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As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. U.S. Department of Justice settlements were also discussed by one key informant. Detecting, investigating and addressing elder abuse in residential long-term care facilities. 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. (2015). Some key informants reported that the living conditions in these places can be subpar. Absent assistance from the ombudsman or other support in finding affordable licensed care options, unlicensed care homes may be the only option these individuals have. After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. Pennsylvania DPW highlights safety and care regulations at personal care homes. Find a qualified, certified administrator. Each landlord must adhere to applicable housing laws, based on the type of room and board offered. Currently, 46 states provide some type of SSP (SSA, 2015). In California, assisted living services can be provided by a licensed home health agency in unlicensed publicly subsidized housing (low-income housing projects, apartment houses, retirement hotels, village models, and private homes). Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. However, there were many reports of poor conditions in legally unlicensed care homes. In California, when an owner rents property to a resident, this typically creates a landlord-tenant relationship. 1600 9th Street, Room 350 Sacramento, CA 95814 (916) 654-3585 . Unless a specific duty is listed in that regulations, the dental assistant is NOT . Health and safety concerns for residents were a major topic of interview discussion. 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. Pennsylvania: In 2012, the Secretary of the Department of Public Welfare stated that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly.". Unlicensed homes to face more state scrutiny. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state. California State Department of Consumer Affairs Homepage is designed to help Californians become informed consumers by learning their rights and protection., portal Key informants also mentioned other resident health concerns including neglect, lack of water, malnourishment, and bed sores or pressure ulcers resulting from inadequate care. One key informant described the selling of residents from an unlicensed care facility located in a house. 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. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. In California, many types of facilities offer room and board, including hotels, universities, residential care facilities and privately owned residences. Many adult facilities, those licensed for ages 18-59 , accept the current SSI board and care rate as payment in full. 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. Finally, a peer-reviewed publication by Perkins, Ball, Whittington, & Combs (2004) provides insights into why an operator continues to operate an unlicensed care home. Some states allow them to assist with ADLs, but do not allow them to administer medication. Fact: Room and Boards (R&Bs) are similar to independent living facilities due to the business setup by the owner which may be a privately-owned or operated 26-bedroom house that provides shared living accommodations for adults with limited disabilities. However, several SMEs and key informants noted that some unlicensed care homes are good and provide a clean, safe environment for individuals who might otherwise be homeless. In either case, while states regulate and provide some level of monitoring and oversight of licensed care homes, state and local oversight of unlicensed care homes can be minimal or non-existent, and these facilities provide questionable care and services. This report was prepared under contract #HHSP23320100021WI between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Research Triangle Institute. Positive Actions by States to Improve Oversight of Unlicensed Facilities. Georgia was selected as a state for our site visit because of the state's actions surrounding unlicensed care homes described during interviews with SMEs, and the numerous news reports about unlicensed care homes in the state. If the AOR is a PO Box, or a mail drop location . A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. If you know of unlicensed activity and just want to report it, then you are in the proper section. 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. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or 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. One Florida media report estimated there were hundreds of congregate living facilities across the state that escaped state oversight because no agency regulates them (Savchuk, 2013). 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. Residents who are unable to climb stairs may be housed in a basement or on a second story without access to an elevator. Occupancy Limit Regulations in California, How to Evict Tenants Without a Contract & California Laws, Month-to-Month Rental Agreements & Evictions in California, Laws on Carpet Replacement in California & Renter's Rights, Termination of Tenancy in California: Types of Eviction Notices, California Department of Consumer Affairs: Who Is A "Landlord" And Who Is A "Tenant", California Department of Consumer Affairs: Before You Agree To Rent, California Department of Consumer Affairs: Dealing With Problems, California Department of Consumer Affairs: Terminations And Evictions, National Center for Health Housing: California Housing Law and Regulations Healthy Homes Provisions, Disability Rights California: Your Rights in Residential Care Facilities. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. The regional and state licensure offices are closely involved in this process. We operate unlicensed room and board homes, some owner-occupied and all managed 24/7. Key informants at the state level were able to provide estimates of the number of complaints they have received pertaining to unlicensed care homes, but not estimates of the number of unlicensed care homes. Key informants described the way the teams function. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. Most interviewees reported that the personal care home regulation change in 2005 caused a loss of small personal care homes due to the increased costs associated with meeting the standards set forth in the regulations. 3.5.2. 3.4.3. State informants did not provide information on the services provided in the unlicensed care homes stating that that the sample of unlicensed care homes they see is too small to make an accurate approximation of the conditions. Retrieved from http://www.ajc.com. At least one administrator, on-site manager, or responsible person must be on duty 24 hours per day, seven days a week, and all staff must be trained as personal care workers within 60 days of hire. 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. Two of our three site visit states aimed to enhance awareness of poor and inadequate unlicensed care homes by increasing education for the public and key stakeholders: Pennsylvania held a statewide education and marketing campaign to inform the public about unlicensed care homes, and Georgia conducted training sessions to educate law enforcement and first responders about these homes. These findings highlight a set of potentially serious problems and issues. 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One SME explained that the operators sell the food stamps for cash. 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. Additionally, agencies such as The National Disability Rights Network's Protection and Advocacy Agency (NDRN P&A) could potentially use representative payee data to identify unlicensed care homes. In many cases, the cost of care in other settings is too high for what individuals with severe and persistent mental illness can able to afford on their SSI stipend. Some interviewees reported that unlicensed care home operators sometimes run homes in more than one state, across state borders to avoid arrest, and may be trafficking residents across state borders as well. Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. Thus, no more than nine individuals were ever asked the same question. We also heard of operators not reporting the death of a resident to SSA so the operator could continue collecting the resident's checks from the government. 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. If you live on the coast, youll pay a premium; the cost of care as you head inland is usually 25-35 percent lower than in coastal communities. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. Assisted living provider resources: Unlicensed facilities. This was described as limiting the capacity of the resident to relocate. Massachusetts exempts small private-pay homes from licensure. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. In some states, residents can pay for their own personal or medical care in an unlicensed facility. In Allegheny County we interviewed key informants from APS, and local ombudsmen and placement coordinators from the local Area Agency on Aging (AAA) who work directly with licensed and unlicensed personal care homes, as well as other staff from a local disability advocacy agency and a local fire department. As noted in Section 4.1, states use a variety of definitions or criteria that allow some homes to operate legally without a license. These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. The cookie is used to store the user consent for the cookies in the category "Other. Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. She was getting good care and it was something the mother could afford. Which agencies get involved when addressing unlicensed care homes? These included: (1) tracking individuals' public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. The informants recommended the formation of teams including a range of stakeholders, including state licensure officials, Adult Protective Services (APS), ombudsmen, police, firefighters, emergency medical services, code enforcement, and local advocacy organization workers.1. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. 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. In California in the early 1970's, the In this section, we summarize results of the literature review and interviews with SMEs and key informants. The cookie is used to store the user consent for the cookies in the category "Performance". One key informant estimated that approximately 3,000 licensed personal care homes have ceased operations in Allegheny County since the 2005 regulatory changes. In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. Due to services being brought into these homes, interviewees thought further interviews with home health staff or hospice staff may yield additional information or lists of unlicensed personal care homes that may include illegally unlicensed establishments. Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. 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. They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches. 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. Retrieved from http://www.thisamericanlife.org/radio-archives/episode/554/not-it. Similarly, APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. This key informant also emphasized that unlicensed care home operators tend to work with a network of collaborators who support moving residents between homes to avoid detection by legal authorities, and also help with re-recruiting residents and reopening a care home after an unlicensed care home is closed down. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. This is a link to a form you can use to file an advertising complaint with CSLB. Perils in personal 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. In addition to serving the elderly, personal care homes can exclusively serve persons with serious mental illness and/or intellectual and developmental disabilities, on condition that the home is appropriately staffed and is capable of providing the needed care within the scope of its license. As described by the majority of key informants, the primary motivation to maintain an unlicensed care home is to maximize profit. 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. Those individuals who remained in the city were placed in day programs. These cookies track visitors across websites and collect information to provide customized ads. For example, key informants in Allegheny County, Pennsylvania, stated that police in rural areas of the county are more responsive to reports of unlicensed care homes than are the city police. Before 2005, Pennsylvania allowed residential care homes with 1-8 individuals to be legally unlicensed. 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. Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. Findings indicate that a variety of policies may have an impact on the supply of and demand for unlicensed care homes. Although the residents who were moved out of this hospital may have been relocated to licensed facilities when the hospital closed, the fact that such institutional settings are no longer an available option may have encouraged unlicensed care homes to open. Government staff lack of respect for the care provided in small residential care homes by non-professional licensed staff. This section describes illegal contracting and the programs CSLB has in place to combat the activity. However, we did not focus on these populations in the interview. The state's BHSL office also has the legal authority to act as an enforcement agency. 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. There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. This key informant also noted that the residents frequently transition in and out of the home, as is often the case with illegally unlicensed personal care homes. Specific concerns included: Managing resident medications improperly. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. Residential care homes that are legal often serve as covers for or conduits to illegal homes. Without having a qualified, certified administrator on your team, none of the rest can follow. You must fill out a separate complaint form for each physician or other healthcare provider you wish to file a complaint against. 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. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. Texas Department of Aging and Disability Services. 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. Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping" by the operator. Key informants indicated financial exploitation in unlicensed care homes is an area for future research. Some state have too few inspectors to detect and investigate allegations about unlicensed homes and too little time and manpower to bring a prosecutable case to the AG's office. A paper by Tobia (2014) describes the state of unlicensed residential care in one county in Maryland, where as many as 78 unlicensed care homes may be serving as many as 400 individuals. 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). DISCLAIMER: The opinions and views expressed in this report are those of the authors. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2021 California Room and Board Coalition, All Rights Reserved. Estimate of 2-year cost of implementing HB216. Estimates of the number of unlicensed RCFs, as detailed in this report, were in the hundreds in two states: one state estimated more than 200 unlicensed homes in contrast to their 400 licensed facilities; and the other state estimated more than several hundred unlicensed homes but noted there was no reliable count. Some of these homes are legally unlicensed while others operate illegally. The Scope of Abuse and Exploitation Concerns. These cookies track visitors across websites and collect information to provide customized ads. Others may require higher rates; these are called private pay homes. The new regulations were implemented to monitor and provide oversight of personal care homes with four or more residents, while reducing the number of homes that legally did not require licensure. 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. We are here to support operators who desire to provide safe and affordable housing for the people living in their facilities as an alternative to homelessness and institutionalization. Both states use a penalty system to fine operators for illegal operations. Some continue to operate after their license expired or was revoked. In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. (2012a). I'm not going to report it. Although recognized as important, the state has not yet begun investigating cases of financial exploitation. Retrieved from https://www.socialsecurity.gov/ssi/text-benefits-ussi.htm. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. Once a room-and-board tenant is served with a termination notice, the landlord must offer the tenant an opportunity to cure some types of violations but not all violations. Retrieved from http://www.state.gov/documents/organization/245365.pdf. In California, all leases and rental agreements must include an implied warranty of habitability, which means the landlord must make repairs to keep the room livable. 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. The state regulatory agency can send letters to illegally operating facilities and fine them $500. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but they are unlicensed by . 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.