State inspection staff, already overwhelmed with large caseloads, are required to obtain warrants to execute searches, a time-consuming process, when trying to follow up on reports of unlicensed homes and determine whether the home is illegal. One key informant estimated there are approximately 526 Dom Care operations in the state. A wide range of specific concerns about unlicensed care homes were identified in this study, including improper management of residents' medications; unsafe, unsanitary, and inadequate living environments; failure to adequately feed residents; and monetary theft of benefits. Pennsylvania was selected as a site visit location because of the state's past and current experiences with illegally unlicensed personal care homes. A separate search of a few state Attorney General (AG) reports of unlicensed RCFs identified six cases of successful prosecutions in New York, Nevada, Florida, and California for operating an RCF without a license--and, in several cases, for gross neglect. It might also determine which states provide additional state funding to the ombudsman program, and whether the level of available resources is a limitation on ombudsman involvement in unlicensed care homes. Since 1983, California Advocates for Nursing Home Reform has been fighting for the rights of long-term care . 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. . Key informants also noted that unlicensed care homes may serve mixed populations within the same home (e.g., elderly residents as well as individuals with severe and persistent mental illness). For example, a care home with three persons with at least one personal care need might also house three people with personal care needs whose community housing arrangement is covered by the U.S. Department of Veterans Affairs. In Durham County we interviewed key informants from APS, Group Care Monitoring Services, a local hospital discharge planner, a local ombudsman, and one local law enforcement official, who also serves on a crisis intervention task force. Some have residents that receive Medicaid funded services. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. 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. He noted that residents with disabilities in unlicensed homes were at risk during fires and natural disasters such as tornados, hurricanes, and severe storms. Ombudsmen program does not extend to unlicensed facilities (Hawes & Kimbell, 2010). Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. I'm not going to report it. These cookies will be stored in your browser only with your consent. 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. Furthermore, many licensed facilities are unwilling to admit or retain individuals with challenging behaviors. Available at https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition. (2012b). Ombudsmen. A landlord must ensure that the room-and-board tenant has access to a working toilet, running water, trash disposal, natural light and proper ventilation for each room. This report was prepared under contract #HHSP23320100021WI between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Research Triangle Institute. 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). Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. 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. The study by Hawes & Kimbell also provided reasons operators do not seek licensure, including: inability to meet fire safety codes (e.g., installing sprinklers), lack of state supplemental payment for SSI residents or Medicaid waiver funds (which can be restricted to licensed facilities), and avoidance of inspections and sanctions/fines for not meeting state regulation. For example, as part of interviews with SMEs, we asked them to recommend potential key informants to meet with during site visits. Hawes, C. & Kimbell, A.M. (2010). While the information herein is not generalizable--it is based on a targeted scan and a limited number of interviews--it does highlight the fact that unlicensed care homes appear to be a problem in at least some states. As noted above, placement agencies work with Allegheny County hospitals and discharge planners, therefore these agencies may also have lists that include illegally unlicensed personal care homes. Having a license attempts to ensure the home has met minimal health and safety requirements placed upon it by the State of California. azmfairall. Between 2012 and 2015, the California legislature enacted several laws that will affect the operation of these facilities. If the illegally unlicensed personal care home can be deemed unsafe, code enforcement has the authority to condemn the building and shut the illegal operation down. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. Failing to have safety equipment available, such as smoke detectors and fire extinguishers. 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. We exist to empower, promote self-advocacy, and make available safe and supportive housing for adults, low income individuals, residents and Behavioral Health Consumers. Some continue to operate after their license expired or was revoked. Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Fact: Room and Boards (R&Bs) are similar to independent living facilities due to the business setup by the owner which may be a privately-owned or operated 26-bedroom house that provides shared living accommodations for adults with limited disabilities. But there are homes providing room, board, and personal care that either fall outside the bounds of the state licensure requirements or are deliberately avoiding state licensure requirements. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. Government Owned Pharmacy (PHE) (PDF) Hospital Pharmacy/Drug Room (PDF) Renew Online (HSP/DRM license Only) NOTE: If the facility . Which agencies get involved when addressing unlicensed care homes? In California, the basic principles of landlord-tenant law apply to room-and-board facilities. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. Another state-level key informant was unable to estimate how many calls the agency receives that result in investigations of unlicensed group homes for persons with mental illness. 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. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. Several states (California, Pennsylvania, Maryland, and Mississippi) publish notices of how and where to report unlicensed care facilities, which implies that these states may be experiencing problems with unlicensed homes. Each interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Some of these housed mainly older residents. Dallas Morning News. Texas and Georgia had numerous cases of unlicensed homes in deplorable conditions: infested with insects, lacking air conditioning or heat, residents sleeping on the floor, faulty wiring, no bathroom access, residents deprived of food or fed scraps, and theft of medications. 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. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. Based in Los Angeles, Victoria McGrath has been writing law-related articles since 2004. Retrieved from http://www.ajc.com. This had a direct impact on the operating budgets of licensed group homes. These local and regional offices--as well as ombudsmen and other national, state, and local advocacy groups--receive complaint calls from a variety of sources including residents' family members; members of the general community such as neighbors or other providers; and medical and service providers (e.g., hospital or clinic doctors, nurses, social workers) who interact with residents inside and outside of unlicensed homes. However, you may visit "Cookie Settings" to provide a controlled consent. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. 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. Demographic trends are placing an increasing number of older persons at-risk for needing residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. As noted, jurisdictional disagreements exist as to whether licensure agencies or APS agencies are responsible for the illegally unlicensed facilities. The information focused on specific cases, but not on how many of these places exist in these states. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but they are unlicensed by the state. An oral agreement may be legally binding for short terms of less than one year. 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2021 California Room and Board Coalition, All Rights Reserved. One interviewee estimated that licensed personal care homes used to reserve 50% of their beds for individuals who only had SSI benefits and now this amount has decreased to fewer than 25%, leaving SSI recipients with fewer licensed options. 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. In fact, these concerns extended across illegally and legally unlicensed homes, and some stakeholders reported these concerns also exist about care being provided in some licensed residential care homes. Several examples of unlicensed personal care homes were described by key informants during the site visit. 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). Licensed Care Home Admission and Discharge Policies, http://www.agingavenues.com/topics/assisted-living-facilities-in-indianapolis-indiana, https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition, http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/requirements-for-home-and-community-settings.pdf, http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf, https://aspe.hhs.gov/report/medicaid-residential-care, http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf, http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/p_011015.pdf, http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926, http://www.phlp.org/wp-content/uploads/2011/03/PCH_manual-for-advocates-Feb-20071.pdf, https://www.socialsecurity.gov/ssi/text-benefits-ussi.htm, http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html, http://www.dads.state.tx.us/providers/alf/howto.html, http://www.state.gov/documents/organization/245365.pdf, APPENDIX B. Per state regulations, residential settings providing room, board and personal assistance with three or fewer residents who have at least one personal care need do not meet the requirements for licensure as a personal care home and are legally unlicensed. Given these diverse concerns, SMEs and site visits interviewees suggested that coordinated efforts across a range of stakeholders, including state licensure agencies, ombudsmen, APS, law enforcement, and others may be necessary to address unlicensed care homes. Residents may not have access to their personal identification cards due to the care provider retaining those items, which can limit the capacity of the resident to relocate. Managing the care needs of low-income board-and-care home residents: A process of negotiating risks. In essence, unlicensed care home operators have several opportunities for gaining almost absolute control over these residents who are physically, cognitively, and financially vulnerable. Several key informants reported that unlicensed care home operators "troll" the psychiatric wards of facilities like Grady Memorial Hospital, looking for residents. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). 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. If the SSA implements this requirement, it could become a potential source for identifying unlicensed care homes. Operators seizing the residents' food stamps and selling them for cash. 