In Pennsylvania, facilities providing or arranging for housing, food service, and one or more personal care needs for four or more unrelated adults must be licensed as personal care homes. 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. This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. I do the best I can with what I have, said Glover-Hogan. 3.2.1. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. Financial abuse was the most commonly cited form of exploitation and the fastest growing form of abuse in illegally unlicensed personal care homes. Key informants in all three site visit states provided examples of how this might happen. Boarding homes are allowed to provide the following services beyond room and board: light housecleaning, transportation, money management, and assistance with self-administration of medication, but no personal care service. Monograph for the National Institute of Justice, U.S. Department of Justice. One SME, who works on the Representative Payee Project,4 mentioned that this project only investigates a sample of individuals who are representative payees for 15 or more 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. The base rate is $982.46. Characteristics of Residents and Unlicensed Care Homes. Based on our findings, the residents of these homes are extremely vulnerable. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. The state has also been in the news based on actions resulting from state compliance with the Olmstead decision which has moved adults with mental illness from institutional settings into less segregated settings in the community. The nature of health and safety concerns described by key informants were wide-ranging and often included neglect and the risk of death to residents. 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. Moreover, unlicensed care home operators have an opportunity to operate virtually unchecked in terms of seizing control of the residents' government benefits. Although a substantial amount of information and suggestions about methods of identifying unlicensed care homes came from site visits to communities in three states (Pennsylvania, North Carolina, and Georgia), whether any of these strategies will apply to other states or other communities is unclear. The site is secure. Another state-level key informant was unable to estimate how many calls the agency receives that result in investigations of unlicensed group homes for persons with mental illness. Discussions with key informants in the state suggest Georgia has a high prevalence of these 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 some cases they avoid licensure by holding themselves out as not providing services or housing residents that would require a license under state law. Several key informants discussed the role hospitals and hospital discharge planners potentially play in referring patients to unlicensed care homes. Schneider, C., & Simmons, A. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. In another report, a representative of the Arizona Department of Health Services stated that unlicensed assisted living facilities were not a problem because licensed operators monitor the industry and report illegal activity (Arizona Department of Health Services, n.d.). The environmental scan did not yield peer-reviewed publications or reports about unlicensed residential care in North Carolina. Tobia's report (2014) described residents of unlicensed facilities as vulnerable older adults with "hard to place" mental health and paroled individuals who are warehoused. Web log.Retrieved from http://www.stopelderabusepetition.blogspot.com/2013_06_01_archive.html. Residents of unlicensed care homes are vulnerable adults. 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. Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. <> According to many of the key informants interviewed, hospitals are increasingly under financial pressure to discharge patients to free up beds, which is believed to contribute to the ability of unlicensed care homes to fill beds and stay in business. . 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. 4 0 obj Health, Safety, and Sanitary Conditions. Several key informants expressed concern about neglect of the health needs of residents because of too few or inadequately trained staff, particularly in regard to the care of residents who have severe and persistent mental illness and need monitoring of their conditions and reactions to medications. Not all states license all residential settings with as few as one resident, as Georgia does; therefore many states, such as Pennsylvania, legally allow some unlicensed care homes to operate. Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Residential care homes that are legal often serve as covers for or conduits to illegal homes. 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. Interview findings indicate that many residents of unlicensed care home are Supplemental Security Income (SSI) beneficiaries. Based on this information, we chose three states, and subsequently identified three communities within those states, to visit and conduct case studies.2 Following is a summary of the literature, media coverage, and regulations for those three states (Georgia, Pennsylvania, and North Carolina). 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. Several states (California, Pennsylvania, Maryland, and Mississippi) publish notices of how and where to report unlicensed care facilities, which implies that these states may be experiencing problems with unlicensed homes. Key informants also noted that unlicensed care homes may serve mixed populations within the same home (e.g., elderly residents as well as individuals with severe and persistent mental illness). One issue that remains to be determined is the conditions or criteria by which such places constitute "unlicensed residential care homes." Licensed personal care homes are required to assist with personal services including ADLs and IADLs, and can include supervision of medication administration and provision of social activities, as needed. We conducted an environmental scan primarily focused on information spanning a five year period from 2009 through 2014. She had on the same clothes every day, it was for a week, said Klavinger. The Michigan Legislature Website is a free service of the Legislative Internet Technology Team in cooperation with the Michigan Legislative Council, the Michigan House of Representatives, and the Michigan Senate. . The state's BHSL office also has the legal authority to act as an enforcement agency. Intellectual and Developmental Disabilities The monthly rates for I/DD residents are based on a support needs assessment. In some states, APS has very limited responsibility and involvement. 