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. Key informants included representatives from the state licensure office. 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. Based on the information gathered, we determined key criteria for site visit location selection, including having good leads/contacts for identifying key informants in the state, and having geographic variation across states. Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. Interview questions were based on respondent expertise, and were tailored for each respondent. 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: [email protected] Website: Law Foundation of Silicon Valley 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. An official website of the United States government. A separate search of a few state Attorney General (AG) reports of unlicensed RCFs identified six cases of successful prosecutions in New York, Nevada, Florida, and California for operating an RCF without a license--and, in several cases, for gross neglect. Tobia, M. (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. Federal government websites often end in .gov or .mil. Areas for Future Research and Potential Data Sources. Based on our findings, the residents of these homes are extremely vulnerable. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. 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. 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. Her work has been published in the Daily Bruin and La Gente Newsmagazine. Housing by California Room & Board Coalition Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes, 6.4. 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. . Miami Herald. While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. Although some SMEs and key informants provided a few examples of unlicensed care homes where residents receive what they categorized as good care, it appears that abuse, neglect, and financial exploitation of these vulnerable residents is commonplace. ", 3.5.5. Pennsylvania: In 2012, the Secretary of the Department of Public Welfare stated that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly.". The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option, the types of individuals who reside in them, their characteristics including quality and safety and the policies that influence the supply of and demand for these homes. In Pennsylvania counties, a multidisciplinary team called the Personal Care Risk Reduction (PCRR) team helps to address illegally unlicensed care homes; thus we attempted to interview key informants involved in this process. Public funds, like state supplements, are inadequate. You also have the option to opt-out of these cookies. According to key informants from APS and law enforcement, care home operators and residents crossing state borders poses several challenges that make it difficult to ensure the safety of residents and address the criminal activities of the operators. Typically, the reports refer to physically or mentally disabled adults, some with disease specific conditions, or just described as mentally ill or elderly. Our residents include men, women and residents who do not need continual supervision and guidance. Frustrations continue among licensure agencies and advocates with unlicensed care homes, and residents are largely unprotected by licensing agencies (Hawes & Kimbell, 2010). Because of the potential for a large loss of life from fires in these places, comprehensive emergency management planning and practices are reported to be needed to proactively protect those at risk (Tobia, 2014). Find a qualified, certified administrator. They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches. The following acronyms are mentioned in this report and/or appendices. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. Some of these ideas may be relevant for agencies other than or in addition to ASPE, such as the National Institute of Justice, CMS, or ACL. All of the key informants shared their perspectives about what is driving the closure of personal care homes. In fact, these concerns extended across illegally and legally unlicensed homes, and some stakeholders reported these concerns also exist about care being provided in some licensed residential care homes. Additionally, what we heard about the policies that affect demand for and supply of unlicensed homes, and how unlicensed homes can be identified or detected, may not be representative of the situation in other states. Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. 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. Abuse, neglect, and financial exploitation of these vulnerable residents appear common. Connie's Room and Board Independent Living 2 3333 Hickerson Drive San Jose CA 95127 Connie Reyes 408-649-6452 or 408-518-2088 txt conniesroomandboard2 Downtown Independent's [email protected] Home 1188 East Santa Clara St San Jose CA 95112 408-849-8404 Complaints General searchterms included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. One state, Pennsylvania, begins licensure with four beds, but the state has locally certified Dom Care homes that serve 1-3 residents. 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. 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. Unlicensed Room & Boards: These facilities are not licensed or certified by any state or local agencies. 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. 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. In California, many types of facilities offer room and board, including hotels, universities, residential care facilities and privately owned residences. Additional potential research questions or issues were raised by one or more SMEs or arose from our state site visits or the environmental scan. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. Concerns expressed across several interviews included providers locking residents in rooms; locking food away so that it is inaccessible to residents; using basements to house individuals, including individuals who are unable to climb the stairs and those on hospice; providing accommodations that are unclean, infested with bedbugs, and lack heat, air conditioning or running water. He noted that residents with disabilities in unlicensed homes were at risk during fires and natural disasters such as tornados, hurricanes, and severe storms. 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. These individuals do not pay taxes, have insurance or bonds. 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. Retrieved from http://www.miamiherald.com. Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. As described by the majority of key informants, the primary motivation to maintain an unlicensed care home is to maximize profit. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. The research team interviewed 12 key informants in Georgia. Government Owned Pharmacy (PHE) (PDF) Hospital Pharmacy/Drug Room (PDF) Renew Online (HSP/DRM license Only) NOTE: If the facility . One key informant stated that one in four residents of Allegheny County are over age 60, and that this population presents a growing need for affordable residential care homes. 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). This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. It is not unusual for them to be involved in other illegal activities as well. She earned a Juris Doctor from the University of Arizona, College of Law. Monitoring and Improving Quality in Legally Unlicensed Care Homes. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. Anne Arundel County Fire Department, Millersville, Maryland. Medication is visible. These legally unlicensed residential care homes are exempt from licensure because they do not provide 24-hour supervision, though residents may be receiving intermittent skilled nursing care, and help with ADLs, medication administration, and social activities. Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. To accomplish this we conducted an environmental scan, including a review of the peer-reviewed and grey literature and interviews with SMEs. We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. Following the Olympics, funding for these day programs was not renewed, and all but one of these programs ceased operations. New Jersey and Tennessee have a licensure category that specifies the maximum number of beds required for licensure, but not a minimum, which also implies that in these states some residential care homes may be legally unlicensed. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. 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. Cross-state human trafficking is another area for future research. Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. While this may be a promising source of unlicensed homes only in Allegheny County, Pennsylvania, similar tracking mechanisms may be used or developed for use in other communities as well. 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. Troubled group homes escape state scrutiny. 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. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. Understanding Supplemental Security Income SSI benefits, 2015 edition. are room and board licensed in california? Report on Texas boarding houses. 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. Residents who are unable to climb stairs may be housed in a basement or on a second story without access to an elevator. Each landlord must adhere to applicable housing laws, based on the type of room and board offered. 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 of California. Licensed Care Home Admission and Discharge Policies, http://www.agingavenues.com/topics/assisted-living-facilities-in-indianapolis-indiana, https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition, 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, http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf, https://aspe.hhs.gov/report/medicaid-residential-care, http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf, http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/p_011015.pdf, http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926, http://www.phlp.org/wp-content/uploads/2011/03/PCH_manual-for-advocates-Feb-20071.pdf, https://www.socialsecurity.gov/ssi/text-benefits-ussi.htm, http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html, http://www.dads.state.tx.us/providers/alf/howto.html, http://www.state.gov/documents/organization/245365.pdf, APPENDIX B. The new regulations were implemented to monitor and provide oversight of personal care homes with four or more residents, while reducing the number of homes that legally did not require licensure.