Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. Operators forcing the resident to name the operator as the representative payee for government payments, such as SSI, and controlling the use of that money. It is not unusual for them to be involved in other illegal activities as well. individuals with serious mental illness who require care and supervision as well as room and board. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. The scan included published peer-reviewed and grey literature, including abuse blogs and media reports about legally and illegally unlicensed residential care homes. Finally, as noted later in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or being unnecessarily institutionalized. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. 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). 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. 3.5.2. As noted, we found the prevalence of legally and illegally unlicensed residential care homes varies by state. 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. A 2010 report from the Pennsylvania BHSL noted that enforcement actions against illegal personal care homes had increased from four homes in 2009 to 27 in 2010 (most were located in the Philadelphia area). 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. She has practiced in the field of financial planning and investment management since 2000. Populations in Unlicensed Care Homes. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. Texas Department of Aging and Disability Services. These fines ($50 for a first offense in North Carolina and $500 for a first offense in Pennsylvania) become more severe if criminal activity or a resident's death is involved. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. (2011). Residential care homes that are legal often serve as covers for or conduits to illegal homes. 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. azmfairall. Legal homes serve as conduits to illegally unlicensed homes in some instances. Unlicensed Practice. Potential SMEs were included in the initial listing based on their familiarity with residential care regulations, experience in and research about residential care, experience working with the potential target populations of unlicensed care homes, and knowledge of Medicare and Medicaid payment policies and home and community-based services (HCBS) waiver programs. Anne Arundel County Fire Department, Millersville, Maryland. Similar to the information summarized in the environmental scan, interviews with key informants revealed that unlicensed care homes make money off of residents in sophisticated and profitable ways. We also use third-party cookies that help us analyze and understand how you use this website. As a resident of a licensed residential care or unlicensed room and board facility, you have all the rights guaranteed by the Constitution of the United States and by the State of California. 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. Such practices violate residents' rights, and the profit-enhancing practices of the operators, such as limiting the availability of food, water, and other basic needs, endanger residents' lives and well-being. Unlicensed homes to face more state scrutiny. One state key informant told us that the state licensure office is currently working on an amendment to add a graduated fine system which would increase fines overtime for those operators who are repeat offenders which could potentially serve as a deterrent to continuing illegal operations. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. In contrast, in Pennsylvania, the BHSL has the authority to execute a warrant to investigate a suspected illegally unlicensed care home. Retrieved from http://www.dallasmorningnews.com. A few key informants suggested cross-referencing different agency lists as another potential source for identifying unlicensed care homes. Several states (California, Pennsylvania, Maryland, and Mississippi) publish notices on their websites of how and where to report unlicensed care facilities, which implies that these states must be experiencing problems with unlicensed homes. In Georgia, key informants also noted that hospitals directly discharge individuals to unlicensed care homes and some pay the first month of the resident's fees. Improper medication assistance and management were most commonly noted by key informants as problematic; informants were concerned that operators or staff of illegally licensed care homes may not be properly trained in medication management and administration. 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. (2015). 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. See http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf. 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. Some key informants noted that EMS personnel are a better source than firefighters to learn about unlicensed care homes in a community because EMS personnel respond to all emergency calls while firefighters do not. Candidate forums provide an opportunity for the public to learn about the candidates and their views on the issues. For many such individuals, their only options may be unlicensed facilities or homelessness. We operate unlicensed room and board homes, some owner-occupied and all managed 24/7. Unlicensed contracting is part of California's estimated annual $60 to $140 billion dollar underground economy. These key informants agreed that because discharge planners are under pressure to quickly discharge hospital patients to contain hospital costs, they must have a list of care homes (including licensed and illegally unlicensed personal care homes) that they can reference if the discharge planner has no other option for placement. Hawes, C. & Kimbell, A.M. (2010). The advocacy agency also collects information about whether the operators own more than one unlicensed care home. Necessary cookies are absolutely essential for the website to function properly. Maryland, Mississippi, and the District of Columbia have no minimum bed size for licensure, implying that some residential care homes can be legally unlicensed. Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Advocates reported a growing number of unlicensed facilities and difficulties distinguishing them from boarding homes or other types of RCFs. The key informant likened these networked operations to organized crime: "The other thing we are seeing too is that people [operators] are well networked, and within a day or two people are identified and going back, herding them up againthey are well networked so we look at them as organized crime organizations.". Residential Care Facilities for the Elderly (RCFEs) serve persons 60 and older. Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. General searchterms included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. Medicaid fraud reports, 2009-2013. U.S. Department of Health and Human Services A follow-up story revealed that these unlicensed rehabilitation centers may have been selling the identities of the victims on the black market for as much as $2,500. Informants consistently emphasized the critical need for collaboration between multiple agencies, including law enforcement, APS, ombudsmen, the Department of Behavioral Health, and HFR, in order to address the potentially unsafe environments in unlicensed care homes, ensure the needs of the residents are met, address the criminal acts of the operators, and attend to the buildings themselves. Examples of financial exploitation described by key informants include the operator becoming a resident's representative payee and then withholding a resident's money, and pocketing profits while providing inadequate care and services or no services at all. Thus, unlicensed care homes close and leave one area of the city, but reopen in another area, contributing to the difficulty of identifying and permanently shutting down these places, while also disrupting the residents' access to day services and other community-based sources of support nearby the original care home location. In Florida, the Secretary of the Agency for Health Care Administration told a senate committee that the agency wanted to work more with law enforcement. 