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. 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. While many key informants stated that illegally unlicensed personal care homes primarily serve adults with a wide spectrum of mental health disorders, they also noted that some of the residents in unlicensed care homes are frail and elderly individuals. According to the regulations, some states also allow residential care homes to be legally unlicensed if they have 1-2 beds. 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. In some instances, these places may be certified or otherwise listed at a local level, but they may not be monitored by the state for quality and safety issues. 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. In 2006, HB 5245 Created a medication technician pilot program involving 30 Key informants suggested interviewing individuals from other agencies to learn more about illegally unlicensed personal care homes or to obtain potential lists of illegally unlicensed personal care homes. endobj There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited financial resources. We were only able to obtain an estimate on the number of unlicensed care homes from the Durham County Group Care Monitoring Office. 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. Several states have taken steps in improve oversight of unlicensed facilities, often as a result of newspaper exposs on unlicensed residential care homes. Hawes, C. & Kimbell, A.M. (2010). 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. Other key informants stated that some operators do not want the state regulating or monitoring their business. Other SMEs reported that efforts to discharge or divert residents from nursing facilities to community-based settings led to greater use of licensed RCFs and noted instances in which residents who exhausted their private funds might have no options other than unlicensed residential care homes. An Online Resource for Skilled Immigrants. Michigan Agency Michigan Department of Licensing and Regulatory Affairs, Bureau of Community Health Systems, Adult Foster Care and Homes for the Aged Licensing Division Contact Ashley Harris E-mail HarrisA29@michigan.gov Phone (866) 856-0126 or (517) 284-9700 Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. Similarly, APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. The DSP may only assist individuals with administration of medications that have been ordered and prescribed by a person licensed to do so by the Department of Licensing and Regulation (i.e., Doctor, Dentist, or Nurse Practitioner.) Miami Herald.Retrieved from http://www.miamiherald.com. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. 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. Research about legally unlicensed care homes might focus on collecting information about characteristics of legally unlicensed care homes, the services they offer and the residents they serve, such as through a larger number of site visits and interviews with ombudsmen and state regulatory agencies or through a survey of the operators of legally unlicensed homes in states or areas that maintain lists of these homes, such as Florida, Georgia and Texas. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. Although recognized as important, the state has not yet begun investigating cases of financial exploitation. 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. In North Carolina, facilities providing or arranging for housing, food service, and 24-hour scheduled and unscheduled personal care services to two or more unrelated adults must be licensed as an adult care home or a group home. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. The information collected as part of this exploratory study was intended to provide a foundation for a more complete understanding about unlicensed care homes and the gaps these homes might fill as housing options for persons with low incomes. If you seek a pleasant peninsula, look about you. Michigans official state motto holds many truths our state is a land of great splendors. 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. He argued that comprehensive emergency management planning and proactive practices were needed to protect those at risk in unlicensed homes. Atlanta Journal-Constitution. 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. We primarily heard about phone complaints. A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. Key informants in all three site visit states provided examples of how this might happen. 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. Retrieved from http://www.miamiherald.com. *Z Licensure offices and other agencies or organizations respond to complaints made by concerned citizens, including family members and friends of residents, neighbors of unlicensed care home operators, health care providers serving unlicensed care home residents, firemen, ambulance services, police, and licensed care home operators. 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. More than 30 people were being housed there without adequate food or medication. 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. 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, receipt of a complaint was the most commonly cited method to spur identification of an unlicensed care home. 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. However, the effectiveness of these strategies in monitoring or otherwise addressing the prevalence of unlicensed care homes is unknown. 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. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. We were told that after discovering a group home is unlicensed (via information from the state), the LME-MCO will ask the state to fast track licensure because there are no other licensed housing options available to this vulnerable population. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit. 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. 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. Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. The North Carolina Office for Mental Health Licensure also licenses group homes for adults with developmental disabilities (5600B) and group homes for adults with substance abuse issues or chemical dependency. Assisted living provider resources: Unlicensed facilities. 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). For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Emily Rosenoff, at HHS/ASPE/DALTCP, Room 424E, H.H. One-bed and two-bed residential care homes are lawfully allowed in several states. Zoning approval is required under the Zoning Enabling Act (2006 PA 110, MCL 325.32016). Interview discussions often touched on the question of how best to identify illegally unlicensed care homes, and key informants noted this as a major challenge. 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. According to the key informant, these individuals were given one-way bus tickets out of the city under the stipulation that they never return. Atlanta Journal-Constitution. Tobia, M. (2014). 2O 6@@ zR"k4 DISCLAIMER: The opinions and views expressed in this report are those of the authors. Sallah, M., Miller. [13] 3 Retrieved from http://www.ajc.com. Frustrations continue among licensure agencies and advocates with unlicensed care homes, and residents are largely unprotected by licensing agencies (Hawes & Kimbell, 2010). Health, Safety, and Sanitary Conditions. 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 their quality and safety; and policies that influence the supply of and demand for these homes. (2012a). <> If you have a story for Heather Catallo, please email her at hcatallo@wxyz.com or call 248-827-4473. Pennsylvania's BHSL is currently working on an amendment to create a graduated fine system for those operators who continue their illegally unlicensed care homes after they have been ordered to cease operations. There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. . 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.). In Florida, the Secretary of the Agency for Health Care Administration told a senate committee that the agency wanted to work more with law enforcement. 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. In the latter state, it was said that unlicensed homes "flourished in the larger cities, particularly those that had significant populations of poor elders and persons with mental illness who had been released from state mental hospitals" (Hawes & Kimbell, 2010). These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. Given their direct linkage to unlicensed care homes, these three sources (hospitals, homeless shelters, and licensed personal care homes) are potential sources of information for identifying unlicensed care homes. endobj Further, evidence exists from several states that there are still unlicensed residential care homes and that, in some states at least, the number of unlicensed facilities is increasing. Pennsylvania Department of Public Welfare. That's what they're doing, targeting individuals with cognitive impairment.". 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. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. The payments also vary considerably from state to state, and are quite modest in some states (e.g., from $46 to $100 per month). Very little was mentioned about elderly residents living in unlicensed homes; only one informant reported that unlicensed adult care homes may serve a mixed population (e.g., elderly residents in addition to residents with mental illness). Two key informants thought that the ongoing statewide mental health reform, which began in 2002, has exacerbated issues related to the general lack of infrastructure and knowledge about needs of persons with mental illness. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. Few of the investigations focus solely on financial exploitation. Klavinger says his grandmother, 80-year-old Mary Helen Plummer, had lived on her own for years. What information exists reflects a concern about the conditions under which residents in these places live. Following the Olympics, funding for these day programs was not renewed, and all but one of these programs ceased operations. Most of the literature or media reports were not specific about the types of residents served in unlicensed residential care. Multiple key informants provided details of two specific cases of illegally unlicensed care homes. Based on the findings from this exploratory study, unlicensed care homes appear to be widespread in some areas within some states. 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