Troubled Group Homes Escape State Scrutiny. Potential Data Sources or Listings of Unlicensed Care Homes, 5.3. 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. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. What types of reports of mistreatment do the agencies receive? State and Local Policies Related to the Supply and Demand for Illegally Unlicensed Care Homes. Residents may still be in bed during the late morning or early afternoon when they should be active. Some states allow legally unlicensed facilities to assist with ADLs and administer medication, but do not allow them to provide 24-hour supervision. Legal homes serve as conduits to illegally unlicensed homes in some instances. We targeted site visits in communities that varied according to whether the state: (1) has legally unlicensed care homes; (2) has a list of unlicensed care homes; and (3) ranks among the highest or lowest in HCBS waiver expenditures. A few strategies exist in the state for addressing illegally unlicensed personal care homes. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. In 2005, Pennsylvania changed the regulations so all residential care homes with four or more individuals had to be licensed by the state, but 1-3 bed residential care homes still could be legally unlicensed. Maryland, Nevada, and Florida: The National Ombudsman Reporting System noted an increase in unlicensed care homes in these states, but no unlicensed care reports from any state provided evidence on the prevalence of unlicensed care. Those individuals who remained in the city were placed in day programs. This section describes illegal contracting and the programs CSLB has in place to combat the activity. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Ultimately, several key informants acknowledged and emphasized that remaining unlicensed is lucrative if the care home operator successfully avoids detection by the authorities. Yes. In addition to the church-affiliated home described above, examples of the types of places where unlicensed homes operate included an old elementary school as well as single family homes in residential neighborhoods. Unlicensed homes tended to flourish in larger cities where there were significant numbers of low-income elderly and people with mental illness released from state mental hospitals. 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. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' The cookie is used to store the user consent for the cookies in the category "Other. These cookies ensure basic functionalities and security features of the website, anonymously. As noted, the responsibility and authority of ombudsmen in unlicensed care homes--even in terms of receiving and acting on complaints--varies from state to state. Many key informants noted that regulatory loopholes provided potential ways that operators of illegally unlicensed personal care homes can persist and evade licensure. In California in the early 1970's, the 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). Unlicensed Practice | MBC - California Dallas Morning News. Texas Department of Aging and Disability Services. Some SMEs and key informants noted that if lists could be obtained from these organizations, they could then be compared to state licensure lists to determine whether the residential care homes are unlicensed. Her e-mail addresses is: Emily.Rosenoff@hhs.gov. 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. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. Some legislatures made it a felony to operate an unlicensed care home. Necessary cookies are absolutely essential for the website to function properly. Key informants expressed a desire for future research that helps to categorize the necessary organizations and the number of personnel hours needed from each organization at each phase of the processes to identify, investigate, and close unlicensed homes; determine the optimal tactics to effectively implement investigation and closure; and develop a safe and seamless relocation and follow-up plan for residents. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. All key informants described how the Local Management Entity-Managed Care Organization (LME-MCO) oversees the provision of mental health services in Durham County. revision is needed, completion of a new Room and Board Residency Agreement is required. Safe food handling and storage and nutritionally balanced menus. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. Clients Rights & Advocacy - Santa Clara County, California And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. Operators of small care homes lack knowledge of licensure regulations and how to navigate the different government agencies, and there is a perceived lack of respect from government staff regarding the quality of care that non-professional staff can provide in these small residential care homes. Given the types of key informants interviewed for this study, and the limited viewpoints captured, more information is needed to understand the characteristics of unlicensed care homes and the residents they serve. As such, they could be a key source for learning about currently unlicensed care homes. ", 3.4.2. Room-and-board facilities typically provide residents with a room, a bed and prepared meals for a set price. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. 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. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or states. In some cases, the landlord may be an employer and room and board may be part of the employment contract, with room-and-board charges deducted from the employee's paycheck. Multiple key informants also stated that interviews with small licensed personal care home operators may result in learning more about the motivations for operating an illegally unlicensed personal care home. DISCLAIMER: The opinions and views expressed in this report are those of the authors. The cookie is used to store the user consent for the cookies in the category "Other. Disability Rights California have investigated squalid conditions at a number of unlicensed room and board homes serving adults with psychiatric disabilities across the state. Based on the criteria noted above, we recommended six states to ASPE as possible site visit locations: Georgia, Indiana, Maryland, North Carolina, Pennsylvania, and Texas. What information exists reflects a concern about the conditions under which residents in these places live. No. Interview results indicate that police may also be helpful in identifying unlicensed care homes, but the extent of that help may vary from state to state and across communities within states. 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. Populations Served and Conditions in Unlicensed Care Homes, 3.3. Having a license attempts to ensure the home has met minimal health and safety requirements placed upon it by the State of California. U.S. Department of Justice settlements were also discussed by one key informant. Some key informants described frustration with the lack of monitoring and lack of jurisdiction by the licensing offices to access or track legally unlicensed care homes. We focused on a range of questions, including: How do agencies handle specific complaints about unlicensed care homes? Cooperative efforts are underway amongst state and local agencies in some states. 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. 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. The issue of financial exploitation is described in detail in Section 3.3.2. SMEs and key informants consistently noted that many low-income individuals cannot afford licensed facilities, which makes the less expensive unlicensed care home an attractive option, and thus contributes to the existence of unlicensed care homes. 