These findings highlight a set of potentially serious problems and issues. The state's BHSL office also has the legal authority to act as an enforcement agency. State and Local Policies Related to the Supply of and Demand for Illegally Unlicensed Care Homes. 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. In California, assisted living services can be provided by a licensed home health agency in unlicensed publicly subsidized housing (low-income housing projects, apartment houses, retirement hotels, village models, and private homes). Illegally Unlicensed Residential Care Homes, 6.3. We all serve as public servants its not an easy job.. Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. These include tapping into fire/EMS databases to identify addresses of care homes that could be unlicensed, and tracking multiple SSI payments that go to a single representative payee at the same address. 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. The objective of the literature review was to identify current information (2009-2014) on both legally and illegally unlicensed RCFs and to inform the conduct of SME interviews and site visits to communities in three states. (2009). Medicaid fraud reports, 2009-2013. Thus, no more than nine individuals were ever asked the same question. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. A six-state study conducted by Hawes & Kimbell in 2010 for the U.S. Department of Justice, National Institute of Justice, found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Personal board and care homes: A hidden population in Anne Arundel County. We are cleaning our homes, facilities and offices routinely, including regularly sanitizing all high touchpoint surfaces. Incentives this modest provide little encouragement for residential care homes to incur the cost of licensure if their primary clientele has only SSI to pay for care. According to the regulations, some states also allow residential care homes to be legally unlicensed if they have 1-2 beds. In contrast, in North Carolina (and other states not included in our site visits) ombudsmen have no authority in or responsibility for residents in unlicensed care homes according to state regulations. According to findings from these interviews, there are a few different pathways into unlicensed care homes, including unlicensed homes receiving residents directly from hospital discharges, representatives of unlicensed homes picking up residents from homeless shelters, and owners of licensed facilities taking residents to unlicensed homes. Although these regulatory changes occurred ten years ago, multiple key informants reported that many more licensed personal care homes have continued to close in recent years. Unlicensed care homes--which provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state--fill some of the gaps in the availability of housing and services for these populations. Another strategy is the creation and involvement of interagency and multidisciplinary teams at the state and local levels, which based on our key informant interviewsappears to be a successful strategy. 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. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. There were reports that while unlicensed homes in some states (such as Maryland) serve elderly and physically disabled residents, many also serve a clientele who once were homeless, persons who may have substance use disorders, and individuals who were formerly incarcerated. One state key informant stated that her office receives one to two calls a month pertaining to unlicensed adult care homes, but she noted that these calls are sporadic. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. A few strategies exist in the state for addressing illegally unlicensed personal care homes. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. State key informants emphasized that they could not make estimates about the scope of abuse and exploitation issues because unlicensed care homes are not systematically monitored. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. 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. 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. 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. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. Federal government websites often end in .gov or .mil. 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). In the past 15 years, the issues surrounding unlicensed personal care homes in the state have become more prominent, and coordinated action across several agencies has been taken to address them. 3.2.3. State and local funding that was designated for clean-up activities in preparation for the 1996 Summer Olympic Games in Atlanta was used to encourage homeless individuals (often with mental illness) to leave the city. Interagency and Multidisciplinary Teams. 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. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. Licensing rules for family child care homes can be found in Sections 400.1901-400.1963 of the Michigan Administrative Code. In Indiana, legally unlicensed residential care homes serving fewer than five residents can provide assistance with at least one ADL, assistance with medications or meal reminders, or two scheduled supportive services, but cannot administer the medications. (586) 819-7573. Finally, as noted later in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or being unnecessarily institutionalized. Desperate, Plummers family hired an attorney. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. AS800397501. In other types of residential care, if the care is arranged or managed by the owner, manager, or staff of the building, home, or community, then the facility must be licensed. 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. Klavinger says his grandmother, 80-year-old Mary Helen Plummer, had lived on her own for years. Concerns remain that agencies do not have the resources to monitor and follow through with the appropriate actions (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the facility remains closed and has not reopened in another location) for the unlicensed facilities. What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. 3.5.4. 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. 