Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. Some continue to operate after their license expired or was revoked. d8 krDlxS^ s P,R^RDS=52oXj]]>b4M|{4q 4OH,kaG/ 4+P}COWz`)29z+QO i#.i[Yuv42 A::E%~wA/N^H[of=8"v~=Gk` *Xl?( J[J#'I@hSh 8 =;z+MZ>7x0mF D7& One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. 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. The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. Abuse, Neglect, and Financial Exploitation, 3.4. 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. Most key informants noted that hospital discharge is a critical juncture at which individuals can be directed to, or end up in, unlicensed care homes. Some operators use homes that do not meet personal care home building code regulations; for example, the home may lack proper ramps for wheelchair access. One key informant in North Carolina indicated that fines for the operation of unlicensed care homes have little impact on closing the homes, are rarely collected, and are not enforceable by their agency because the operation of an unlicensed care home is considered a criminal offense, and thus under the purview of law enforcement. 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. Glass, I. However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. In 2005, Pennsylvania state regulations for personal care homes were changed, reducing the minimum number of residents a personal care home could serve from seven to four. Both states use a penalty system to fine operators for illegal operations. SMEs and key informants discussed a number of factors that may have an effect on the supply of and demand for unlicensed care homes. (2015). NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. Areas for future research and potential data sources related to unlicensed care homes. Unlicensed staff may administer medications after completing a 16-hour medication course from an approved medication training provider. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. These complaints may be made to the police, APS, ombudsmen, and the Department of Community Health, HFR Division. Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. However, unlicensed care homes, which provide room and board and some level of personal care services, but are notlicensed by the state, fill some of the gaps in the availability of housing and services for these populations. 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. Failing to have safety equipment available, such as smoke detectors and fire extinguishers. 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. It is important to note that we do not know whether the types of financial exploitation and abuse described by the SMEs and key informants occur in both legally and illegally unlicensed care homes, or how commonplace they are. 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. In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. 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. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. For example, one SME from a state licensure office reported that their database does not include information on whether the call pertains to a licensed or unlicensed care home. Licensure and APS have the same difficulties in terms of moving residents out of unlicensed facilities into good supportive housing sites (Hawes & Kimbell, 2010). The Bureau supervises the states 4200 licensed group homes. Desperate, Plummers family hired an attorney. 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. 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). . (2009). At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. (n.d.). A Homes for the Aged (HFA) provides 24-hour room, board, and supervised personal care to: 21 or more unrelated, non-transient individuals 55 years of age or older. In Michigan, you can have both. One way to collect this information to develop a frame of unlicensed care homes and conduct a small scale study of unlicensed care home operators. % As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental illness to community-based care settings, such as legally unlicensed care homes. For example, as part of interviews with SMEs, we asked them to recommend potential key informants to meet with during site visits. They took her dignity from her, they took everything from her, said Peter Klavinger. Even with relatively low payment rates, operators can make profits by cutting corners in housing and services and trafficking in the federal benefits they seize from residents. Multiple interviewees suggested that it was important to quickly involve code enforcement and local health departments in efforts to close an illegally unlicensed personal care home. 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). The NDRN P&A reportedly has suggested that SSA require representative payees to self-identify if they own a residential care home (licensed or unlicensed). The following are some examples of financial exploitation depicted during interviews; these examples are discussed at greater detail below: Operators of unlicensed care homes collecting the residents' medications and selling the medications on the street for cash. Licensure staff admitted they only learn about the unlicensed facilities when someone reports them. If ombudsmen become aware of such discharges, they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified. In Allegheny County, key informants said that some hospitals use placement agencies to assist with difficult discharges (e.g., persons with severe or persistent mental illness, the homeless, or persons with little money). No Legally Unlicensed Residential Care Homes Are Allowed in Some States. Facilities providing or arranging for housing, food service, and one or more personal services for two or more unrelated adults must be licensed by the state as a personal care home. 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. Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. 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. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. If you seek a pleasant peninsula, look about you. Michigans official state motto holds many truths our state is a land of great splendors. 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. Some states allow legally unlicensed facilities to assist with ADLs and administer medication, but do not allow them to provide 24-hour supervision. 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. Full of natural beauty, historical importance, and a talented, resourceful population, Michigan has it all. 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. 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. Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option; the types of individuals who reside in them; their characteristics, including their quality and safety; and policies that influence the supply of and demand for these homes. 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. 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. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). We were told that after discovering a group home is unlicensed (via information from the state), the LME-MCO will ask the state to fast track licensure because there are no other licensed housing options available to this vulnerable population. Other key informants stated that some operators do not want the state regulating or monitoring their business. <> Most key informants stated that many unlicensed care home operators receive the income from the SSA directly, either in the name of the resident or by requiring the resident to name the operator or someone else as a representative payee. They speculated that there may not be enough licensed mental health group homes available to care for persons with mental illness, and that unlicensed group homes can potentially fill that gap. See http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. The DSP may only assist individuals with administration of medications that have been ordered and prescribed by a person licensed to do so by the Department of Licensing and Regulation (i.e., Doctor, Dentist, or Nurse Practitioner.) They also noted that, despite receiving payment for room, board, and services, some unlicensed care home operators provide subpar or poor quality accommodations and services to residents. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. Although the majority of key informants described unlicensed care homes as unsafe environments where residents are abused, neglected, or exploited, it also was noted that some unlicensed care homes may provide quality care in safe and clean environments. Unlicensed care homes are not required by law to open their doors to the state licensure office because the state licensure office does not have the legal authority to enter them. Further, when a licensed facility surrenders its license (or the license is revoked) but it operates as an unlicensed residential care home, regulatory and advocacy agencies no longer have the authority to inspect the facility, unless there is a complaint filed (Tobia, 2014). In August 2013, the law to prosecute an unlicensed personal care home operator was used for the first time. One key informant suggested that lists of available housing maintained by a local homeless housing assistance program may include illegally unlicensed personal care homes. Indeed, several key informants in Allegheny County reported that the closure of Mayview Psychiatric Hospital led to an increase in the prevalence of illegally unlicensed care homes in the county. The nature of health and safety concerns described by key informants were wide-ranging and often included neglect and the risk of death to residents. Health Management Associates. Detecting, investigating and addressing elder abuse in residential long-term care facilities. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. Limited information is available about the unlicensed facilities to assist with ADLs and administer medication, do. 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