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. Key informants indicated financial exploitation in unlicensed care homes is an area for future research. Funds are being allocated to relocate residents out of unlicensed residential care. Additionally, some of what we heard about policies that affect demand for and supply of unlicensed care homes was based on the opinions of the individuals interviewed and may not be representative of others' views, and we do not have data to support these viewpoints. 10 Steps to Open an RCFE in California - Assisted Living Education 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. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. However, as recently as 2013, the number had decreased to ten enforcement actions. Key informants included representatives from the state licensure office. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. Strategies for Identifying Legally and Illegally Unlicensed Care Homes, 3.5. Informants expressed other specific concerns about unlicensed care homes, including improper management of residents' medications; unsafe, unsanitary, and uncomfortable living environments; theft of utilities from neighbors; and fraudulent collection of government payments (e.g., not reporting residents' deaths and continuing to collect their SSI payments). Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. Study staff screened each of the collected articles, blogs, and reports to identify relevant material for review. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. In another example of differing payment sources, a key informant described a housing situation with three Dom Care residents plus three other residents who can live independently; this care home did not require state licensure as a personal care home. Staffing levels are not adequate to meet the needs of the residents. Several key informants expressed concern about neglect of the health needs of residents because of too few or inadequately trained staff, particularly in regard to the care of residents who have severe and persistent mental illness and need monitoring of their conditions and reactions to medications. Analytical cookies are used to understand how visitors interact with the website. Retrieved from http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf. We hypothesized that states that do not have well-funded HCBS programs may have a higher incidence of illegally unlicensed homes than states with more robust HCBS programs. 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. We found a number of publications and media reports in both Florida and Texas (e.g., the Miami Herald newspaper series in Florida, and the U.S. Department of Justice report in Texas), and a few media reports and a research report on unlicensed care homes in Maryland; however, these states were not selected as site visit states. Key informants described a coordinated effort between the state licensure offices and the local group care monitoring office once there is recognition that a complaint call is about an unlicensed facility. Locking refrigerators or pantries to limit resident access to food between meals, with some residents being malnourished and dehydrated and one resident breaking into a neighbor's home for food. Following the environmental scan, we conducted interviews with SMEs on the topic of unlicensed care homes. Medicaid fraud reports, 2009-2013. PDF Residential Care Facilities for The Elderly (Rcfe) One former fire department battalion chief reported that the elderly living in unlicensed residential care homes are hidden from the view of public health agencies, social service agencies, and ombudsman programs --the entities that generally protect and advocate for older people and individuals with disabilities. In addition, states differ in whether they provide additional funds to the ombudsman program, over and above the federal funds from the Older Americans Act. 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. Business and Professions Code Section 2052 states that any person who practices or attempts to practice or who advertises or holds him/herself out as practicing any system or mode of treating the sick or afflicted or who diagnoses, treats, operates for or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury or other . This report describes the methods used to conduct the study, summarizes the information learned from an environmental scan and the results from interviews with subject matter experts (SMEs) and site visits, discusses implications of the findings and, based on the study findings, offers recommendations for future research on unlicensed care homes. All of the key informants shared their perspectives about what is driving the closure of personal care homes. A landlord and tenant can enter into an oral or written contract for room and board. 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. What is Residential Care for the Elderly? For additional information, interested parties can contact the Paso Robles AAUW's Marty Diffley at (805) 440-2078 or pstevens4044@gmail.com, or the League of Women Voters at (805) 242-6990 or candidateforums@lwvslo.org. Findings from this study are necessarily limited by the number of experts we identified and states we visited. What federal and state policies affect the supply and demand of unlicensed care homes? Of the approximately 1,400 complaints received by APS each year, an estimated 20% pertain to unlicensed personal care homes. Presumably, this led to an increase in need for LTSS for these populations. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. The Pennsylvania BHSL provides specific documentation to potential operators and consumers outlining situations that do not have to be licensed by the state. 3.4.3. These are important issues since they affect many vulnerable adults who have physical, intellectual, or cognitive disabilities. Unlicensed care homes commonly will accept these individuals and many market themselves to discharge planners. Teri Parker CFP is a vice president for CAPTRUST Financial Advisors. Operators seizing the residents' food stamps and selling them for cash. Strategies to Address Unlicensed Care Homes. Although the scope of our research was limited--involving a small number of interviews with subject matter experts (SMEs) and interviews with informants in three communities in three states--the findings have relevance for national, state, and local policies and practices and for future research. These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. In some states, APS has very limited responsibility and involvement. NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. Facilities provide two types of services in addition to room and board: (1) basic services, which include personal . While no comprehensive nationwide list of unlicensed care homes exists, the environmental scan identified one state (Florida) and one city (Houston, Texas) that maintain listings of unlicensed care homes. Additional potential research questions or issues were raised by one or more SMEs or arose from our state site visits or the environmental scan. One of the key informants, who operatesa day program that serves many individuals who are residents of unlicensed care homes, also described the 20 year history surrounding the operation of unlicensed care homes. Almost all SMEs and key informants recommended more proactive strategies to identify unlicensed care homes. Two key informants noted that they only see the worst cases of illegally unlicensed personal care homes, so they could not offer examples of adequate or good care that may occur in those they do not investigate. licensure for adult foster care. 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.