This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. 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. Residential Care Facilities for the Elderly (RCFEs) serve persons 60 and older. As noted in earlier sections, many unlicensed care home residents receive federal SSI benefits, and many unlicensed care homes receive these benefits directly through the SSI representative payee program. 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. 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. These individuals do not pay taxes, have insurance or bonds. Miami Herald. 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. Assisted living provider resources: Unlicensed facilities. Unlicensed Practice. Interviewees had varying opinions on the causes for Dom Care homes closing. Retrieved from http://www.ajc.com. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. 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. In the view of the majority of key informants, the operators of unlicensed homes do not want to have to pay for more staff to provide needed services. Strategies for Addressing Issues in Legally and Illegally Unlicensed Care Homes, 3.6. Our residents include men, women and residents who do not need continual supervision and guidance. . U.S. Department of State, Office of the Under Secretary for Civilian Security, Democracy and Human Rights. However, the individual may have been arrested with no criminal conviction, convicted of a minor traffic offense or adjudicated as a juvenile. However, there were many reports of poor conditions in legally unlicensed care homes. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety, or appropriateness of those other environments. To reduce abuse, several informants indicated that state officials should target closing unlicensed care homes. 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 SMEs and key informants explicitly differentiated between legally and illegally unlicensed care homes only minimally, but the opinion of SMEs and key informants we interviewed seemed to be that state efforts to address legally unlicensed care homes should focus on monitoring and improving quality, whereas state efforts to address illegally unlicensed care homes should be on identifying these homes and shutting them down. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. A 2010 report from the Pennsylvania BHSL noted that enforcement actions against illegal personal care homes had increased from four homes in 2009 to 27 in 2010 (most were located in the Philadelphia area). Between 2012 and 2015, the California legislature enacted several laws that will affect the operation of these facilities. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Advocates reported a growing number of unlicensed facilities and difficulties distinguishing them from boarding homes or other types of RCFs. This cookie is set by GDPR Cookie Consent plugin. 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. Oversight was spread across several agencies and depicted as convoluted and overstretched. 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. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. Primary data collection in 385 licensed and 129 unlicensed board and care homes, including interviews with 490 operators, 1,138 staff, 3,257 residents, and observations of the physical environment and care of residents. 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. If an illegally unlicensed personal care home continues to operate, the state regulatory agency has the authority to take out a warrant on the operator ordering her to cease operations. One key informant in North Carolina indicated that fines for the operation of unlicensed care homes have little impact on closing the homes, are rarely collected, and are not enforceable by their agency because the operation of an unlicensed care home is considered a criminal offense, and thus under the purview of law enforcement. Next, the local group monitoring office or the state would attempt a site visit. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. 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. 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. However, our key informants (including representatives of adult protective services, ombudsmen programs, and police and fire departments) were informed about unlicensed care homes only in response to complaints or emergencies, which may have biased their views of these homes. However, residents may pay for such services or receive them through Medicaid waivers. If ombudsmen become aware of such discharges, they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified. And regardless of whether states have regulations concerning unlicensed homes, many operators choose to operate illegally unlicensed homes. Incentives this modest provide little encouragement for residential care homes to incur the cost of licensure if their primary clientele has only SSI to pay for care. 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. SMEs indicated that such reports can be used to identify unlicensed care home operators. These individuals do not pay taxes, have insurance or bonds. Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. An estimate for another locality in Maryland was much higher, with twice as many unlicensed homes as licensed, or about 1,500 facilities, many of which operate out of single family dwellings (Tobia, 2014). The Pennsylvania BHSL provides specific documentation to potential operators and consumers outlining situations that do not have to be licensed by the state. The following are some examples of financial exploitation depicted during interviews; these examples are discussed at greater detail below: Operators of unlicensed care homes collecting the residents' medications and selling the medications on the street for cash. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. 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: healthintake@lawfoundation.org Website: Law Foundation of Silicon Valley 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. 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. 3.4.4. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. From a county perspective, one ombudsman and housing officer estimated that perhaps there may be less than 20 lawfully unlicensed facilities and less than five illegally unlicensed, however Tobia's team found that there may be as many as 78 unlicensed care homes serving as many as 400 individuals in that county. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. If the facility does not close, law enforcement (not the state licensure offices) fines the illegal operation $50 for the first offense and $500 for each additional offense. What information exists reflects a concern about the conditions under which residents in these places live. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. By interviewing residents of unlicensed care homes, HFR is trying to understand the pathways that individuals take to end up in these situations. One prominent case required more than 40 people in law enforcement and social service agencies to investigate and close a home, find placements for the residents being displaced, and prosecute the violators. Glass, I. Each landlord must adhere to applicable housing laws, based on the type of room and board offered. 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. For example, SMEs indicated that law enforcement investigators have discovered operators of unlicensed homes with scores of electronic cards for food stamp benefits that belonged to current and former residents. Retrieved from http://www.miamiherald.com. (2012a). At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. Based in Los Angeles, Victoria McGrath has been writing law-related articles since 2004. Miami Herald.Retrieved from http://www.miamiherald.com. Complaints can also be received by fax, letter, or email. Some operators use homes that do not meet personal care home building code regulations; for example, the home may lack proper ramps for wheelchair access. Unlicensed care homes are not required by law to open their doors to the state licensure office because the state licensure office does not have the legal authority to enter them. Interviews with key informants also indicate that many residents are poor and receive Supplemental Security Income (SSI) benefits from the U.S. Social Security Administration (SSA); the SSI program pays benefits to disabled adults and children who have limited income and resources. 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. One key informant from Pennsylvania spoke about the difficulty in handling reports of neglect or abuse in legally unlicensed care homes: "we will have repeated incidences, or alleged incidences [at legally unlicensed residential care homes] and we don't report to anyone [any agency or the state] either. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. Potential SMEs were included in the initial listing based on their familiarity with residential care regulations, experience in and research about residential care, experience working with the potential target populations of unlicensed care homes, and knowledge of Medicare and Medicaid payment policies and home and community-based services (HCBS) waiver programs. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. This cookie is set by GDPR Cookie Consent plugin. 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. Operators seizing the residents' food stamps and selling them for cash. For complaints against Health Care Facilities, please contact the California Department of Public Health, Licensing and Certification Division. Retrieved from http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/p_011015.pdf. (2015) Assisted living provider resources: Unlicensed facilities. Find a qualified, certified administrator. This results in different payment streams and different regulatory agencies that have responsibility for different residents in the same residence. These included: (1) tracking individuals' public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. Yes. Residential care homes that are legal often serve as covers for or conduits to illegal homes. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. Media reports described operators with licensed facilities who also operated a series of unlicensed homes in secret. 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. PubMed and other database searches yielded very little literature related to unlicensed RCFs. 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. See http://www.disabilityrightswa.org/stop-fraud-and-abuse-rep-payees. Available at http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Key informants recommended several tactics to address poor quality in unlicensed care homes, but the overall strategy consistently discussed was to shut down these homes.