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. 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. 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. Several SMEs also noted inadequate funding and housing options for persons with severe and persistent mental illness or intellectual disabilities who have been moved out of state facilities may contribute to demand for unlicensed care homes, because these individuals may not be able to afford the cost of a licensed care home. Some publish notices of how and where to report unlicensed care facilities. Costs for operating a licensed personal care home can include state fees for licensure, structural renovations or changes to meet required building codes, paying for staff to be on-site 24 hours per day, and paying for and providing adequate staff training. Pennsylvania's BHSL is currently working on an amendment to create a graduated fine system for those operators who continue their illegally unlicensed care homes after they have been ordered to cease operations. Safety issues affect local fire departments. Assisted Living vs. U.S. Department of State, Office of the Under Secretary for Civilian Security, Democracy and Human Rights. than assisted living care. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. references to products, services or publications do not imply the They capture key variables such as the name and any aliases of the illegally unlicensed care home; the owner's name and whether they own more than one unlicensed care home; the licensure status (formerly licensed, never licensed, operating illegally); and any relevant information about the complaint (e.g., investigation dates, or dates any residents were moved/relocated). Along with funding to cover relocation of residents, this legislation empowers state and local multidisciplinary teams to collaboratively plan and coordinate efforts to identify, investigate, and pursue any necessary regulatory enforcement or legal action against unlicensed facilities. For example, is it defined by the services the home offers, the services needed by residents, or the services provided to the residents in the unlicensed care setting. This may include the mobile non-ambulatory persons such Findings from this study are necessarily limited by the number of experts we identified and states we visited. Miami Herald. Personal care homes, also known as a residential care facility, provide24-hour access to personal care, as well as nutrition and wellness services designed specifically for older adults, seniors can also enjoysocial contact, security, and support while still maintaining their independence. Through these regulatory activities, DADS protects Texas citizens who receive long-term care services. Florida publishes a listing but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. In some states, residents can pay for their own personal or medical care in an unlicensed facility. The frequently reported act whereby the operator of an unlicensed home makes money from their control of vulnerable residents and moves these residents from one unlicensed care home to another to avoid detection, led one SME to refer to it as "human trafficking." In the District of Columbia, an ombudsman reported that they were involved in collaborative efforts with University Legal Services, Department of Mental Health, Department of Accountability and other groups, such as APS. This was described as limiting the capacity of the resident to relocate. 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. The Texas Department of Aging and Disability Services (DADS) licenses, certifies and surveys home and community support services agencies(HCSSAs)for compliance with state and federal laws and regulations. Perkins, M., Ball, M., Whittington, F., & Combs, B. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. Legal homes serve as conduits to illegally unlicensed homes in some instances. Properly complete and submit the license application. I am interested in opening a personal care home in Texas and having difficulty with knowing which application and requirements to look for. It is worth noting that this research activity would require developing an operational definition of "unlicensed residential care home," since definitions vary considerably across and sometimes within states, as some focus on services offered, some on size, and some on the characteristics of the residents. The inability or unwillingness to provide appropriate care for residents at an affordable cost also was noted by key informants as a motivator to not pursue licensure. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. However, in Allegheny County, key informants stated that locally the regulation is interpreted and applied differently, and that a Dom Care facility could not have more than three residents total, regardless of the case mix or payment mix. Savchuk, K. (2013). (Hawes & Kimbell, 2010). For example, SMEs indicated that law enforcement investigators have discovered operators of unlicensed homes with scores of electronic cards for food stamp benefits that belonged to current and former residents. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. Custodial care is non-medical assistance 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. 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. Social Security Administration. There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. 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. As an Home Health Aide at Elkins home health care, How do i go by starting my home health care business in getting clients in the homes, Dedicated to the field of Social Work and Helping Others, Is there anyone that can provide info on starting a group home for children 13-18 where would I find that information. The team conducted brief vetting calls with the second subset of SMEs to determine their appropriateness for an interview; if they were not deemed appropriate, they were asked whether they knew of any other potential interviewees. Health Management Associates. As described earlier, some of our key informants noted that hospital discharge planners knowingly discharge these individuals to unlicensed care homes to alleviate the immense pressure they are under to facilitate quick patient turnover, and some hospitals reportedly will pay unlicensed care homes to admit these individuals. Tracking Public Benefits and Representative Payees. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited financial resources. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. There is often confusion about the roles of unlicensed caregivers in the home. In preparation for closing, the operator "turned over the residents to other operators for a fee of $100 per resident.". Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. Positive Actions by States to Improve Oversight of Unlicensed Facilities. (2009). They described this as an example of operators running unlicensed care homes strictly for the money. (2012). Few of the investigations focus solely on financial exploitation. A few strategies exist in the state for addressing illegally unlicensed personal care homes. During each site visit we interviewed state licensure agency staff to obtain a broad perspective on the regulations surrounding residential care in each of the states. In some instances, these places may be certified or otherwise listed at a local level, but they may not be monitored by the state for quality and safety issues. 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. In response, the legislature has appropriated $260,000 to relocate residents identified as living in unlicensed care homes. 