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. Key informants stated that many illegally unlicensed personal care homes they investigate are being operated by repeat offenders who have done this in the past; these same operators just open new illegally unlicensed personal care homes once they are found out. Moreover, the 1976 Keys Amendment to the Social Security Act requires states to assure that SSI recipients do not reside in substandard facilities, and states must annually certify that this is true. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. 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. Although exploratory in nature, these findings point toward concerning issues with unlicensed care homes as well as gaps in our knowledge, and have important implications for future research on unlicensed care homes. Medication is visible. In other cases, the unlicensed facility simply ignores the law and operates below official "radar.". Maximum employee meal and room costs are established under California Employment Law. Deckhand, Unlicensed. 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). Information from interviews with key informants also revealed incidents of emotional and physical abuse, including intimidation, and threats. 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.". California State Department of Consumer Affairs Homepage is designed to help Californians become informed consumers by learning their rights and protection., portal This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. However, we did not focus on these populations in the interview. This results in different payment streams and different regulatory agencies that have responsibility for different residents in the same residence. Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. That's what they're doing, targeting individuals with cognitive impairment.". First, try to resolve minor concerns or differences with the provider. In contrast, one key informant stated that one repeat illegally unlicensed facility had housed residents who had thrived there and had benefited from living in the home. 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. Miami Herald. In the past few years, Georgia has developed an interagency task force including law enforcement and social services agencies which has trained and prepared many staff to deal with these homes. 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. Other states also track complaint calls as a means for identifying unlicensed care homes. New stringent eligibility criteria for state plans to cover services in group homes serving persons with mental illness have reportedly made it financially difficult for the adult care homes and group homes to continue operating, and some have reportedly been forced to close. Monetary theft of benefits is not uncommon. Of the approximately 1,400 complaints received by APS each year, an estimated 20% pertain to unlicensed personal care homes. Unlicensed contracting is part of California's estimated annual $60 to $140 billion dollar underground economy. In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. Clarifying this definition will be critical to understand the prevalence of unlicensed residential care homes, as well as the characteristics of residents in these homes. 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. 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.". Written complaints may be submitted to the Board's Central Complaint Unit by mail, via fax, or online. Reporters from the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local officials, social service providers, and advocates, and then published a series of articles on the status of affairs in unlicensed residential care homes (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). Complaint calls are received by each participating agency, therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. What concerns are there about the quality of care and safety in unlicensed care homes? One informant suggested research that examines the homeless population and the availability of affordable housing as a way to better understand the environment that may be conducive to supporting unlicensed care home operations. They described this as an example of operators running unlicensed care homes strictly for the money. There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited financial resources. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. Troubled group homes escape state scrutiny. Some state have too few inspectors to detect and investigate allegations about unlicensed homes and too little time and manpower to bring a prosecutable case to the AG's office. Thus, we lack information about unlicensed care homes in moststates, and even in our study states there were no reliable counts of illegal unlicensed care homes. One key informant reported that during the investigation of this home, it also was discovered that the operator was taking the residents' food stamps. The landlord also has an obligation to provide adequate electrical wiring, heating and cooling. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. State regulations govern whether ombudsmen can access and advocate for residents in unlicensed care homes; thus ombudsmen may be limited in their ability to serve on these teams. Submitted to the Governor and the Texas Legislature and the Texas Health and Human Services Commission. After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. Operators forcing the resident to name the operator as the representative payee for government payments, such as SSI, and controlling the use of that money. These cookies ensure basic functionalities and security features of the website, anonymously. 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. "Caretaker" Accused of Abusing and Neglecting Mentally Challenged Victims. 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. This cookie is set by GDPR Cookie Consent plugin. Public funds, like state supplements, are inadequate. Personal board and care homes: A hidden population in Anne Arundel County. This home initially drew the attention of the authorities because of a sexual assault case in which one of the residents was raped by a sex offender. 