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With one exception--Georgia--the same held true for the ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island, Alabama, Tennessee, Georgia, New Hampshire, Massachusetts, and Delaware. In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. 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. Nevada stated that no interagency procedures were in place to handle complaints about unlicensed board and care homes in a timely and efficient manner (Ryan, personal communication). 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. A review of state regulations around long-term care ombudsmen could reveal gaps and opportunities in how ombudsmen can access and advocate for residents in unlicensed care homes. 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. Also, the information collected from newspapers, ombudsmen, APS staff, or other agency reports (by their very nature) skew towards negative events. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety or appropriateness of those environments. Homeowners, for example, may have property they cannot rent because the building is not up to code, so to generate income from the property, they begin operating an illegally unlicensed personal care home. Government staff lack of respect for the care provided in small residential care homes by non-professional licensed staff. Thus, future research might be warranted to determine the characteristics of residents in unlicensed care homes and whether they differ across legally and illegally unlicensed homes. Abuse, Neglect, and Financial Exploitation, 3.4. Interview questions were based on respondent expertise, and were tailored for each respondent. California State Department of Consumer Affairs Homepage is designed to help Californians become informed consumers by learning their rights and protection., portal To address the issues surrounding quality and safety in unlicensed care homes, key informants described a process involving the investigation of complaints by visiting the home and interviewing residents and staff (which may necessitate getting an inspection warrant if denied entry upon arrival), then providing a written cease and desist letter if the investigation results indicate that the home should be licensed, issuing fines of $100 per day per resident, and prosecuting the operator. Although a coordinated, multidisciplinary effort appears necessary to comprehensively address unlicensed care homes, several key informants discussed the lack of ombudsman jurisdiction to access residents in unlicensed care homes. (2015). ("Independent Living") As a resident of an unlicensed room & board or "independent living" home, you have all of the same rights given to all tenants in California. Austin, Texas. Further, it is the responsibility of the owner to determine whether the home needs a license. 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. We exist to empower, promote self-advocacy, and make available safe and supportive housing for adults, low income individuals, residents and Behavioral Health Consumers. The state has started training sessions to educate law enforcement and first responders about unlicensed care homes, and these education efforts may contribute to the state's ability to identify unlicensed personal care homes. Key informants at the state level were able to provide estimates of the number of complaints they have received pertaining to unlicensed care homes, but not estimates of the number 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). On the other hand, grey literature--that is, reporting databases, blogs, and media reports--produced more results about unlicensed care homes. This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. In Georgia, the number of complaints about unlicensed facilities rose from 253 in fiscal year 2013 to 293 in fiscal year 2014, with at least one-third of claims being substantiated. In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. Operators often gain control of residents' funds by becoming the representative payee for residents receiving SSI, a common payer source in unlicensed residential care homes. State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. This website uses cookies to improve your experience while you navigate through the website. 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. Strategies for identifying and addressing quality in legally and illegally unlicensed care homes appear to differ across states. My family member has brought a pit bull puppy onto the property and is keeping in a fenced area. Each interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. As a direct result of this regulation change, many personal care homes in Pennsylvania became illegally unlicensed and either shut down, became licensed, or continued to operate illegally. If you live on the coast, youll pay a premium; the cost of care as you head inland is usually 25-35 percent lower than in coastal communities. Thus, one implication of the study is that it may be worthwhile in one or more states or communities to test and evaluate other methods of detecting illegally unlicensed care homes. Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. 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. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. 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). 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. Yes. In Texas, when the bill that would have authorized DADs to inspect and license unlicensed residential care homes, legislation was enacted that permitted cities to license RCFs not licensed by the state licensure agency. Notably, the strategy of responding to complaints limits the amount of information available about unlicensed care homes about which complaints are not made (i.e., possibly better quality homes). At least two states have demonstrated that coordinated efforts can effect changes to laws and policies and create at least initial disincentives or barriers to the operation of illegally unlicensed care homes. You also have the option to opt-out of these cookies. While it is outside the scope of this project to investigate alternatives to unlicensed care homes, we speculate that increasing the supply of alternatives for affordable housing with services would reduce the market for unlicensed homes. 