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. Although such issues are not restricted to unlicensed care homes, as they are known to occur in licensed care facilities as well, future research might examine and describe the mechanisms states use to detect, investigate, and resolve allegations of abuse or neglect in unlicensed residential care homes and how they compare to the mechanisms used to identify and resolve instances of abuse and neglect in licensed care homes. Residents in need of medical assistance such as nursing care can pay for such care from an outside provider, and the facility does not have to be licensed as "assisted living." Although this regulation reduced the number of legally unlicensed care homes and reduced their capacity to three or fewer residents, many key informants in Pennsylvania noted that this had the unintended consequence of spurring many more illegally unlicensed care homes to open. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. These local and regional offices--as well as ombudsmen and other national, state, and local advocacy groups--receive complaint calls from a variety of sources including residents' family members; members of the general community such as neighbors or other providers; and medical and service providers (e.g., hospital or clinic doctors, nurses, social workers) who interact with residents inside and outside of unlicensed homes. Unlicensed Contractors Beware Propietarios Alerta Alerta a Contratistas Sin Liencias Contractors FAQs About Price Gouging in California Forms to continue your business after disaster: Order New Wall Certificate, Pocket License, or to Change Your Address Order New Form to Renew Your Contractors' License Media However, in Allegheny County, key informants stated that locally the regulation is interpreted and applied differently, and that a Dom Care facility could not have more than three residents total, regardless of the case mix or payment mix. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. With regard to recruiting residents from hospitals, we also heard of unlicensed care home operators receiving payments of up to a month's fees from hospitals anxious to discharge the residents to free up hospital beds. In some states, residents can pay for their own personal or medical care in an unlicensed facility. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Interview questions were based on respondent expertise, and were tailored for each respondent. More information exists about licensed RCFs than unlicensed care homes, thus knowledge of the unlicensed care homes is limited. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. Many low-income individuals cannot afford the cost of licensed residential care homes, and some residents exhaust their private funds in licensed facilities and are discharged with no options other than lower cost care homes, some of which may be unlicensed. An oral agreement may be legally binding for short terms of less than one year. Detecting, investigating and addressing elder abuse in residential long-term care facilities. 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. While experts may speculate on changing market dynamics, we do not have a reliable estimate of the unlicensed care home market prior to these policies taking effect, so we do not know what the market would have been without such policies. Although licensed homes were generally depicted by key informants as safer than unlicensed homes, one key informant emphasized that quality of care is not contingent on licensure status; licensed homes may also have health and safety concerns. The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. The cookie is used to store the user consent for the cookies in the category "Other. Spencer, D., & Mimica, L. (2014). This cost ranges widely based on the geographic region you live in. The North Carolina Mental Health Licensure Office licenses group homes for adults with mental illness.5 These homes also serve two or more adults. Providing unsafe housing conditions, including overcrowding of resident rooms, housing many more residents in bedrooms than is allowed by state licensure regulations, housing residents in storage sheds, basements, and attics that were unsafe, unsanitary, and made egress difficult for frail or disabled residents. A private residence, a care facility or an employer might offer room and board. ALERT If you have a contract with an unlicensed individual and wish to file a complaint, please refer to the section on Filing a Construction Complaint. States with concerns about vulnerable adults' access to housing with services may wish to examine their admission and discharge requirements for licensed care homes. Contact Information: HealthProgram Law Foundation of Silicon Valley 4 North Second Street, Suite 1300 San Jose, CA 95113 INTAKE LINE: 1 (408) 280-2420 Fax: (408) 886-3850 Hours: Monday - Friday 9:00 a.m. - 12:00 p.m., 1:00 p.m. - 4:00, except for major holidays E-mail: healthintake@lawfoundation.org Website: Law Foundation of Silicon Valley 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). For example, in Allegheny County, Pennsylvania, informants noted that the closure of Mayview Psychiatric Hospital in 2008 resulted in the displacement of persons with mental illness. 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. Sanitary conditions of the home must be in good condition at all times. We exist to empower, promote self-advocacy, and make available safe and supportive housing for adults, low income individuals, residents and Behavioral Health Consumers. 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. What is Residential Care for the Elderly? 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. These individuals do not pay taxes, have insurance or bonds. Except for special circumstances, complaints must be filed in writing. 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. Hawes, C., & Kimbell, A.M. (2010). This cookie is set by GDPR Cookie Consent plugin. Strategies for Addressing Issues in Legally and Illegally Unlicensed Care Homes, 3.6. Finally, a peer-reviewed publication by Perkins, Ball, Whittington, & Combs (2004) provides insights into why an operator continues to operate an unlicensed care home. While we were specifically told by two key informants that the LME-MCO can only contract mental health services and supports to licensed group homes, these same key informants also shared specific examples of the LME-MCO unknowingly contracting services to unlicensed group homes. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds; Vermont exempts small private-pay homes. State key informants emphasized that they could not make estimates about the scope of abuse and exploitation issues because unlicensed care homes are not systematically monitored. Each of these factors is discussed in more detail in the sections that follow. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. You do not lose your rights when you enter a residential care or room and board facility. Unlicensed dental assistants are not licensed by the Dental Board of California (Board), but they are subject to certain laws governing their conduct. The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices.