Once an unlicensed care home is identified, the PCRR team works closely with the both the state and regional licensure offices to take the necessary steps to deal with the home. Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. Key informants also mentioned other resident health concerns including neglect, lack of water, malnourishment, and bed sores or pressure ulcers resulting from inadequate care. 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. After discussions with ASPE, we identified three states and communities within each state as site visit locations: Atlanta, Georgia; Raleigh/Durham, North Carolina; and Allegheny County, Pennsylvania. 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.". Lists of both known illegal and potentially (identified but not yet confirmed) illegal operations are maintained by APS and the local ombudsman who lead the team. Identification of unlicensed care homes is triggered by complaint calls to state or local authorities by community members or family members. 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. For further information regarding the . 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. No Legally Unlicensed Residential Care Homes Are Allowed in Some States. In North Carolina, facilities providing or arranging for housing, food service, and 24-hour scheduled and unscheduled personal care services to two or more unrelated adults must be licensed as an adult care home or a group home. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. The cookie is used to store the user consent for the cookies in the category "Analytics". You must fill out a separate complaint form for each physician or other healthcare provider you wish to file a complaint against. 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. State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. The North Carolina Office for Mental Health Licensure also licenses group homes for adults with developmental disabilities (5600B) and group homes for adults with substance abuse issues or chemical dependency. Regulatory changes and the role of multidisciplinary task forces (which are relevant to both legally and illegally unlicensed care homes) are described next, followed by a summary of the strategies discussed during interviews to identify and shut down illegally unlicensed care homes and to monitor and improve quality in legally unlicensed care homes. Retrieved from http://www.namfcu.net/resources/medicaid-fraud-reports-newsletters. Oversight was spread across several agencies and depicted as convoluted and overstretched. The advocacy agency also collects information about whether the operators own more than one unlicensed care home. Finally, in some states, SMEs and the environmental scan identified legally and illegally unlicensed residential care homes that were referred to as boarding homes or board and care homes. Illegally Unlicensed Residential Care Homes, 6.3. The landlord agrees to accept rent and in exchange gives the tenant exclusive use and possession of the property. The cookie is used to store the user consent for the cookies in the category "Performance". The facilities are homelike environments that offer adult mental health clients and supervised group living experience. In addition, the APS staff in Pennsylvania had recent communications with local hospital discharge coordinators informing them about known illegally unlicensed care homes and asking them not to discharge patients to these settings; however, key informants noted that hospital discharge planners continue discharge individuals to known unlicensed care homes. The frequently reported act whereby the operator of an unlicensed home makes money from their control of vulnerable residents and moves these residents from one unlicensed care home to another to avoid detection, led one SME to refer to it as "human trafficking." Fiscal note, 81st legislative regular session. 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. In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. 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. Landlords and tenants each have different responsibilities to make repairs and keep the room habitable, including the bed clean. All of the key informants shared their perspectives about what is driving the closure of personal care homes. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. 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 2-6-bedroom house that provides shared living accommodations for adults with limited disabilities. Strategies for Addressing Unlicensed Care Homes. One SME pointed out that many unlicensed care home cases are analogous to human trafficking, such as when residents are held against their will and then moved from one location to another to avoid detection; however, the current federal definition of human trafficking specifies that the trafficking is done for the purpose of labor or sex, and not for the collection of public benefits (U.S. Department of State, 2015). 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. One key informant stated this posted information, as well as general education sessions out in the community; for example, in senior centers or nursing homes, leads to some complaints that can generate investigations into personal care homes that may be identified as illegal operations. Staffing levels are not adequate to meet the needs of the residents. We found reports of Medicaid fraud in unlicensed care homes in Florida and Nevada between 2009 and 2014 involving charges of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility (National Association of Medicaid Fraud Control Units, n.d.). See http://www.disabilityrightswa.org/stop-fraud-and-abuse-rep-payees. Referral and Placement Agencies and Discharge Planners. As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. San Jose, California 95112 Toll-Free (800) 248-MHAP Fax (408) 350-1158 Telephone (408) 294-9730 TDD (408) 294-5667 . It is not unusual for them to be involved in other illegal activities as well. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. Monograph for the National Institute of Justice, U.S. Department of Justice. Providers of housing and care services that are licensed by the state, such as nursing homes and residential care facilities (RCFs), serve some of these individuals. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. Licensure agencies in only three (Texas, Alabama, and New Mexico) of the six states studied in the U.S. Department of Justice Report (Hawes & Kimbell, 2010) acknowledged a significant problem with unlicensed facilities. Schneider, C., & Simmons, A. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. 