Texas Department of Aging and Disability Services. 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. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. Atlanta Journal-Constitution. More than 30 people were being housed there without adequate food or medication. Once an unlicensed care home is identified, the PCRR team works closely with the both the state and regional licensure offices to take the necessary steps to deal with the home. 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. Almost all adult care home operators receive $2,608 per month. 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. 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). 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. Strategies for Addressing Unlicensed Care Homes. 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. Key informants in all three site visit states provided examples of how this might happen. 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. Policies affecting the supply of and demand for unlicensed care homes. Troubled residents languish in flophouses. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. Interagency and Multidisciplinary Teams. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. 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. 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. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. Managing the care needs of low-income board-and-care home residents: A process of negotiating risks. State and Local Policies Related to the Supply of and Demand for Unlicensed Care Homes. Posts about unlicensed group homes written by ppjg. According to key informants, this graduated fine system is intended to be a "bigger hammer" to stop "belligerent repeat illegal operators. 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. Michigan Agency Michigan Department of Licensing and Regulatory Affairs, Bureau of Community Health Systems, Adult Foster Care and Homes for the Aged Licensing Division Contact Ashley Harris E-mail HarrisA29@michigan.gov Phone (866) 856-0126 or (517) 284-9700 We are providing our staff and residents with sanitation and safety supplies, including hand sanitizer and face coverings. 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. ~DNe*FYil2`#T*$E9=`pJ. At the local level, APS and the ombudsman have informational brochures on their agency websites for the purpose of educating individuals and families about residents' rights. One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. 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. HOUSTON - KPRC 2 recently reported on Blessed Hands Independent Homes, an unlicensed group home operating in southeast Harris County. (2004). One key informant stated this posted information, as well as general education sessions out in the community; for example, in senior centers or nursing homes, leads to some complaints that can generate investigations into personal care homes that may be identified as illegal operations. 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. He called Glover-Hogan, and said did you visit? There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. 3.2.1. A few strategies exist in the state for addressing illegally unlicensed personal care homes. 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. We are cleaning our homes, facilities and offices routinely, including regularly sanitizing all high touchpoint surfaces. Others described instances where the unlicensed care homes can be located in either low-income neighborhoods or higher-income neighborhoods, and that they blend in with other houses, which makes them difficult to identify or locate unless reported by the community. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. An individual thats incapacitated that needs a higher level of service, the likelihood is that that type of facility would require a license, said Larry Horvath, the Director of Michigans Bureau of Community and Health Systems. If the facility is providing licensable services in an unlicensed setting, the state then sends a cease and desist letter, copying the LME-MCO and the local APS. Some publish notices of how and where to report unlicensed care facilities. One prominent case required more than 40 people in law enforcement and social service agencies to investigate and close a home, find placements for the residents being displaced, and prosecute the violators. However, as recently as 2013, the number had decreased to ten enforcement actions. 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. Allegheny County was specifically chosen as the site visit community because of their currently active PCRR team, which continues to address illegally unlicensed personal care homes. One key informant shared that, as part of such a campaign in 2012, advertisements were placed in metropolitan areas warning the public against placing people in illegally unlicensed personal care homes. Hawes, C. & Kimbell, A.M. (2010). Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. Some states allow them to assist with ADLs, but do not allow them to administer medication. The site is secure. 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. Areas for Future Research and Potential Data Sources. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. Health Management Associates. Vulnerable adults being put into unlicensed group homes. In addition, investigations by Georgia law enforcement officials indicated that there is considerable fraud with respect to SSI, Social Security, residents' personal needs allowances, Medicare and Medicaid, and the food stamp program. A few key informants suggested cross-referencing different agency lists as another potential source for identifying unlicensed care homes. Clarifying this definition will be critical to understand the prevalence of unlicensed residential care homes, as well as the characteristics of residents in these homes. The primary concern expressed about the unlicensed homes that were otherwise safewas that they might not be able to provide the level of care and services needed by the residents (e.g., medication supervision for residents with severe and persistent mental illness). restriction of group homes, both their siting and operation. Box 30664 Lansing, MI 48909-8164 1. 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. Future research examining the role of hospital discharge planners and strategies to prevent discharge to unlicensed care homes appear warranted. A few interviewees agreed that in cases such as this, the operators are motivated by their desire to care for people; they are just not aware of the licensure requirements. Key informant interviews were conducted in three communities across three states: Allegheny County, Pennsylvania; Atlanta, Georgia; and Raleigh/Durham, North Carolina. Atlanta Journal-Constitution. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. Findings indicate that a variety of policies may have an impact on the supply of and demand for unlicensed care homes. Neglected to death, part 3: Inspectors find violations at Lauderhill ALFs. In Michigan, residential care homes that provide room, board, supervision, and protective oversight, but not personal assistance with ADLs or medication assistance (residents can contract out for personal care), are not required to be licensed. 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. Anne Arundel County Fire Department, Millersville, Maryland. 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. Strategies for Addressing Conditions in Unlicensed Care Homes, 6.1. Listen Live HERE! Call in number 917-388-4520 If you want to see if a certain group home is licensed, please click here. Unlicensed care home operators also were described as sometimes having select residents act in a role of authority over other residents, such as beating the other residents to control their behaviors. Many of the key informants stated that individuals who operate unlicensed care homes are motivated by economic opportunities; but they also stated that in some cases, these operators may not know they need to be licensed. Regardless of what they are called, this study focuses on places that provide room and board and sometimes provide personal care to two or more unrelated individuals, but whose operators are not licensed or certified by the state. Klavinger says he was outraged when Glover-Hogan moved Plummer into an unlicensed group home in Warren -- a home that was operating illegally as an Adult Foster Care facility. Key informants described both state and local infrastructure issues related to the prevalence of unlicensed care homes in the state. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. In 2006, HB 5245 Created a medication technician pilot program involving 30 Failing to have safety equipment available, such as smoke detectors and fire extinguishers. Adult residential licensing, 2010 annual report: A report on licensed personal care homes. Two interviews were completed with representatives from the Federal Government, seven with representatives from state agencies, three with representatives from policy organizations, one with a representative from a national advocacy group, and four interviewees were researchers knowledgeable about unlicensed care homes. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. A facility that advertises or represents via verbal communication that it provides personal assistance is required to make personal services available to its residents. 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. In Pennsylvania and Georgia, key informants indicated ombudsmen are permitted to make site visits to unlicensed care homes if complaints are received, although access can be denied by the operator. Some have residents that receive Medicaid funded services. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. From 2008 to 2013, Pennsylvania reported a stable trend of investigating about ten illegally unlicensed care homes per year with the exception of 2010 when they investigated 27 cases, about three times more than in other years.6. 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. Neglected to death, part 1: Once pride of Florida; now scenes of neglect. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. Thus, future research might be warranted to determine the characteristics of residents in unlicensed care homes and whether they differ across legally and illegally unlicensed homes. 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. 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. 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. Findings from the interviews suggest that the majority of unlicensed care home residents in the metro Atlanta area have severe and persistent mental illness and are highly vulnerable to exploitation. But after a family friend told the Oakland County Probate Court that Plummer was having memory loss, court records show a Judge appointed a Southfield attorney as a co-guardian. The research team interviewed 12 key informants in Georgia. In Michigan, you can have both. One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. After a legal challenge this fall, Mrs. Plummers son and cousin are now her guardians, and she is now living at home with relatives. In these cases, the hospital reportedly pays the placement agencies a fee to find a personal care home, and the placement agencies also receive monetary incentives from the personal care homes for referrals. (Producer). 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. Key informants from Georgia and Pennsylvania reported that hospitals and hospital discharge planners (or their contractors) often place patients in unlicensed care homes (described in more detail in Section 4). In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. 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. Thus, one implication of the study is that it may be worthwhile in one or more states or communities to test and evaluate other methods of detecting illegally unlicensed care homes. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. In Pennsylvania informants described a public education campaign including advertisements warning people about placing their loved ones in unlicensed care homes. Abuse, Neglect, and Financial Exploitation, 3.4. Pennsylvania Department of Public Welfare. This became evident during discussions with informants in Pennsylvania and Georgia; it has also been reported in the literature, as we found in the environmental scan. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. 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. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. Illinois: A story released on the This American Life radio podcast described a scam where individuals with substance use disorders were sent from Puerto Rico to supposed rehabilitation centers in Chicago where they were to be provided with housing, food and counseling services, only to find themselves in crowded, unlicensed rehabilitation centers, their passports and other identifying information taken from them. Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. Specific concerns raised by SMEs and site visit informants are highlighted in this section. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. Identification of unlicensed care homes is triggered by complaint calls to state or local authorities by community members or family members. 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. Once an illegally unlicensed personal care home is identified, it is tracked at the local level to see if it has moved, or, in the case of closure, if it has reopened. Settings Note: Home Help services cannot be approved if a client is residing in a licensed or an unlicensed foster care home. Government staff lack of respect for the care provided in small residential care homes by non-professional licensed staff. Miami Herald. Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. Illegally Unlicensed Residential Care Homes, 6.3. Although limited in scope, the study provides foundational information about unlicensed care homes based on a narrow review of the literature and the reports of select SMEs and key informants in three states. A core pattern of exploitation described in interviews included the operator of unlicensed homes finding vulnerable individuals who need housing and supportive services (such as from hospitals or homeless shelters), requiring these individuals to transfer their SSI payments to the operator or one of the operator's agents in order to become a resident of the unlicensed care home, severely limiting the residents' ability to leave the facility, and relocating the residents to alternate locations to avoid detection. However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). 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. 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). 1 0 obj In this section, we summarize results of the literature review and interviews with SMEs and key informants. Based on this information, we chose three states, and subsequently identified three communities within those states, to visit and conduct case studies.2 Following is a summary of the literature, media coverage, and regulations for those three states (Georgia, Pennsylvania, and North Carolina). Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. Miami Herald. Sallah, M., Miller. All key informants described how the Local Management Entity-Managed Care Organization (LME-MCO) oversees the provision of mental health services in Durham County. 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. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. Adult children separated from their ailing parents. Homes for the aged provide continuous "supervised personal care" to adults older than 55, according to Michigan's public health code. New Jersey and Tennessee have a licensure category that specifies the maximum number of beds required for licensure, but not a minimum, which also implies that in these states some residential care homes may be legally unlicensed. Instances or allegations of physical and psychological abuse and neglect of residents were reported by SMEs and key informants and highlighted in the environmental scan. In the view of the majority of key informants, the operators of unlicensed homes do not want to have to pay for more staff to provide needed services. Leslie was arrested on multiple counts of abuse and. Thus, although our findings consistently highlight concerns about safety and quality, we cannot assess the generalizability of these findings and concerns, and our findings only minimally address unlicensed care homes that are safe and provide quality care. The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. 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. Legally Unlicensed and Licensed Care Home Operators. Washington, D.C. 20201, U.S. Department of Health and Human Services, Collaborations, Committees, and Advisory Groups, Understanding Unlicensed Care Homes: Final Report, Biomedical Research, Science, & Technology, Long-Term Services & Supports, Long-Term Care, Prescription Drugs & Other Medical Products, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS-PCORTF), Health and Human Services (HHS) Data Council, LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS, 4.1. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. 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. During an interview Tuesday, 7 Investigator Heather Catallo shared the Special Investigation Record from the Michigan Department of Licensing and Regulatory Affairs, which oversees Adult Foster Care Facilities. Other issues were identified during the subsequent sexual assault investigation, including abuse at the hands of the operator who beat the residents, false imprisonment in which individuals were locked inside rooms, and financial exploitation. In preparation for closing, the operator "turned over the residents to other operators for a fee of $100 per resident.". Notably, most key informants said the operator of a licensed home may also operate one or more unlicensed homes, often in the same neighborhood and often in collaboration with friends or family members. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. 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." Similarly, by nature of their jobs, many of our interview participants, including APS staff, ombudsmen, police, and fire department personnel, typically hear about care homes when there are complaints or emergencies. We focused on a range of questions, including: How do agencies handle specific complaints about unlicensed care homes? (n.d.). Media reports described operators that continued to operate after their licenses expired or were revoked. As discussed earlier, Pennsylvania is a state that legally allows unlicensed residential care homes, if they serve three or fewer individuals. For Illegally unlicensed personal care services in group homes increased we focused on a range of,. 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