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. 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. In the latter state, it was said that unlicensed homes "flourished in the larger cities, particularly those that had significant populations of poor elders and persons with mental illness who had been released from state mental hospitals" (Hawes & Kimbell, 2010). However, while SMEs reported variability in licensure requirements and the authority, responsibility and funding of ombudsmen agencies with respect to unlicensed homes, there is very little information available about legally unlicensed homes, including the characteristics of residents, their care and service needs, and their preferences. In Iowa, legislation to restrict the actions of some operators of large licensed assisted living facilities to recategorize or redefine themselves as a "residence," (e.g., boarding home) that does not require licensure was proposed but did not pass. 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. A phone number is provided if someone has a question about the licensure status of a facility. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. In Allegheny County, key informants said that some hospitals use placement agencies to assist with difficult discharges (e.g., persons with severe or persistent mental illness, the homeless, or persons with little money). 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. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. We also heard suggestions from some SMEs and state stakeholders for improving safety and quality. Schneider, C., & Simmons, A. Her work has been published in the Daily Bruin and La Gente Newsmagazine. Medicaid in residential care. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Atlanta Journal-Constitution. In some cases, the landlord may be an employer and room and board may be part of the employment contract, with room-and-board charges deducted from the employee's paycheck. KCMH currently links clients with approximately 30 homes ranging from 1-21 beds, usually 2 persons/room. We provide innovative and affordable solutions that makes efficient use of existing housing availability, helps preserve the fabric of the neighborhood and can lessen the need for costly care services or long-term institutional care. Failed Legislative Efforts to Improve Oversight. 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. There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. Pennsylvania lists the number of enforcement actions taken against illegally unlicensed residential care homes in their annual report on personal care homes, but this information may not be representative of how many complaints about unlicensed care homes are made (see the state summaries in Appendix A for more details). No. A wide range of specific concerns about unlicensed care homes were identified in this study, including improper management of residents' medications; unsafe, unsanitary, and inadequate living environments; failure to adequately feed residents; and monetary theft of benefits. More recently within the City of Atlanta, the gentrification of some neighborhoods has resulted in increased property values and rents, which has caused some unlicensed care home operations to relocate to less expensive areas. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. By interviewing residents of unlicensed care homes, HFR is trying to understand the pathways that individuals take to end up in these situations. In several cases at both the state and local level, unlicensed facilities were reported to authorities or licensure offices by the operators of licensed facilities. Based on our exploratory research, we found that a number of factors may have an effect on the demand for unlicensed care homes. This website uses cookies to improve your experience while you navigate through the website. 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. Consistent with findings from the environmental scan, stakeholders (including SMEs and site visit key informants in the three communities we visited) repeatedly raised a variety of concerns about neglect of residents' health care needs and unsafe and unsanitary conditions in unlicensed care homes. Three states (District of Columbia, Maryland, and Mississippi) have no minimum bed size for licensure, implying that some residential care homes can be lawfully unlicensed. In essence, unlicensed care home operators have several opportunities for gaining almost absolute control over these residents who are physically, cognitively, and financially vulnerable. 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. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. In Georgia, informants talked about the Abuse, Neglect and Exploitation Workgroup, which is led by the Georgia Bureau of Investigation and is comprised of individuals from several state, local and federal agencies. Some victims later found that their credit had been ruined by someone who illegally used their identity (Glass, 2015). One key informant noted that residents of unlicensed care homes commonly require assistance with activities of daily living (ADLs), such as getting dressed, as well as assistance with instrumental activities of daily living (IADLs), such as taking medications and managing and accessing transportation to medical appointments. 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. 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. Food may be locked away and inaccessible to residents. 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. 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. Having buildings that were infested with bedbugs, other insects, and rodents. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. 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. This section explains how consumers, building officials and legitimate licensed contractors can report unlicensed activity. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. 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 26-bedroom house that provides shared living accommodations for adults with limited disabilities. Adult residential licensing, 2010 annual report: A report on licensed personal care homes. 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. Troubled residents languish in flophouses. 