care homes, particularly individuals with limited resources and mental health issues. In some states, APS has very limited responsibility and involvement. One former fire department battalion chief reported that the elderly living in unlicensed residential care homes are hidden from the view of public health agencies, social service agencies, and ombudsman programs --the entities that generally protect and advocate for older people and individuals with disabilities. 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. Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. 1. Dont let a bargain price influence your choice. However, Legally Unlicensed Residential Care Homes Are Possible in Several States. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. 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. They capture key variables such as the name and any aliases of the illegally unlicensed care home; the owner's name and whether they own more than one unlicensed care home; the licensure status (formerly licensed, never licensed, operating illegally); and any relevant information about the complaint (e.g., investigation dates, or dates any residents were moved/relocated). Safety issues affect local fire departments. Other charges included: murder, sex trafficking, sexual abuse from staff or other residents who were registered sex offenders, racketeering, forced labor, and fire setting by residents with severe and persistent mental illness. If you know of unlicensed activity and just want to report it, then you are in the proper section. By clicking Accept All, you consent to the use of ALL the cookies. State inspection staff, already overwhelmed with large caseloads, were required to obtain search warrants to execute searches, a time-consuming process, when trying to follow up on reports of unlicensed homes. The facility operators were authorized to make the decision on their own (Tobia, 2014). This section explains how consumers, building officials and legitimate licensed contractors can report unlicensed activity. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit. Fourth, study findings also suggest that efforts are needed to understand the differences in conditions between legally and illegally unlicensed care homes, as well as how illegally unlicensed care homes successfully evade licensure. Public funds, like state supplements, are inadequate. 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.". The reporters described cases of abuse in which residents were being beaten and burned, locked in basements/rooms, given buckets for toilets, and had their benefit checks stolen from them (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). PubMed and other database searches yielded very little literature related to unlicensed RCFs. 3.2.3. Pennsylvania: In 2012, the Secretary of the Department of Public Welfare stated that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly.". However, a representative from a state advocacy agency estimated that about 2%-3% of their 4,800 calls annually, or approximately 120 calls statewide per year, were related to unlicensed facilities. If residents are able to self-determine and choose where they want to live, they may choose to go with the operator to a new residence. Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping" by the operator. The environmental scan did not yield peer-reviewed publications or reports about unlicensed residential care in North Carolina. One SME pointed out that many unlicensed care home cases are analogous to human trafficking, such as when residents are held against their will and then moved from one location to another to avoid detection; however, the current federal definition of human trafficking specifies that the trafficking is done for the purpose of labor or sex, and not for the collection of public benefits (U.S. Department of State, 2015).