What concerns are there about the quality of care and safety in unlicensed care homes? Through these regulatory activities, DADS protects Texas citizens who receive long-term care services. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. Retrieved from http://www.azdhs.gov/als/hcb/index.htm. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. 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. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. However, some SMEs and key informants also noted that many of these individuals with psychiatric conditions are older, having aged in state institutions, and that persons 65 years of age and older who receive SSI payments also often live in unlicensed care homes. Submit all required documents. In addition to the $100 per resident per day fine placed levied against unlicensed facilities, a representative of the state reported that the Georgia legislature has added operating an unlicensed personal care home, which is a criminal offense, to the list of crimes that make it impossible to apply for a license to operate a personal care home. In these cases, licensed operators were reportedly worried that the unlicensed operators would house residents from whom the licensed homes operators could have profited. Additional research on unlicensed care homes will be valuable to build our understanding of the role--intended or unintended--of these places in our long-term services and supports systems, and the policies affecting it. Failing to consistently provide running water and electricity, or having unsafe or illegal electrical wiring. Although a coordinated, multidisciplinary effort appears necessary to comprehensively address unlicensed care homes, several key informants discussed the lack of ombudsman jurisdiction to access residents in unlicensed care homes. For example, one key informant described a recent case of a representative payee in an unlicensed care home who was not managing a resident's money correctly, by providing food on a specific schedule and not providing it when the resident was hungry and requested food. An earlier study by Perkins, Ball, Whittington, & Combs (2004) provided these reasons from the perspective of one small unlicensed care home operator: Regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential homes. Thus, one implication of the study is that it may be worthwhile in one or more states or communities to test and evaluate other methods of detecting illegally unlicensed care homes. However, even if the home continues to operate, the fines are rarely enforced or collected. Qualitative Health Research, 14(4), 478-495. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. (2013). emergency conditions. According to the report, these warehoused residents are vulnerable older adults with "hard to place" mental health needs and paroled individuals. However, this likely is not a viable method for detecting the population of illegally unlicensed residential care homes. Future research examining the role of hospital discharge planners and strategies to prevent discharge to unlicensed care homes appear warranted. One of the SMEs shared comments from ombudsmen that the numbers of unlicensed homes in some states are increasing, while in other states, they reported that they had not heard about unlicensed care homes. In more extreme cases, other personal care homes have stopped accepting any persons whose sole source of income is SSI. Assisted Living Facilities in Indianapolis, Indiana. Media reports described operators with licensed facilities who also operated a series of unlicensed homes in secret. Individuals who are poor, experiencing homelessness, or individuals with a mental illness who cannot return home orhave no home to return to after being discharged from the hospital are a source of clients for unlicensed care homes. 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. These findings highlight a set of potentially serious problems and issues. The North Carolina Mental Health Licensure Office licenses group homes for adults with mental illness.5 These homes also serve two or more adults. Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). 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. They typically provide meals, laundry, housekeeping, medication supervision, assistance with activities of daily living, and an activity programs. Presumably, this led to an increase in need for LTSS for these populations. Copyright 2001-2022 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. As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. After recommending six states for site visits, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation and the research team selected three communities in three states for on-site visits: Atlanta, Georgia; Raleigh/Durham, North Carolina; and Allegheny County, Pennsylvania. They 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. Nursing Homes: What's the Difference? When choosing a personal care homes keep in mind that in Texas, they are licensed according to size, type and building safety features so be sure to ask. 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. In the first half of 2013, 37 other unlicensed homes had been identified. At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. Tracking Public Benefits and Representative Payees. Medicaid fraud reports, 2009-2013. Personal board and care homes: A hidden population in Anne Arundel County. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. Key informants recommended more proactive strategies for identifying unlicensed care homes, such as tracking individuals' benefits (e.g., SSI) to unlicensed care homes, obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them, and utilizing owners of licensed or legally unlicensed facilities as a source of information about illegally unlicensed care homes. 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. Interview findings indicate that many residents of unlicensed care home are Supplemental Security Income (SSI) beneficiaries. Residential care homes that serve three or fewer residents are legally unlicensed in this state. example, if your mother requires skilled care, Medicare will cover State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. Once an illegally unlicensed personal care home is identified, it is tracked at the local level to see if it has moved, or, in the case of closure, if it has reopened. Troubled Group Homes Escape State Scrutiny. Another motivation to operate an unlicensed care home, equally mentioned by key informants, relates to costs directly associated with meeting building code requirements specified in the regulations. There have been limited prosecutions by the legal system. investigation. Ombudsmen. Key informants described the way the teams function. Regulatory changes and the role of multidisciplinary task forces (which are relevant to both legally and illegally unlicensed care homes) are described next, followed by a summary of the strategies discussed during interviews to identify and shut down illegally unlicensed care homes and to monitor and improve quality in legally unlicensed care homes. Unlicensed Assisted Living Facilities; Page 11; Does the facility need a license? The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental illness to community-based care settings, such as legally unlicensed care homes. These included: (1) tracking individuals' public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. Multiple key informants discussed the impact that policy changes regarding community-based care have had on unlicensed care homes in their communities, including state efforts to comply with the Americans with Disabilities Act (ADA) requirements. Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). Residential Care providers must be licensed as an assisted living facility and have a contract with the Texas Health and Human Services Commission. State and Local Policies Related to the Supply and Demand for Illegally Unlicensed Care Homes. Next, the local group monitoring office or the state would attempt a site visit. what is the first step. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. 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. The determination of the 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. Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping" by the operator. 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. Some of these housed mainly older residents. (2015) Assisted living provider resources: Unlicensed facilities. 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. Monthly fees run anywhere from $1,500 a month to $4,500 each . The agencies do not typically get complaints from residents inside the home, although if the home is bringing in services such as home health or hospice nurses, those outside agency staff could file reports that result in the identification of an illegally unlicensed personal care home. Hospice. Second, the findings highlight the need for federal and state agencies to determine the nature and scope of financial fraud being committed by operators of unlicensed residential care homes. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. (2009). Abuse and Neglect. The Texas Assisted Living Association (TALA) is a Chapter of the Assisted Living Federation of America exclusively dedicated to representing professionally operated assisted-care living communities and residential homes for the aged for seniors. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? However, it won't cover We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants. than assisted living care. Through a targeted series of interviews and a scan of the literature, we sought to contribute foundational information about unlicensed care homes. Some illegally unlicensed facilities deny services are being provided. As described by all informants, complaint systems are the most common strategy used for a state or locality to become aware of unlicensed care homes. One SME, who works on the Representative Payee Project,4 mentioned that this project only investigates a sample of individuals who are representative payees for 15 or more individuals. We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limit the scope of our findings. All states license residential care such as assisted living, and most states license small adult care homes, often referred to as adult foster care (Carder, O'Keeffe, & O'Keeffe, 2015). Finally, a peer-reviewed publication by Perkins, Ball, Whittington, & Combs (2004) provides insights into why an operator continues to operate an unlicensed care home. perform those activities without help. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. In 2012, the Secretary of the Department of Public Welfare noted 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" (Pennsylvania Department of Public Welfare, 2012). In Texas, anyone with three or less residents (unrelated to them) does not have to be licensed. 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. Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes, 6.4. APS professionals there estimate three reports or complaints about unlicensed personal care homes every month in the metro Atlanta area, and about one complaint or report about unlicensed personal care homes every three months in rural areas of the state. Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. Washington, D.C. 20201, U.S. Department of Health and Human Services, Collaborations, Committees, and Advisory Groups, Understanding Unlicensed Care Homes: Final Report, Biomedical Research, Science, & Technology, Long-Term Services & Supports, Long-Term Care, Prescription Drugs & Other Medical Products, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS-PCORTF), Health and Human Services (HHS) Data Council, LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS, 4.1. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). references to products, services or publications do not imply the 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. Many interviewees mentioned monetary motivations of operators as one factor.