This website uses cookies to improve your experience while you navigate through the website. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. 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. 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. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. Some states allow them to assist with ADLs, but do not allow them to administer medication. Landlords and tenants each have different responsibilities to make repairs and keep the room habitable, including the bed clean. Also, new HHS Centers for Medicare and Medicaid Services (CMS) policies on waivers and where waiver services may be provided may alter the prevalence of legally and illegally unlicensed care homes across the nation. The landlord may also issue a three-day notice immediately to a tenant who uses his room for illegal activities. (2015). 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. Informants noted that unlicensed care homes vary in their appearance and condition. Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). We utilized the information obtained in the literature review, in addition to our own expertise, that of our consultant, as well as that of U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the HHS Administration for Community Living (ACL) staff familiar with unlicensed care homes, to develop an initial listing of SMEs to interview. Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). Miami Herald. Tobia, M. (2014). These cookies ensure basic functionalities and security features of the website, anonymously. Several SMEs and key informants noted that individuals who had only SSI to pay for care have few options for housing and care, and often end up in unlicensed care homes. The 10 study States were: California, Florida, New Jersey, Oklahoma, and Oregon in the extensive regulatory stratum and . In Indiana, legally unlicensed residential care homes serving fewer than five residents can provide assistance with at least one ADL, assistance with medications or meal reminders, or two scheduled supportive services, but cannot administer the medications. Troubled residents languish in flophouses. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. 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. Hawes, C., & Kimbell, A.M. (2010). 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. Locking refrigerators or pantries to limit resident access to food between meals, with some residents being malnourished and dehydrated and one resident breaking into a neighbor's home for food. States with concerns about the prevalence of unlicensed care homes may wish to examine their licensure regulations, as these may influence the supply of and demand for unlicensed care homes, either because the complexity of some regulations makes them hard for operators to understand, or because they might contain loopholes that operators can easily exploit. Glass, I. Currently human trafficking is defined as "the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts" (U.S. Department of State, 2015), however, one SME recommended expanding this definition to include the situation in which an administrator for the unlicensed care homes seize and maintain control of vulnerable individuals in order to maximize revenue by taking the public benefits that the individual may be receiving. In August 2013, the law to prosecute an unlicensed personal care home operator was used for the first time. 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. 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. According to SMEs and key informants, the following factors are likely drivers of the demand for unlicensed care homes in their communities or states: The policies that licensed care homes have against admitting residents who exhibit behavior problems and those who have substance use disorders, or to discharge residents who develop these problems. The study by Hawes & Kimbell also provided reasons operators do not seek licensure, including: inability to meet fire safety codes (e.g., installing sprinklers), lack of state supplemental payment for SSI residents or Medicaid waiver funds (which can be restricted to licensed facilities), and avoidance of inspections and sanctions/fines for not meeting state regulation. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. This home initially drew the attention of the authorities because of a sexual assault case in which one of the residents was raped by a sex offender. Social Security Administration. You also have the option to opt-out of these cookies. One-bed and two-bed residential care homes are lawfully allowed in several states. In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. Potential Data Sources or Listings of Unlicensed Care Homes, 5.3. Leases are for a fixed period of time-usually a month or longer. Retrieved August 6, 2015 from 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. In a licensed facility, medications should be locked in a central location and disbursed at the appropriate time to the residents. The payments also vary considerably from state to state, and are quite modest in some states (e.g., from $46 to $100 per month). First, there is a lack of information about the effect of various state and national policies on the vulnerable individuals the policies were designed to protect and whose well-being they were intended to enhance. If you know of unlicensed activity and just want to report it, then you are in the proper section. Having a license attempts to ensure the home has met minimal health and safety requirements placed upon it by the State of California. NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. However, residents may pay for such services or receive them through Medicaid waivers. Texas and Georgia had numerous cases of unlicensed homes in deplorable conditions: infested with insects, lacking air conditioning or heat, residents sleeping on the floor, faulty wiring, no bathroom access, residents deprived of food or fed scraps, and theft of medications. The same held true, with one exception (Georgia), for the top ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island, Alabama, Tennessee, Georgia, New Hampshire, Massachusetts, and Delaware. It does not store any personal data. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. Teri Parker CFP is a vice president for CAPTRUST Financial Advisors. It was noted that many sheriffs and District Attorneys do not want their resources to go to cases of this nature unless serious and numerous complaints lead them to believe the group home is a major problem. Room-and-board facilities typically provide residents with a room, a bed and prepared meals for a set price. 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. In one state, Pennsylvania, three bed residential care homes are legally unlicensed. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. 3.5.2. Interview results indicate that police may also be helpful in identifying unlicensed care homes, but the extent of that help may vary from state to state and across communities within states. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. McGrath pursued both her Bachelor of Arts and Master of Fine Arts at University of California, Los Angeles, in film and television production. Connie's Room and Board Independent Living 2 3333 Hickerson Drive San Jose CA 95127 Connie Reyes 408-649-6452 or 408-518-2088 txt conniesroomandboard2 Downtown Independent's 7@gmail.com Home 1188 East Santa Clara St San Jose CA 95112 408-849-8404 Complaints Red flags that a care facility may not be licensed include: Before moving a family member into any care facility, visit the facility and verify that it meets licensing requirements. 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. What types of reports of mistreatment do the agencies receive? The PCRR team shares the complaints they receive about potential illegally unlicensed personal care homes between the AAA, APS, Disability Rights Network, code enforcement and state licensure office. Legally Unlicensed and Licensed Care Home Operators. 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. Unlicensed homes tended to flourish in larger cities where there were significant numbers of low-income elderly and people with mental illness released from state mental hospitals. A phone number is provided if someone has a question about the licensure status of a facility. 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. One key informant indicated that this reduction is due to the increasing numbers of HCBS waivers giving potential Dom Care residents the option to live alone in apartments. In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. 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. Arizona Department of Health Services. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). Business and Professions Code Section 2052 states that any person who practices or attempts to practice or who advertises or holds him/herself out as practicing any system or mode of treating the sick or afflicted or who diagnoses, treats, operates for or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury or other . Press Release.Retrieved from http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926. If you suspect that a facility is not licensed or in violation of its license, call 1-844- LET US NO (1-844-538-8766) to file a complaint with the Department of Social Services. U.S. Department of Health and Human Services Several reports noted that local law enforcement, EMS, and fire departments had frequent interactions with unlicensed residential care homes. Available at http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Failed Legislative Efforts to Improve Oversight. 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. These are Alaska, Arizona, Arkansas, Connecticut, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New York, North Dakota, Ohio, Oregon, South Dakota, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Second, the findings highlight the need for federal and state agencies to determine the nature and scope of financial fraud being committed by operators of unlicensed residential care homes. Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. What federal and state policies affect the supply and demand of unlicensed care homes? This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. 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 enactment of state laws or penalties and fines related to the operation of illegally unlicensed care homes is a strategy that states can use to address illegal unlicensed care homes. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. Media reports were usually about an action by a licensing agency, Medicaid Fraud Unit, APS, or the police arresting an operator; these reports do not provide much information about the extent to which unlicensed homes exist in the state. Residents may still be in bed during the late morning or early afternoon when they should be active. Some states allow them to assist with medication storage but not with ADLs. Key informants mentioned that state funding and regulatory mechanisms specific to Pennsylvania had a direct influence on the state's capacity to address illegally unlicensed personal care homes. 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. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. One key informant provided additional information, stating that hospitals in Allegheny County use placement agencies to help find residential settings for discharges, and that illegally unlicensed personal care homes are used as an option. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS. 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. 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). These findings highlight a set of potentially serious problems and issues. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Some operators remain undetected by moving residents from one facility in one state to another facility in another state. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. In another example of differing payment sources, a key informant described a housing situation with three Dom Care residents plus three other residents who can live independently; this care home did not require state licensure as a personal care home. Compendium of residential care and assisted living regulations and policy, 2015 edition.Prepared for U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. To accomplish this we conducted an environmental scan, including a review of the peer-reviewed and grey literature and interviews with SMEs. First Responders: EMS, Firefighters, and Police. Public funds, like state supplements, are inadequate. 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. Schneider, C., & Simmons, A.