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. FINDINGS FROM THE ENVIRONMENTAL SCAN, http://www.stopelderabusepetition.blogspot.com/2013_06_01_archive.html, http://www.thisamericanlife.org/radio-archives/episode/554/not-it, http://www.namfcu.net/resources/medicaid-fraud-reports-newsletters, http://www.disabilityrightswa.org/stop-fraud-and-abuse-rep-payees, http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf, http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp, HHS Office of the Assistant Secretary for Planning and Evaluation, Pennsylvania Bureau of Human Services and Licensure, HHS Centers for Medicare and Medicaid Services, Texas Department of Aging and Disability Services, 3.2. Federal government websites often end in .gov or .mil. But there are homes providing room, board, and personal care that either fall outside the bounds of the state licensure requirements or are deliberately avoiding state licensure requirements. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. (n.d.). At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. 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. In this section, we summarize results of the literature review and interviews with SMEs and key informants. One key informant shared a specific case of a repeat offender that operates an unlicensed adult care home out of a double-wide trailer. Further, in site visits and the literature, we found reports of situations that were repeatedly depicted as involving activity that was similar to "human trafficking" and "false imprisonment" of vulnerable individuals. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. We utilized the information obtained in the literature review, in addition to our own expertise, that of our consultant, as well as that of U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the HHS Administration for Community Living (ACL) staff familiar with unlicensed care homes, to develop an initial listing of SMEs to interview. Candidate forums provide an opportunity for the public to learn about the candidates and their views on the issues. It is worth noting that this research activity would require developing an operational definition of "unlicensed residential care home," since definitions vary considerably across and sometimes within states, as some focus on services offered, some on size, and some on the characteristics of the residents. Section 1750.1 is the statute governing the duties that unlicensed dental assistants are allowed to perform. unlicensed room and board californiaatlanta hawks courtside. Potential Data Sources or Listings of Unlicensed Care Homes, 5.3. One key informant estimated this hospital served 3,700 patients at its peak. Residents of unlicensed care homes are vulnerable adults. And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. 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. 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. One woman was marketing heavy to the hospitals, and taking them to the licensed facilities, and then moving them to the unlicensed facilities, in result to those types of facilities. UnCruise Adventures Small Ship Cruising Juneau, AK 1 month ago . We then examined if those percentages might be related to the number of unlicensed care facilities in those states. At least one administrator, on-site manager, or responsible person must be on duty 24 hours per day, seven days a week, and all staff must be trained as personal care workers within 60 days of hire. Florida: A media report stated that in 2012 the licensure agency received more than 200 complaints about unlicensed activity and confirmed 62 were unlicensed--a 60% increase since 2010. Key informants recommended more proactive strategies for identifying unlicensed care homes, such as tracking individuals' benefits (e.g., SSI) to unlicensed care homes, obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them, and utilizing owners of licensed or legally unlicensed facilities as a source of information about illegally unlicensed care homes. In some cases, a tenant who receives room and board is considered a lodger as opposed to a tenant. In 2011, only two such warrants were obtained. In some states, residents can pay for their own personal or medical care in an unlicensed facility. Ombudsmen. Some of these homes are legally unlicensed while others operate illegally. Indeed, several key informants in Allegheny County reported that the closure of Mayview Psychiatric Hospital led to an increase in the prevalence of illegally unlicensed care homes in the county. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). Figueroa, L. (2011). The following sections define illegal contracting and how to report unlicensed activity with the Statewide Investigative Fraud Team (SWIFT). Pennsylvania Department of Public Welfare. Unlicensed assisted living facilities. While experts may speculate on changing market dynamics, we do not have a reliable estimate of the unlicensed care home market prior to these policies taking effect, so we do not know what the market would have been without such policies. 3.4.5. These findings highlight a set of potentially serious problems and issues. Room-and-board facilities typically provide residents with a room, a bed and prepared meals for a set price. The literature review was not an exhaustive effort, but rather a targeted scan of information on unlicensed care homes in the peer-reviewed and grey literature, abuse blogs, and media reports. 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. However, the individual may have been arrested with no criminal conviction, convicted of a minor traffic offense or adjudicated as a juvenile. 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. The regional and state licensure offices are closely involved in this process. Business and Professions Code Section 2052 states that any person who practices or attempts to practice or who advertises or holds him/herself out as practicing any system or mode of treating the sick or afflicted or who diagnoses, treats, operates for or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury or other . The main goal of these efforts is to shut down facilities where residents are financially exploited, abused, neglected, or subject to unsanitary and unsafe conditions. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. These cookies ensure basic functionalities and security features of the website, anonymously. Although these regulatory changes occurred ten years ago, multiple key informants reported that many more licensed personal care homes have continued to close in recent years. Social Security Administration. 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.". Findings from this study are necessarily limited by the number of experts we identified and states we visited. After recommending six states for site visits, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation and the research team selected three communities in three states for on-site visits: Atlanta, Georgia; Raleigh/Durham, North Carolina; and Allegheny County, Pennsylvania. Retrieved from https://www.socialsecurity.gov/ssi/text-benefits-ussi.htm. Although we attempted to conduct interviews with operators of unlicensed care homes on our site visit states, we could not identify or gain access to any. We then asked questions specific to the type of SME, including: What gaps unlicensed care homes may fill in the spectrum of long-term services and supports (LTSS)? 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. Several SMEs also noted inadequate funding and housing options for persons with severe and persistent mental illness or intellectual disabilities who have been moved out of state facilities may contribute to demand for unlicensed care homes, because these individuals may not be able to afford the cost of a licensed care home. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. 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. 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. Retrieved from http://www.thisamericanlife.org/radio-archives/episode/554/not-it. 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. The 2014 annual report for DADS shows that the number of referrals to the AG increased from two to nine for injunctive/other relief and civil penalties. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. The Department of Public Welfare also can take action against boarding homes and similar facilities that house four or more people if they are providing personal care services because they are considered illegally unlicensed. Some trawl for residents, picking residents up off the street, from homeless shelters, and from hospitals, and routinely shift residents from one facility to another in order to keep their occupancy rates high. Two key informants spoke about the lack of oversight of these homes and the concern for the well-being and safety of their residents. The administrator may request any amount he or she can get. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. In the first half of 2013, 37 other unlicensed homes had been identified. Retrieved from http://www.namfcu.net/resources/medicaid-fraud-reports-newsletters. In one court case, the judge deemed a "boarding house" as an unlicensed residential care home because only three of the six people renting rooms received personal care from the owner's licensed home care agency, even though four actually needed those services. Pennsylvania's BHSL and the North Carolina Adult Care Licensure Office and Mental Health Licensure Office will offer to work with unlicensed residential care homes to help facilitate licensure. Anne Arundel County Fire Department, Millersville, Maryland. Further details on findings from the environmental scan can be found in Appendix B. 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. The state made bridge funding available to those group homes impacted by this funding change, but one key informant said that according to a recent report, very few group homes accessed this bridge funding. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Atlanta Journal-Constitution. 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. 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. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. 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. 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). Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit. Regulatory changes and the role of multidisciplinary task forces (which are relevant to both legally and illegally unlicensed care homes) are described next, followed by a summary of the strategies discussed during interviews to identify and shut down illegally unlicensed care homes and to monitor and improve quality in legally unlicensed care homes. Education: Statewide or Interagency. In some states, APS has very limited responsibility and involvement. Retrieved from http://www.state.gov/documents/organization/245365.pdf. 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. Owners of current small licensed personal care homes are also potential sources of information; they will be able to fully describe the monetary costs associated with licensure, and these costs appear to be one reason why some people choose to operate illegally. I have allowed a family member to rent a room from me but we don't have a written rental agreement. Costs for operating a licensed personal care home can include state fees for licensure, structural renovations or changes to meet required building codes, paying for staff to be on-site 24 hours per day, and paying for and providing adequate staff training. The site is secure. 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. County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. 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. Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. They capture key variables such as the name and any aliases of the illegally unlicensed care home; the owner's name and whether they own more than one unlicensed care home; the licensure status (formerly licensed, never licensed, operating illegally); and any relevant information about the complaint (e.g., investigation dates, or dates any residents were moved/relocated). In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. Media and state reports have highlighted homes operating deliberately illegally--that is, they are avoiding required licensure or certification (Tobia, 2014; Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect & Exploitation, 2013).