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. In several cases at both the state and local level, unlicensed facilities were reported to authorities or licensure offices by the operators of licensed facilities. Thus, unlicensed care home operators are known to directly market themselves to hospitals and to pick up patients at the hospitals when they are discharged, and some hospitals have been known to pay a month of the residents' fees at the unlicensed home to secure a quick discharge from the hospital. . Hawes, C., & Kimbell, A.M. (2010). Fraud reports have been filed with the U.S Department of Housing and Urban Development for the misuse of funds to send users from Puerto Rico to unlicensed rehabilitation centers in the United States. The site is secure. 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. As noted in earlier sections, many unlicensed care home residents receive federal SSI benefits, and many unlicensed care homes receive these benefits directly through the SSI representative payee program. Analytical cookies are used to understand how visitors interact with the website. These are important issues since they affect many vulnerable adults who have physical, intellectual, or cognitive disabilities. However, while SMEs reported variability in licensure requirements and the authority, responsibility and funding of ombudsmen agencies with respect to unlicensed homes, there is very little information available about legally unlicensed homes, including the characteristics of residents, their care and service needs, and their preferences. Key agencies and team members involved in local or state teams to address unlicensed care homes include APS, ombudsmen, building code enforcement, social workers and first responders such as EMS, police, or firefighters, and other representatives from local advocacy groups such as Disability Rights. See http://www.disabilityrightswa.org/stop-fraud-and-abuse-rep-payees. These locations were selected based on their differences across the selection criteria domains described above, as well as our understanding of the environments surrounding unlicensed care homes in each of the locations, and our ability to identify potential informants in each of the selected locations. 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. One SME, who was a firefighter and paramedic who has responded to calls from several unlicensed care homes, stated that he often had more comprehensive listings of unlicensed care homes than the local ombudsman. Identification of unlicensed care homes is triggered by complaint calls to state or local authorities by community members or family members. Owners of current small licensed personal care homes are also potential sources of information; they will be able to fully describe the monetary costs associated with licensure, and these costs appear to be one reason why some people choose to operate illegally. 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. Alabama's APS agency estimated that there were more than 200 unlicensed homes in the state, in contrast to their 400 licensed facilities. Notably, the strategy of responding to complaints limits the amount of information available about unlicensed care homes about which complaints are not made (i.e., possibly better quality homes). Funds are being allocated to relocate residents out of unlicensed residential care. They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches. 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. These challenges include differences in laws and regulations pertaining to care homes across states, and the lack of cooperative arrangements across states to facilitate tracking residents or operators who traverse state borders. Positive Actions by States to Improve Oversight of Unlicensed Facilities. 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. (2) "Capacity" means that maximum number of persons authorized to be provided services at any one time in any licensed facility. If you know of unlicensed activity and just want to report it, then you are in the proper section. See http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf. Troubled group homes escape state scrutiny. New stringent eligibility criteria for state plans to cover services in group homes serving persons with mental illness have reportedly made it financially difficult for the adult care homes and group homes to continue operating, and some have reportedly been forced to close. 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. However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. However, key informants at the state said that operators of suspected unlicensed care homes usually do open their door for inspection. Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. A private residence, a care facility or an employer might offer room and board. Next, the local group monitoring office or the state would attempt a site visit. This was described as limiting the capacity of the resident to relocate. Strategies used to address health, quality and safety issues in unlicensed care homes. Residents who are unable to climb stairs may be housed in a basement or on a second story without access to an elevator. Costs for bringing the building up to code to meet state regulatory requirements may be another reason why operators of care homes choose to remain unlicensed. If you live in an unlicensed Room and Board facility, all California Landlord-Tenant Laws apply to your facility. 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). unlicensed room and board californiaatlanta hawks courtside. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. The research team completed seven interviews with eight participants that included both state and local community stakeholders. Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit. Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. 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. We also heard from nearly all state-level informants that some operators routinely shifted residents from one address to another if an APS worker, other advocate, or potential regulator showed up at the facility asking questions.
