Strategies used to address health, quality and safety issues in unlicensed care homes. Hawes, C. & Kimbell, A.M. (2010). Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. Very little discussion centered on improving the quality 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. U.S. Department of Justice settlements were also discussed by one key informant. Three reports are worth noting separately. However, a representative from a state advocacy agency estimated that about 2%-3% of their 4,800 calls annually, or approximately 120 calls statewide per year, were related to unlicensed facilities. Each interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Very little was mentioned about elderly residents living in unlicensed homes; only one informant reported that unlicensed adult care homes may serve a mixed population (e.g., elderly residents in addition to residents with mental illness). In some states, APS has very limited responsibility and involvement. 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. According to one key informant in the state, moving individuals from institutions for mental illness with an inadequate plan for housing these individuals has contributed to an increase in the numbers of people available for unlicensed personal care homes to serve, thus motivating the opening of unlicensed care homes. Results of key informant interviews from site visits, as well as the SME interviews and the literature review, are presented in the Findings section that follows. Key informants noted that it is important to know the history of Pennsylvania's personal care home regulation changes in order to understand why and how the state has addressed illegally unlicensed personal care homes. These calls spur investigations that sometimes result in the identification of unlicensed care homes. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. The first, a six-state study on elder abuse in RCFs conducted by Hawes & Kimbell (2010) for the U.S. Department of Justice found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. As a result, 3,000 individuals with mental illness were transitioned into community-based supported housing. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Retrieved from http://www.namfcu.net/resources/medicaid-fraud-reports-newsletters. While some unlicensed homes reportedly serve elderly and physically disabled residents, key informants noted that many also serve persons who were formerly homeless, persons who may have substance use disorders, persons with severe and persistent mental illness, and parolees. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. C., & Barry, R. (2011).Neglected to death, part 2: Assisted-living facility caretakers unpunished: 'There's a lack of justice.' One key informant reported that during the investigation of this home, it also was discovered that the operator was taking the residents' food stamps. Three-bed residential care homes are lawfully allowed in at least one state. Adult children separated from their ailing parents. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. 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. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. Homes for individual residential care are licensed to provide food, shelter, assistance, and supervision for no more than two persons who are aged, . However, this likely is not a viable method for detecting the population of illegally unlicensed residential care homes. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. Below we present a sample of the varying state definitions of lawfully unlicensed and illegally unlicensed residential care homes. 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State investigators from the Bureau of Licensing and Regulatory Affairs inspected the home in October and found that Carter was violating the law. Some victims later found that their credit had been ruined by someone who illegally used their identity (Glass, 2015). In several cases, the potential interviewees did not have direct knowledge on the topic of unlicensed care homes, and were not interviewed, but referred us to interviewees with more knowledge on the topic. Hawes, C., & Kimbell, A.M. (2010). ADULT SMALL GROUP HOME (CAPACITY 1-6) 8138 HEDGEWAY DR. SHELBY TOWNSHIP. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. Desperate, Plummers family hired an attorney. 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. Additionally key informants indicated that many unlicensed care home residents who receive SSI payments participate in Social Security's Representative Payment Program, whereby payments are managed by an individual or organization that is representing the beneficiary because the beneficiary is unable to manage the payments independently. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. Most state informants said legally unlicensed care homes did not fall under state regulatory purview, and thus were not monitored (or investigated unless there is a complaint). One key informant estimated this hospital served 3,700 patients at its peak. An estimate for another locality in Maryland was much higher, with twice as many unlicensed homes as licensed, or about 1,500 facilities, many of which operate out of single family dwellings (Tobia, 2014). The financial pressure hospitals feel to free up hospital beds sometimes results in discharges to unlicensed care homes, both unintentionally and for expediency. Clarisse Carter runs Due Season Residential Services LLC, the unlicensed group home in Warren. 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). We all serve as public servants its not an easy job.. (2013). We chose the Raleigh/Durham area for the site visit because it is where the state licensing agency is located and because of recent media reports of unlicensed group homes. While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. 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. Unlicensed care homes--which provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state--fill some of the gaps in the availability of housing and services for these populations. In addition, states differ in whether they provide additional funds to the ombudsman program, over and above the federal funds from the Older Americans Act. 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. State officials have touted group homes as a preferred option, citing cost savings that can be used to fund more community care. In addition, the reports of financial abuse also may represent considerable financial fraud of federal programs including SSI, food stamps, and the programs paying for resident medications (i.e., Medicare and Medicaid). Social Security Administration. Group Home: Individuals can choose to reside in a licensed or unlicensed group home with 2-5 other individuals. 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. QX;zI!({?^2'hy^xe(z>! R As a result, Pennsylvania enacted a strategy to address the illegally unlicensed care homes, which included providing the Pennsylvania Bureau of Human Services and Licensure (BHSL) the ability to serve warrants and creating the PCRR team mentioned earlier and discussed in the next section. Dallas Morning News. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds, noting that Vermont, like Massachusetts, exempts small private-pay 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. 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. However, the long-term placement of individuals after discharge to an unlicensed care home may be unstable, and no follow-up by the hospital with the patient after placement was described. Audio podcast. 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