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. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. (2007).Personal care homes in Pennsylvania: A guide for advocates. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. Per the California Registry (California Registry, 2017), "Residential Care facilities operate under the supervision of Community Care Licensing, a sub agency of the California Department of Social Services. If the SSA implements this requirement, it could become a potential source for identifying unlicensed care homes. It is now a misdemeanor to operate an unlicensed RCF. Per one report, the Department of Public Welfare lacks the legal authority to inspect, require plans of correction, or fine these facilities; however, APS can act on referrals of abuse (Pennsylvania Health Law Project & North Penn Legal Services, 2007). Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. 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. In California, when an owner rents property to a resident, this typically creates a landlord-tenant relationship. One of the key informants, who operatesa day program that serves many individuals who are residents of unlicensed care homes, also described the 20 year history surrounding the operation of unlicensed care homes. 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. This website uses cookies to improve your experience while you navigate through the website. With the passage of a new law in July 2012, it is a misdemeanor to operate an unlicensed personal care home, and if an unlicensed care home is linked to abuse, neglect, or exploitation, the violation is considered a misdemeanor. Press Release.Retrieved from http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Treatment of residents as a commodity was a common theme across interviews. The CMHPC's Policy and System Development Committee conducted a brief One interviewee, who interacts with residents of unlicensed care homes on a daily basis, estimated that for every licensed personal care home in Georgia there is one unlicensed care home. 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. Unlicensed care homes commonly will accept these individuals and many market themselves to discharge planners. Several key informants mentioned that hospital discharge planners sometimes discharge patients to unlicensed care homes (described in more detail in Section 4), and as such they might be a potential source for compiling a list of these homes. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". In some states, APS has very limited responsibility and involvement. Consistent with information from the environmental scan, key informant interviews indicate that some unlicensed homes use basements to house residents, including residents who do not have the capacity to exit safely in the event of a fire or similar emergency, such as those who are unable to climb the stairs and those receiving hospice care. State inspection staff, already overwhelmed with large caseloads, are required to obtain warrants to execute searches, a time-consuming process, when trying to follow up on reports of unlicensed homes and determine whether the home is illegal. Of these, three were determined to be unlicensed care homes. In these cases, the hospital reportedly pays the placement agencies a fee to find a personal care home, and the placement agencies also receive monetary incentives from the personal care homes for referrals. Assistant Secretary for Planning and Evaluation, Room 415F Schneider, C., & Simmons, A. In addition to legally unlicensed residential care homes, there are a variety of places that operate illegally. Most of the literature or media reports were not specific about the types of residents served in unlicensed residential care. Few of the investigations focus solely on financial exploitation. As noted by one SME, unlicensed care homes that provide good care and a safe environment may intentionally not be brought to the attention of state agencies nor be reported by these agencies when they learn of these homes: "We do receive reports, about 6 months ago someone wrote to me about their mother who was getting care in an unlicensed homeshe was getting wonderful care, she wasn't going to report it. Safety issues affect local fire departments. 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. In contrast, one key informant stated that one repeat illegally unlicensed facility had housed residents who had thrived there and had benefited from living in the home. Targeted search terms incorporated specific licensure category names for each specific state. 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. 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. Maryland, Mississippi, and the District of Columbia have no minimum bed size for licensure, implying that some residential care homes can be legally unlicensed. Some key informants reported that the living conditions in these places can be subpar. The primary concern expressed about the unlicensed homes that were otherwise safewas that they might not be able to provide the level of care and services needed by the residents (e.g., medication supervision for residents with severe and persistent mental illness). In Pennsylvania informants described a public education campaign including advertisements warning people about placing their loved ones in unlicensed care homes. Demographic trends are placing an increasing number of older persons at-risk for needing residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. Additionally, interviewee discussions revealed a lack of ombudsman involvement in unlicensed care homes, which is another area for future research. From May 2015 through February 2016, Mr. Akinsete operated three unlicensed Room and Board homes in South Sacramento, luring gravely disabled elders and dependent adults into his homes with false promises of medical care, medication dispensing, transportation to and from medical appointments, food, and cleaning. These calls spur investigations that sometimes result in the identification of unlicensed care homes. 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). This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. 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. They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches. 