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. State regulations govern whether ombudsmen can access and advocate for residents in unlicensed care homes; thus ombudsmen may be limited in their ability to serve on these teams. NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. Specific concerns raised by SMEs and site visit informants are highlighted in this section. We focused on a range of questions, including: How do agencies handle specific complaints about unlicensed care homes? While experts may speculate on changing market dynamics, we do not have a reliable estimate of the unlicensed care home market prior to these policies taking effect, so we do not know what the market would have been without such policies. One key informant stated that one in four residents of Allegheny County are over age 60, and that this population presents a growing need for affordable residential care homes. Some states allow them to assist with medication storage but not with ADLs. Trafficking in persons report. In contrast, a key informant stated that complaints of physical and mental abuse are the issues that most often draw attention to unlicensed care homes. Types of Assisted Living Facilities; Overview: ALF Types; Resident Characteristics; Residents of Type A Small or Large Facilities; Page 17; Residents of Type B Small or Large Facilities; Type C Facilities; Facilities with Alzheimer's Certification; License Fees . Having buildings that were infested with bedbugs, other insects, and rodents. Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). Additionally, interviewee discussions revealed a lack of ombudsman involvement in unlicensed care homes, which is another area for future research. A 2010 annual report from the Department noted that the number of illegal residential care homes had increased from four homes in 2009 to 27 in 2010, most of them located in the Philadelphia area (Pennsylvania Department of Public Welfare, 2011). 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. The state has also been in the news based on actions resulting from state compliance with the Olmstead decision which has moved adults with mental illness from institutional settings into less segregated settings in the community. In the states we visited, a common theme across interviews was that addressing quality in illegally unlicensed care homes tends to focus on shutting down the operations. The LME-MCO oversees contract services in a four county area. Therefore, the purpose of this project was to conduct exploratory research on unlicensed care homes to understand more about their prevalence, factors contributing to their prevalence, their characteristics (including their overall quality and safety), and the types of residents they serve. Learn more in our Cookie Policy. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. The Texas Department of Aging and Disability Services (DADS) licenses and inspects personal care homes to ensure compliance with state regulations. This makes it difficult, if not impossible, for residents to leave the facility, a difficulty sometimes exacerbated by limiting residents' access to their funds, to the facility phone, and, as noted above, by locking residents in their rooms or the facility. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. have. It is important to note that most key informants did not speak to or have direct experience with very small (1-3 beds) legally unlicensed personal care homes, and therefore could not estimate the prevalence of these types of homes or compare them to illegally unlicensed personal care homes. SME interviews primarily focused on federal and state policies that may impact the prevalence of unlicensed care homes. As noted in Section 4.1, states use a variety of definitions or criteria that allow some homes to operate legally without a license. An official website of the United States government. 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. as those who are in wheelchairs or electric carts and have the capacity to transfer and evacuate themselves in an emergency. In addition, one key informant stated that penalties for operating unlicensed care homes are similar to only a Class C offense, which is "equivalent to fishing without a license." Miami Herald. sleeping hours and must be capable of following directions under We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. Retrieved from http://www.phlp.org/wp-content/uploads/2011/03/PCH_manual-for-advocates-Feb-20071.pdf. Reporters from the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local officials, social service providers, and advocates, and then published a series of articles on the status of affairs in unlicensed residential care homes (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. 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. Three reports are worth noting separately. Below we present a sample of the varying state definitions of lawfully unlicensed and illegally unlicensed residential care homes. 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. One key informant in Allegheny County shared a list of seven current placement agencies that likely have registers of illegally unlicensed care homes. Interview discussions often touched on the question of how best to identify illegally unlicensed care homes, and key informants noted this as a major challenge. 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. 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. Report on Texas boarding houses. In Georgia, the number of complaints about unlicensed facilities rose from 253 in fiscal year 2013 to 293 in fiscal year 2014, with at least one-third of claims being substantiated. This is evidenced by the number of reports and complaints received about unlicensed personal care homes, the number of hours spent by law enforcement officials on investigating unlicensed personal care homes, and the estimates given of the numbers of unlicensed care homes that are operating in the state (reported by one informant as one unlicensed care home for every licensed home). One key informant provided additional information, stating that hospitals in Allegheny County use placement agencies to help find residential settings for discharges, and that illegally unlicensed personal care homes are used as an option. In some states, facilities that provided room, board, and "control and security of medication" could be legally unlicensed. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Retrieved from http://www.dallasmorningnews.com. 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. 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. 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. Key informants indicated financial exploitation in unlicensed care homes is an area for future research. 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. While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. In these cases, licensed operators were reportedly worried that the unlicensed operators would house residents from whom the licensed homes operators could have profited. A follow-up story revealed that these unlicensed rehabilitation centers may have been selling the identities of the victims on the black market for as much as $2,500. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. (2013). 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. Though outside the scope of our focus, some of the searches also produced media reports and grey literature about concerns in licensed care homes; however, reports about unlicensed care homes and the quality of care described therein was sometimes worse than those for licensed care homes. 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. 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. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. Key informants in metro Atlanta also indicate that the state conducts interviews with residents during investigations and closures of unlicensed home to gain a better understanding of how individuals end up in these homes. In Pennsylvania, one key informant noted that this assistance is given only to those operators who have opened their first illegally unlicensed care home without realizing they needed to be licensed; assistance is not provided for those who are repeat offenders. Senior Care & Assisted Living Services South Carolina Assisted Living Facilities, Care Homes, Senior Housing $249,000. This often includes three meals a day, but each facility designates its own costs.
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