Some assess fines for continuing to operate an unlicensed facility. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. 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. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. The team conducted interviews with key informants in each of these communities. 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. For instance, they may start by caring for one resident, and gradually take in more individuals without realizing there are state regulations governing homes caring for two or more unrelated adults. 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. With the passage of a new law in July 2012, it is a misdemeanor to operate an unlicensed personal care home, and if an unlicensed care home is linked to abuse, neglect, or exploitation, the violation is considered a misdemeanor. Monograph for the National Institute of Justice, U.S. Department of Justice. If your concerns are still not addressed and you believe that . Two key informants spoke about the lack of oversight of these homes and the concern for the well-being and safety of their residents. We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. Some key informants described illegally unlicensed personal care homes as filthy and potentially filled with rodents and insects; they also noted that these homes are unsafe structures that could be condemned. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. There were no reports of varying frequencies of unlicensed facilities between urban and rural areas. Conditions (including quality and safety) of unlicensed care homes. If the homes are closed and the residents' identification cards and personal paperwork are not able to be retrieved, this poses challenges for residents to get SSI payments and medications. Contact Information: HealthProgram Law Foundation of Silicon Valley 4 North Second Street, Suite 1300 San Jose, CA 95113 INTAKE LINE: 1 (408) 280-2420 Fax: (408) 886-3850 Hours: Monday - Friday 9:00 a.m. - 12:00 p.m., 1:00 p.m. - 4:00, except for major holidays E-mail: healthintake@lawfoundation.org Website: Law Foundation of Silicon Valley There is no regulation covering rates. Glass, I. Media and state reports have highlighted homes operating deliberately illegally--that is, they are avoiding required licensure or certification (Tobia, 2014; Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect & Exploitation, 2013). 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. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. Often these homes serve very vulnerable populations, such as individuals with serious mental illness or older adults with functional limitations and limited financial resources. In other cases, the unlicensed facility simply ignores the law and operates below official "radar.". In more extreme cases, other personal care homes have stopped accepting any persons whose sole source of income is SSI. Maximum employee meal and room costs are established under California Employment Law. Detecting, investigating and addressing elder abuse in residential long-term care facilities. Poor quality of care, instances of physical abuse, toxic combinations of medication, and use of stun guns, were also reported (National Association of Medicaid Fraud Control Units, 2015). This was described as limiting the capacity of the resident to relocate. Positive Actions by States to Improve Oversight of Unlicensed Facilities. 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. During interviews, informants talked about situations in which the operators of unlicensed care homes continue to be the representative payee and continue collecting the SSI checks of residents even after the resident moved out of home. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. One key informant stated that if a call comes in and the name of the care home that is being reported is unknown, then the next step is to call the state licensure office. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. Two key informants mentioned that changes to the state's Medicaid Personal Care Services program had a direct impact on available funding for group homes that serve individuals with mental illness. Three reports are worth noting separately. 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. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified ten states that spent the highest percentage of their LTSS expenditures on HCBS and those that spent the least. 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. The state's annual Personal Care Homes Report provides the number of illegally unlicensed personal care homes that result in enforcement actions and details the historical trend of the number of enforcement actions taken against illegal unlicensed personal care homes. Anne Arundel County Fire Department, Millersville, Maryland. Austin, Texas. Schneider, C., & Simmons, A. Key informants noted that the possibility for theft from residents and from government programs also exits with the practice of operators taking control of residents' monthly income from SSA. Most of the literature we found referenced problems in and the prevalence of unlicensed residential care homes prior to 2009, or addressed abuse and exploitation of adults living in licensed facilities. States with concerns about vulnerable adults' access to housing with services may wish to examine their admission and discharge requirements for licensed care homes. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. The following section presents individual research topics and identifies the related questions that might guide future research on unlicensed residential care homes. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. How can I report illegal advertising by an unlicensed contractor. Food may be locked away and inaccessible to residents. As with health and safety concerns, the environmental scan and interviews conducted with SMEs and key informants revealed myriad concerns about abuse, neglect and financial exploitation. Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. One key informant described a recent (2015) case of human trafficking in which a care home operator who was closing a home was explicitly selling residents for $100 each to other personal care home operators. Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. Her work has been published in the Daily Bruin and La Gente Newsmagazine. Boarding homes are allowed to provide the following services beyond room and board: light housecleaning, transportation, money management, and assistance with self-administration of medication, but no personal care service. Strategies for Identifying Legally and Illegally Unlicensed Care Homes, 3.5. Unlicensed Practice. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. Dom Care homes, which also provide care to three or fewer individuals, are governed and regulated by the state with the authority to certify, supervise and monitor delegated to the local AAA. Key informants suggested interviewing individuals from other agencies to learn more about illegally unlicensed personal care homes or to obtain potential lists of illegally unlicensed personal care homes. In Pennsylvania, facilities providing or arranging for housing, food service, and one or more personal care needs for four or more unrelated adults must be licensed as personal care homes. 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. The cookies is used to store the user consent for the cookies in the category "Necessary". Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. This cost ranges widely based on the geographic region you live in. The state has started training sessions to educate law enforcement and first responders about unlicensed care homes, and these education efforts may contribute to the state's ability to identify unlicensed personal care homes. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. The literature review was not an exhaustive effort, but rather a targeted scan of information on unlicensed care homes in the peer-reviewed and grey literature, abuse blogs, and media reports. One key informant estimated this hospital served 3,700 patients at its peak. Before sharing sensitive information, make sure youre on a federal government site. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. Overall, key informants were able to provide little information about the prevalence of illegally unlicensed care homes (henceforth referred to as unlicensed care homes); informants we spoke with at both the state, local licensure office and APS reported that they do not currently systematically monitor or track unlicensed care homes. With regard to recruiting residents from hospitals, we also heard of unlicensed care home operators receiving payments of up to a month's fees from hospitals anxious to discharge the residents to free up hospital beds. 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. 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.