In Maryland, licensure is not required for a provider who serves individuals who are dependent on the provider for room, board, and control and security of their medication but do not need assistance with any ADL. Other states also track complaint calls as a means for identifying 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. Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. Our search of state AG reports of unlicensed RCFs identified only six cases of successful prosecutions in New York, Nevada, Florida, and California for operating a residential care home without a license--and in several cases, gross neglect in these homes. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety, or appropriateness of those other environments. In the view of the majority of key informants, the operators of unlicensed homes do not want to have to pay for more staff to provide needed services. Typically, the reports refer to physically or mentally disabled adults, some with disease specific conditions, or just described as mentally ill or elderly. 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. If you live in an unlicensed Room and Board facility, all California Landlord-Tenant Laws apply to your facility. In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. 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. In addition, investigations by Georgia law enforcement officials indicated that there is considerable fraud with respect to SSI, Social Security, residents' personal needs allowances, Medicare and Medicaid, and the food stamp program. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. 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. Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. ", 3.4.2. Pennsylvania Department of Public Welfare. Retrieved from http://www.dallasmorningnews.com. Facilities provide two types of services in addition to room and board: (1) basic services, which include personal . Oversight was spread across several agencies and depicted as convoluted and overstretched. Some key informants noted that EMS personnel are a better source than firefighters to learn about unlicensed care homes in a community because EMS personnel respond to all emergency calls while firefighters do not. There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. Sometimes the care providers require residents make the care home operator their representative payee for Supplemental Security Income (SSI) from Social Security. 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. National Association of Medicaid Fraud Control Units. It is not unusual for them to be involved in other illegal activities as well. In Pennsylvania informants described a public education campaign including advertisements warning people about placing their loved ones in unlicensed care homes. Multidisciplinary PCRR teams were then formed at the county level to address the relocation of residents to licensed facilities and to investigate illegally unlicensed personal care homes in coordination with the state licensure office. Consequently, although we attempted to elicit information about the positive aspects of unlicensed care homes, key informants largely provided us with a less favorable view of unlicensed care homes. However, this likely is not a viable method for detecting the population of illegally unlicensed residential care homes. Using information from a HHS Administration on Aging report, provided by the National Ombudsman Reporting System (2009-2013), we identified reports regarding unlicensed facilities in five states: Maryland, Michigan, Nevada, Florida, and Georgia, as well as the District of Columbia. The team conducted interviews with key informants in each of these communities. 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. What federal and state policies affect the supply and demand of unlicensed care homes? The informants recommended the formation of teams including a range of stakeholders, including state licensure officials, Adult Protective Services (APS), ombudsmen, police, firefighters, emergency medical services, code enforcement, and local advocacy organization workers.1. There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. 3.2.3. 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. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". Treatment of residents as a commodity was a common theme across interviews. By taking control of the resident's benefits, the operator controls the resident's funds, and should be using those funds for room and board and other beneficiary expenses. Many adult facilities, those licensed for ages 18-59 , accept the current SSI board and care rate as payment in full. Key informants from Georgia and Pennsylvania shared examples of efforts to increase awareness of unlicensed care homes through education or marketing for the general public or the agencies they involve in addressing unlicensed care homes. LeasesandRentalAgreements Leases state the amount of rent and the rights and duties of the landlord and tenant. None of these approaches or strategies completely addresses the concern about providing a safe environment and quality services to the vulnerable individuals being served in unlicensed care homes. This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. In some states, residents can pay for their own personal or medical care in an unlicensed facility. Assisted Living Facilities in Indianapolis, Indiana. 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. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. A landlord and tenant can enter into an oral or written contract for room and board. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. (n.d.). A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. 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. We found three cases in Florida of charges against unlicensed RCFs involving allegations of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility; and three cases in Nevada of neglect and/or criminal offenses while operating without a license (one where the accused also operated a licensed facility). What causes infertility and how the IVF works? If you are seeking more information on a facility than is provided on this site, call your local Regional Social Services office. 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. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. This cookie is set by GDPR Cookie Consent plugin. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. Landlords and tenants each have different responsibilities to make repairs and keep the room habitable, including the bed clean. Massachusetts exempts small private-pay homes from licensure. The cookie is used to store the user consent for the cookies in the category "Other. Otherwise, standard room-and-board rental agreements typically include the amount of rent to be paid, meals included in the rent and terms of occupancy. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. 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. 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. To address unlicensed care homes, states commonly use a strategy that includes penalty systems that fine operators as a way to try and close illegally unlicensed 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. (2012a). Some victims later found that their credit had been ruined by someone who illegally used their identity (Glass, 2015). Available at https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition. More recently within the City of Atlanta, the gentrification of some neighborhoods has resulted in increased property values and rents, which has caused some unlicensed care home operations to relocate to less expensive areas. Interview results indicate that the majority of unlicensed care homes investigated by state officials and local APS agencies involve situations in which residents are not being cared for properly. 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). And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. Although exploratory in nature, these findings point toward concerning issues with unlicensed care homes as well as gaps in our knowledge, and have important implications for future research on unlicensed care homes. Tracking Public Benefits and Representative Payees. For example, one SME from a state licensure office reported that their database does not include information on whether the call pertains to a licensed or unlicensed care home. States with concerns about vulnerable adults' access to housing with services may wish to examine their admission and discharge requirements for licensed 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. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. (2009). The facility operators were authorized to make the decision on their own (Tobia, 2014). 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. The following acronyms are mentioned in this report and/or appendices. However, the long-term placement of individuals after discharge to an unlicensed care home may be unstable, and no follow-up by the hospital with the patient after placement was described. Some assess fines for continuing to operate an unlicensed facility. Some continue to operate after their license expired or was revoked. Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes, 6.4. In a licensed facility, medications should be locked in a central location and disbursed at the appropriate time to the residents. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. Moreover, unlicensed care home operators have an opportunity to operate virtually unchecked in terms of seizing control of the residents' government benefits. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. One informant suggested research that examines the homeless population and the availability of affordable housing as a way to better understand the environment that may be conducive to supporting unlicensed care home operations. 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. Some state have too few inspectors to detect and investigate allegations about unlicensed homes and too little time and manpower to bring a prosecutable case to the AG's office. Centers for Medicare and Medicaid Services. What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? One-bed and two-bed residential care homes are lawfully allowed in several states. Results of key informant interviews from site visits, as well as the SME interviews and the literature review, are presented in the Findings section that follows.