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. Similarly, by nature of their jobs, many of our interview participants, including APS staff, ombudsmen, police, and fire department personnel, typically hear about care homes when there are complaints or emergencies. Advocates reported a growing number of unlicensed facilities and difficulties distinguishing them from boarding homes or other types of RCFs. Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential care homes. Regardless of what they are called, this study focuses on places that provide room and board and sometimes provide personal care to two or more unrelated individuals, but whose operators are not licensed or certified by the state. Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. For example, in Georgia it recently became a misdemeanor to operate an unlicensed care home,therefore we aimed to speak with law enforcement officials who had been involved in the process of investigating unlicensed care homes. However, as recently as 2013, the number had decreased to ten enforcement actions. Our state services support residents, businesses, and visitors to the Great Lakes state. Identification of unlicensed care homes is triggered by complaint calls to state or local authorities by community members or family members. In the District of Columbia, an ombudsman reported that they were involved in collaborative efforts with University Legal Services, Department of Mental Health, Department of Accountability and other groups, such as APS. Additional key informants for the site visit interviews were selected based on information provided by the SMEs or what we learned from the environmental scan. We targeted site visits in communities that varied according to whether the state: (1) has legally unlicensed care homes; (2) has a list of unlicensed care homes; and (3) ranks among the highest or lowest in HCBS waiver expenditures. Some continue to operate after their license expired or was revoked. This includes bothprescription and over-the- counter medications. While the information herein is not generalizable--it is based on a targeted scan and a limited number of interviews--it does highlight the fact that unlicensed care homes appear to be a problem in at least some states. 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). Some of these places are legally unlicensed, while others operate without a license illegally. Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). Abuse, Neglect, and Financial Exploitation, 3.4. I will guide you on how to start and open your Unlicensed Group Home so you can have a life of freedom to do the things that you want to do and on your own terms. 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.". If you have a story for Heather Catallo, please email her at hcatallo@wxyz.com or call 248-827-4473. State officials have touted group homes as a preferred option, citing cost savings that can be used to fund more community care. 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. 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. https://dev.michigan.local/som/json?sc_device=json. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds; Vermont exempts small private-pay homes. But after a family friend told the Oakland County Probate Court that Plummer was having memory loss, court records show a Judge appointed a Southfield attorney as a co-guardian. The team conducted brief vetting calls with the second subset of SMEs to determine their appropriateness for an interview; if they were not deemed appropriate, they were asked whether they knew of any other potential interviewees. Hospital discharge planners are not required to check the licensure status of the place to which they are discharging patients, and often discharge them to unlicensed homes. The guardian later moved Plummer to a licensed facility, but according to state records, Glover-Hogan still has one ward inside the Warren group home. 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. In general, the FHA provides group homes, their residents and developers with important protection. One was a fairly large ranch style house that accommodates 15-23 individuals at any one time. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. 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. One key informant suggested that lists of available housing maintained by a local homeless housing assistance program may include illegally unlicensed personal care homes. Overall, key informants were able to provide little information about the prevalence of illegally unlicensed care homes (henceforth referred to as unlicensed care homes); informants we spoke with at both the state, local licensure office and APS reported that they do not currently systematically monitor or track unlicensed care homes. [12] State licensing for your facility is likely only the start of the process. 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. Retrieved from http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf. 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. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. 8"r7GrAg 365o){11c>9c)T:/V;Mi/nf>b-agH3z=r+Bb0a^0 XPX;.GbJ\ ^koLs%t)+#&l. (2015). 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. Managing the care needs of low-income board-and-care home residents: A process of negotiating risks. 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. Currently at the state level, the primary strategy used in Georgia to identify unlicensed care homes is through complaints, including complaints from neighbors, residents, residents' family members, and hospitals serving residents of unlicensed care homes. In addition, many unlicensed care homes operate as family businesses in single family dwellings allowing shifting of residents to avoid detection by regulators (Tobia, 2014). For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. What information exists reflects a concern about the conditions under which residents in these places live. During an interview Tuesday, 7 Investigator Heather Catallo shared the Special Investigation Record from the Michigan Department of Licensing and Regulatory Affairs, which oversees Adult Foster Care Facilities. Florida can impose fines of up to $1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). 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. Care must be provided in a private home where the licensee is a permanent resident and household member. 3.4.3. 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. According to key informants, this graduated fine system is intended to be a "bigger hammer" to stop "belligerent repeat illegal operators. In preparation for closing, the operator "turned over the residents to other operators for a fee of $100 per resident.". Sallah, M., Miller. (2012). Three-bed residential care homes are lawfully allowed in at least one state. One SME explained that the operators sell the food stamps for cash. They can fine the operator directly which may lead to the unlicensed care home being forced to shut down. Failed Legislative Efforts to Improve Oversight. Some SMEs noted that many licensed facilities are unwilling to admit or retain individuals with severe and persistent mental illness, intellectual disabilities, or challenging behaviors. 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. But several judges in metro Detroit like to appoint Public Administrators as professional guardians for adults who are considered legally incapacitated.. R For example, is it defined by the services the home offers, the services needed by residents, or the services provided to the residents in the unlicensed care setting. 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. Concerns about abuse and neglect were a major topic of discussion during interviews, and they extended across illegally and legally unlicensed homes. Homes for individual residential care are licensed to provide food, shelter, assistance, and supervision for no more than two persons who are aged, . 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. And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. Few of the investigations focus solely on financial exploitation. Public funds, like state supplements, are inadequate. Key informants were divided in their opinions on the motivations for operating illegally unlicensed personal care homes. Key informants also cited the process of discharging patients from hospitals in Allegheny County as a potential source for linking individuals with illegally unlicensed personal care homes. Audio podcast. We found little published information about unlicensed residential care homes; in fact, the scan revealed that most of the literature about conditions in RCFs covered licensed residential care or were about unlicensed care staff. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. In Illinois, there are several categories of adult group homes: Shared Housing Establishment (SHE) - Residence for 16 persons, at least 80% of whom are age 55 or older. The remainder of this section summarizes findings from interviews with SMEs and site visit key informants, and also includes additional information from the environmental scan. Some legislatures made it a felony to operate an unlicensed care home. The research team completed seven interviews with eight participants that included both state and local community stakeholders. DISCLAIMER: The opinions and views expressed in this report are those of the authors. Neglected to death, part 3: Inspectors find violations at Lauderhill ALFs. Key agencies and team members involved in local or state teams to address unlicensed care homes include APS, ombudsmen, building code enforcement, social workers and first responders such as EMS, police, or firefighters, and other representatives from local advocacy groups such as Disability Rights. Carter applied for a license 11 months ago, but refused to answer our questions about why she was operating the home before being approved by the state. According to reports and state-level investigators, many of the residents in unlicensed homes are living on SSI or Social Security Disability Income. 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. Site visit locations were based on the information gathered in the environmental scan, SME interviews, and a review of residential care regulations. Many interviewees mentioned monetary motivations of operators as one factor. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. 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. Zoning approval is required under the Zoning Enabling Act (2006 PA 110, MCL 325.32016). 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. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. 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. 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. Licensure and APS have the same difficulties in terms of moving residents out of unlicensed facilities into good supportive housing sites (Hawes & Kimbell, 2010). We heard stories from SMEs and site visit informants of operators recruiting vulnerable individuals from psychiatric wards of hospitals, from acute care hospitals through the hospital discharge planners, from homeless shelters, and directly from the street, similar to those we found in media reports (see Appendix B for details). Treatment of residents as a commodity was a common theme across interviews. 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." In addition to the church-affiliated home described above, examples of the types of places where unlicensed homes operate included an old elementary school as well as single family homes in residential neighborhoods. By taking control of the resident's benefits, the operator controls the resident's funds, and should be using those funds for room and board and other beneficiary expenses. Many key informants and SMEs suggested that discharge planners face difficulty placing residents in licensed care homes because these homes often do not accept patients who only have SSI (or otherwise have little money), and they often will not accept individuals with a history of mental illness, substance abuse, or those who are homeless. And concerns described by key informants in the environmental scan, SME interviews and... Notably, reliance on complaints to identify unlicensed care homes. part 3: Inspectors find violations at Lauderhill.! 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