3.5.2. If an illegally unlicensed personal care home continues to operate, the state regulatory agency has the authority to take out a warrant on the operator ordering her to cease operations. Furthermore, some key informants noted that some unlicensed homes fail to provide or arrange treatment for residents' conditions in order to avoid bringing the attention of authorities. As a result, 3,000 individuals with mental illness were transitioned into community-based supported housing. We found reports of Medicaid fraud in unlicensed care homes in Florida and Nevada between 2009 and 2014 involving charges of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility (National Association of Medicaid Fraud Control Units, n.d.). 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.". As noted in Section 4.1, states use a variety of definitions or criteria that allow some homes to operate legally without a license. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. These are important issues since they affect many vulnerable adults who have physical, intellectual, or cognitive disabilities. A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. Despite this lack of information about prevalence, we heard about many strategies for addressing the existence of unlicensed care homes and the conditions in them. Education: Statewide or Interagency. Cooperative efforts are underway amongst state and local agencies in some states. 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. Although limited in scope, the findings of this exploratory study provide important foundational information about current conditions in some unlicensed care homes, factors that may influence demand for these homes, and strategies to identify them and address their quality. 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. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified the ten states that spent the highest percentage of their LTSS expenditures on HCBS and the ten that spent the least. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. Press Release.Retrieved from http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926. These unlicensed care homes are referred to by several different names in different states, such as "board and care homes," "boarding homes," and "adult care homes." Failing to have safety equipment available, such as smoke detectors and fire extinguishers. 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. ADULT SMALL GROUP HOME (CAPACITY 1-6) 8138 HEDGEWAY DR. SHELBY TOWNSHIP. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. 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. 1 0 obj It is important to learn if such abuses and frauds are limited to a small number of communities or if they are more widespread. Pennsylvania's BHSL and the North Carolina Adult Care Licensure Office and Mental Health Licensure Office will offer to work with unlicensed residential care homes to help facilitate licensure. Key informants included representatives from the state licensure office. Because of the potential for a large loss of life from fires in these places, comprehensive emergency management planning and practices are reported to be needed to proactively protect those at risk (Tobia, 2014). Figueroa, L. (2011). 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. (2009). PubMed and other database searches yielded very little literature related to unlicensed RCFs. They also noted that, despite receiving payment for room, board, and services, some unlicensed care home operators provide subpar or poor quality accommodations and services to residents. Oversight was spread across several agencies and depicted as convoluted and overstretched. One potential strategy suggested by an interviewee for proactively identifying unlicensed care homes is to hold community meetings to inform community members about unlicensed care homes, including ways to identify them and how to notify APS and licensure officials if they suspect an unlicensed home operation. 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. . 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. Some of these places are legally unlicensed, while others operate without a license illegally. What is the scope of concerns in unlicensed care homes, including quality of care, safety, sexual or physical abuse, and financial exploitation concerns? In contrast, identifying and addressing quality in legally unlicensed care homes was only minimally discussed; however, in at least one of our site visit states, interviewees felt that it was feasible to identify these homes, given the existence of listings of these homes. Operators often gain control of residents' funds by becoming the representative payee for residents receiving SSI, a common payer source in unlicensed residential care homes. In one case well publicized by the media, residents of one unlicensed facility in Pennsylvania were moved between Pennsylvania, Texas, Virginia and Florida to escape law enforcement. 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. Dallas Morning News. (n.d.). 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. SMEs and key informants also noted that states varied in their licensure laws and their ability to enter and investigate unlicensed care homes without a warrant issued by a judge. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. One key informant explained how North Carolina regulations restrict ombudsman activity in unlicensed care homes, stating "our structure is pretty clear as far as the accountability," implying that the regulations make ombudsmen unaccountable for residents in unlicensed care homes. @XF( &F{$&LEdOITXm Health Management Associates. The owner of the group home would not return our phone calls to comment on this story. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. Moreover, the 1976 Keys Amendment to the Social Security Act requires states to assure that SSI recipients do not reside in substandard facilities, and states must annually certify that this is true. Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. One strategy recommended by key informants to address unlicensed care homes is to change the regulations to reduce the number of unlicensed care homes that operate legally. Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. U.S. Department of State, Office of the Under Secretary for Civilian Security, Democracy and Human Rights. "=H@tLh,j;jDLOTY$%6?T@cFBQm14X$`CX"fGQX@":S\Q()*fT6?3(#,R)1EQ The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental issues to community-based care settings, such as legally unlicensed care homes. 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