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). We also use third-party cookies that help us analyze and understand how you use this website. Residents lack personal hygiene and are not properly groomed. 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). Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. However, even if the home continues to operate, the fines are rarely enforced or collected. One strategy recommended by key informants to address unlicensed care homes is to change the regulations to reduce the number of unlicensed care homes that operate legally. The advocacy agency also collects information about whether the operators own more than one unlicensed care home. General searchterms included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. Arizona Department of Health Services. The cookie is used to store the user consent for the cookies in the category "Other. Key informants did not offer any information on potential ways to identify unlicensed care homes or existing databases of these places. Anne Arundel County Fire Department, Millersville, Maryland. 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. Treatment of residents as a commodity was a common theme across interviews. 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. A copy of the Room and Board Residency Agreement must be provided to ODP or its In Allegheny County we interviewed key informants from APS, and local ombudsmen and placement coordinators from the local Area Agency on Aging (AAA) who work directly with licensed and unlicensed personal care homes, as well as other staff from a local disability advocacy agency and a local fire department. But opting out of some of these cookies may affect your browsing experience. Key informants described a coordinated effort between the state licensure offices and the local group care monitoring office once there is recognition that a complaint call is about an unlicensed facility. 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. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). Others may require higher rates; these are called private pay homes. (Producer). Room-and-board facilities typically provide residents with a room, a bed and prepared meals for a set price. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. Key informants in metro Atlanta also indicate that the state conducts interviews with residents during investigations and closures of unlicensed home to gain a better understanding of how individuals end up in these homes. This report was prepared under contract #HHSP23320100021WI between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Research Triangle Institute. The California Room and Board Advisory Coalition provides innovative and affordable solutions that makes efficient use of existing housing availability, helps preserve the fabric of the neighborhood and can lessen the need for costly care services or long-term institutional care. State licensure offices primarily depend on complaints via phone calls3 that come first to a local county APS or regional licensure or monitoring office. Sanitary conditions of the home must be in good condition at all times. According to the American Elder Care Research Organization, the average cost of assisted living in 2018 in California is $4,070 per month. Renew Online (PHY license Only) NOTE: If the facility license expired more over one year ago, you are not able to renew your license online. 1600 9th Street, Room 350 Sacramento, CA 95814 (916) 654-3585 . That makes it difficult for the licensing agencies to understand what's going on because they don't have the information and aren't privy to it.". Dont let a bargain price influence your choice. Key informants in all three site visit states provided examples of how this might happen. In Georgia, efforts are now under way to provide workshops for law enforcement that clarify the new laws about unlicensed care homes and how law enforcement and agencies, such as aging and licensure can work together to identify and investigate crimes against at-risk adults and prepare the necessary components for successful prosecutions. 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 facility operators were authorized to make the decision on their own (Tobia, 2014). Anne Arundel County Fire Department, Millersville, Maryland. 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. In the past 15 years, the issues surrounding unlicensed personal care homes in the state have become more prominent, and coordinated action across several agencies has been taken to address them. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. Following the environmental scan, we conducted interviews with SMEs on the topic of unlicensed care homes. If your concerns are still not addressed and you believe that . For example, key informants in Allegheny County, Pennsylvania, stated that police in rural areas of the county are more responsive to reports of unlicensed care homes than are the city police. 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. If you know of unlicensed activity and just want to report it, then you are in the proper section. Monitoring and Improving Quality in Legally Unlicensed Care Homes. And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. However, the effectiveness of these strategies in monitoring or otherwise addressing the prevalence of unlicensed care homes is unknown. North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. In one case well publicized by the media, residents of one unlicensed facility in Pennsylvania were moved between Pennsylvania, Texas, Virginia and Florida to escape law enforcement. 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. The research team interviewed 12 key informants in Georgia. Other states also track complaint calls as a means for identifying unlicensed care homes. 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. What populations do unlicensed care homes serve? 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. 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. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. (2009). Most key informants and SMEs suggested that first responders such as EMS, firefighters, and police are potential sources for identifying unlicensed care homes because they respond to emergency calls received from or about them.