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. Residential care homes that are legal often serve as covers for or conduits to illegal homes. As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. States with concerns about quality and safety in unlicensed care homes may also wish to examine their requirements for monitoring legally unlicensed care homes and the information available about safety and quality in these places. Preventing residents from using the bathrooms after a certain time at night and providing buckets for residents to use rather than toilets. 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. Atlanta Journal-Constitution. What information exists reflects a concern about the conditions under which residents in these places live. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified the ten states that spent the highest percentage of their LTSS expenditures on HCBS and the ten that spent the least. Strategies used to address health, quality and safety issues in unlicensed care homes. Troubled Group Homes Escape State Scrutiny. 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. It smelled, she didnt look like her hair was brushed. According to the report, these warehoused residents are vulnerable older adults with "hard to place" mental health needs and paroled individuals. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. 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. 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. Consequently, although we attempted to elicit information about the positive aspects of unlicensed care homes, key informants largely provided us with a less favorable view of unlicensed care homes. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. Instances or allegations of physical and psychological abuse and neglect of residents were reported by SMEs and key informants and highlighted in the environmental scan. State informants did not provide information on the services provided in the unlicensed care homes stating that that the sample of unlicensed care homes they see is too small to make an accurate approximation of the conditions. Also, new HHS Centers for Medicare and Medicaid Services (CMS) policies on waivers and where waiver services may be provided may alter the prevalence of legally and illegally unlicensed care homes across the nation. Licensure staff only learnabout the unlicensed residential care homes when someone reports them. A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. Informants expressed other specific concerns about unlicensed care homes, including improper management of residents' medications; unsafe, unsanitary, and uncomfortable living environments; theft of utilities from neighbors; and fraudulent collection of government payments (e.g., not reporting residents' deaths and continuing to collect their SSI payments). Further, when a licensed facility surrenders its license (or the license is revoked) but it operates as an unlicensed residential care home, regulatory and advocacy agencies no longer have the authority to inspect the facility, unless there is a complaint filed (Tobia, 2014). Efforts are now under way to provide workshops that clarify the new laws about unlicensed care facilities and how law enforcement and other agencies can work together to identify and investigate crimes against at-risk adults and prepare the necessary components for successful prosecutions. In contrast, in North Carolina (and other states not included in our site visits) ombudsmen have no authority in or responsibility for residents in unlicensed care homes according to state regulations. In California, assisted living services can be provided by a licensed home health agency in unlicensed publicly subsidized housing (low-income housing projects, apartment houses, retirement hotels, village models, and private homes). Results of key informant interviews from site visits, as well as the SME interviews and the literature review, are presented in the Findings section that follows. 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. Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). This became evident during discussions with informants in Pennsylvania and Georgia; it has also been reported in the literature, as we found in the environmental scan. States with concerns about the prevalence of unlicensed care homes may wish to examine their licensure regulations, as these may influence the supply of and demand for unlicensed care homes, either because the complexity of some regulations makes them hard for operators to understand, or because they might contain loopholes that operators can easily exploit. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental issues to community-based care settings, such as legally unlicensed care homes. 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. Informants noted that interagency, multidisciplinary teams at state and local levels are imperative to the success of shutting down unlicensed care homes, and to address the various issues involved in such closures, such as meeting the housing and services needs of residents, addressing any criminal behaviors of the care home operators, and ensuring the safety of the house or facility and neighboring properties. An operation needs to be licensed under Act 368 as a home for the aged (HFA) if it provides room and board and supervised personal care to 21 or more unrelated people who are 55 years of age or older; or if operated as a distinct part of a licensed nursing home, can be provided to fewer than 21 residents. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds, noting that Vermont, like Massachusetts, exempts small private-pay homes. However, key informants at the state said that operators of suspected unlicensed care homes usually do open their door for inspection. In the first half of 2013, 37 other unlicensed homes had been identified. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental illness to community-based care settings, such as legally unlicensed care homes. Atlanta Journal-Constitution. At the local level, APS and the ombudsman have informational brochures on their agency websites for the purpose of educating individuals and families about residents' rights. Additionally, several SMEs and key informants noted that in many cases unlicensed homes are the only option, other than homeless shelters or living on the streets, for some of these residents. 4 0 obj 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. Another key informant suggested that it would be key to involve the LME-MCO because they cover a four county area and must receive calls that are about unlicensed care homes. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. 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. Homes for individual residential care are licensed to provide food, shelter, assistance, and supervision for no more than two persons who are aged, . Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. 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. [12] State licensing for your facility is likely only the start of the process. 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. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. An AFC Small Group Home is at least three but not more than 12 residents. We found three cases in Florida of charges against unlicensed RCFs involving allegations of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility; and three cases in Nevada of neglect and/or criminal offenses while operating without a license (one where the accused also operated a licensed facility). State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. Pennsylvania's BHSL is currently working on an amendment to create a graduated fine system for those operators who continue their illegally unlicensed care homes after they have been ordered to cease operations. They deny services such as assistance with medication are being provided to residents, or assert they are only providing housing for alcoholics, ex-convicts or people with mental health issues to avoid having to become licensed. How do states address unlicensed care homes, and if states or other organizations maintain lists of unlicensed care homes (legal or illegal)? Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. endobj However, key informants emphasized that in some cases,the residents become tethered to the operators through financial exploitation and emotional manipulation, and as a result are unable to leave these abusive and exploitative situations. 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.". Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. 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