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. Some have residents that receive Medicaid funded services. Indeed, many key informants emphasized that they only knew about unlicensed care homes because of complaints being made about them. For example, one ombudsman report from Florida noted the difficulty in identifying an unlicensed care home due to the quantity and quality of evidence needed to obtain a search warrant in order to enter the home and positively identify a place as providing unlicensed care or housing residents who must be cared for in a licensed facility. In addition to the $100 per resident per day fine placed levied against unlicensed facilities, a representative of the state reported that the Georgia legislature has added operating an unlicensed personal care home, which is a criminal offense, to the list of crimes that make it impossible to apply for a license to operate a personal care home. Many key informants regarded the closing of Mayview State Psychiatric Hospital in 2008, which was located in Allegheny County, as an important factor contributing to the gap of services and affordable housing available for individuals with mental health diagnoses. One key informant suggested that lists of available housing maintained by a local homeless housing assistance program may include illegally unlicensed personal care homes. The environmental scan did not yield peer-reviewed publications or reports about unlicensed residential care in North Carolina. 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. Thus, although our findings consistently highlight concerns about safety and quality, we cannot assess the generalizability of these findings and concerns, and our findings only minimally address unlicensed care homes that are safe and provide quality care. 3.5.4. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. (2015). A local ombudsman in Maryland stated that they had no authority to inspect an unlicensed home and therefore did not have reliable knowledge about whether unlicensed care homes exist, how many individuals are living in such homes or what level of care or assistance those residents needed (Tobia, 2014). Key informant interviews were conducted in three communities across three states: Allegheny County, Pennsylvania; Atlanta, Georgia; and Raleigh/Durham, North Carolina. 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. Texas Legislative Budget Board. Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. Find a qualified, certified administrator. Dont let a bargain price influence your choice. Ombudsmen. Hawes, C. & Kimbell, A.M. (2010). Both the information we collected about unlicensed homes in the literature review and that which we collected through interviews mostly paint a negative view of these settings. SMEs and key informants discussed a number of factors that may have an effect on the supply of and demand for unlicensed care homes. Fourth, study findings also suggest that efforts are needed to understand the differences in conditions between legally and illegally unlicensed care homes, as well as how illegally unlicensed care homes successfully evade licensure. In 2011, only two such warrants were obtained. One potential strategy suggested by an interviewee for proactively identifying unlicensed care homes is to hold community meetings to inform community members about unlicensed care homes, including ways to identify them and how to notify APS and licensure officials if they suspect an unlicensed home operation. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. There were no reports of varying frequencies of unlicensed facilities between urban and rural areas. In essence, unlicensed care home operators have several opportunities for gaining almost absolute control over these residents who are physically, cognitively, and financially vulnerable. She has practiced in the field of financial planning and investment management since 2000. For example, one key informant described a recent case of a representative payee in an unlicensed care home who was not managing a resident's money correctly, by providing food on a specific schedule and not providing it when the resident was hungry and requested food. State and Local Policies Related to the Supply of and Demand for Illegally Unlicensed Care Homes. Interview discussions often touched on the question of how best to identify illegally unlicensed care homes, and key informants noted this as a major challenge. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. If you wish to make a complaint, you may do so here or by phone at 1-855-949-2212. Fraud reports have been filed with the U.S Department of Housing and Urban Development for the misuse of funds to send users from Puerto Rico to unlicensed rehabilitation centers in the United States. Ultimately, several key informants acknowledged and emphasized that remaining unlicensed is lucrative if the care home operator successfully avoids detection by the authorities. We work closely with leaders in the community, case managers, housing referral sources and Community Care Licensing agencies to identify homes that are meeting peer-quality standards and to assist those, who through lack of knowledge and preparation make mistakes that can cause harm to individuals at risk who are dependent on safe, supportive and well-managed Room and Board facilities. Schneider, C., & Simmons, A. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. Some violations may not be cured, such as ongoing illegal activities including drug abuse, abusive behavior or threats of violence. Targeted searches of media reports in states with the lowest percentages (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield a higher number of reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). Multiple key informants spoke about a reduction in the number of Dom Care homes in the state and how this reduction may also give rise to illegally unlicensed personal care homes. Reports of financial abuse include fraud of federal programs, including SSI, Medicare, and Medicaid. Characteristics of Residents and Unlicensed Care Homes. Residents in R&Bs and independent living facilities are able to care for themselves, live independently on a fixed income, and do not need around the clock care or supervision their landlord. Centers for Medicare and Medicaid Services. In the states we visited, a common theme across interviews was that addressing quality in illegally unlicensed care homes tends to focus on shutting down the operations. individuals with serious mental illness who require care and supervision as well as room and board. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. We also heard from nearly all state-level informants that some operators routinely shifted residents from one address to another if an APS worker, other advocate, or potential regulator showed up at the facility asking questions.
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