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. Given their direct linkage to unlicensed care homes, these three sources (hospitals, homeless shelters, and licensed personal care homes) are potential sources of information for identifying unlicensed care homes. (2) "Capacity" means that maximum number of persons authorized to be provided services at any one time in any licensed facility. Key informants described the way the teams function. The following acronyms are mentioned in this report and/or appendices. Medication is visible. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. Many key informants noted that regulatory loopholes provided potential ways that operators of illegally unlicensed personal care homes can persist and evade licensure. In the District of Columbia, an ombudsman reported that they were involved in collaborative efforts with University Legal Services, Department of Mental Health, Department of Accountability and other groups, such as APS. However, you may visit "Cookie Settings" to provide a controlled consent. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. Unlicensed care home operators also were described as sometimes having select residents act in a role of authority over other residents, such as beating the other residents to control their behaviors. 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. (2013). Florida publishes a listing of unlicensed homes but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. In Pennsylvania and Georgia, key informants indicated ombudsmen are permitted to make site visits to unlicensed care homes if complaints are received, although access can be denied by the operator. (2004). 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. And regardless of whether states have regulations concerning unlicensed homes, many operators choose to operate illegally unlicensed homes. 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. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. 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. Key informants in all three site visit states provided examples of how this might happen. 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. In another report, a representative of the Arizona Department of Health Services stated that unlicensed assisted living facilities were not a problem because licensed operators monitor the industry and report illegal activity (Arizona Department of Health Services, n.d.). 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. 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. 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). Those individuals who remained in the city were placed in day programs. 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. It is important to note that most key informants did not speak to or have direct experience with very small (1-3 beds) legally unlicensed personal care homes, and therefore could not estimate the prevalence of these types of homes or compare them to illegally unlicensed personal care homes. Key informants noted that the possibility for theft from residents and from government programs also exits with the practice of operators taking control of residents' monthly income from SSA. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. As noted, we found the prevalence of legally and illegally unlicensed residential care homes varies by state. As noted in Section 4.1, states use a variety of definitions or criteria that allow some homes to operate legally without a license. One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. Populations in Unlicensed Care Homes. Characteristics of Residents and Unlicensed Care Homes. (2015). We completed 17 interviews with SMEs. Unlicensed homes tended to flourish in larger cities where there were significant numbers of low-income elderly and people with mental illness released from state mental hospitals. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Moreover, unlicensed care home operators have an opportunity to operate virtually unchecked in terms of seizing control of the residents' government benefits. 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). If you live in an unlicensed Room and Board facility, all California Landlord-Tenant Laws apply to your facility. Unless a specific duty is listed in that regulations, the dental assistant is NOT . document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2021 California Room and Board Coalition, All Rights Reserved. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. . Another safety official stated that their department can keep automated notes on potentially dangerous places, like unlicensed personal care homes, so that if they are called out to a repeat offender, the team on call automatically gets the notes. The SME noted that this approach misses individuals who are representative payees for fewer than 15 individuals and as such may miss operators of small unlicensed residential care homes. Necessary cookies are absolutely essential for the website to function properly. My family member has brought a pit bull puppy onto the property and is keeping in a fenced area. County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. One key informant specifically mentioned a 10% cut to state funding for mental health in 2012 while another key informant mentioned block grants as a potential contributor to lower funding amounts for mental health services and supports. Even with relatively low payment rates, operators can make profits by cutting corners in housing and services and trafficking in the federal benefits they seize from residents. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. Concerns remain that agencies do not have the resources to monitor and follow through with the appropriate actions (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the facility remains closed and has not reopened in another location) for the unlicensed facilities. These cookies track visitors across websites and collect information to provide customized ads. As a result, Pennsylvania enacted a strategy to address the illegally unlicensed care homes, which included providing the Pennsylvania Bureau of Human Services and Licensure (BHSL) the ability to serve warrants and creating the PCRR team mentioned earlier and discussed in the next section. 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. These steps include site visits to suspected illegally unlicensed care homes, during which an ombudsman may inform residents of their rights, APS may conduct abuse or neglect investigations, licensure staff may assess whether the residents should be in a licensed care home based on the level of service needs, and code enforcement staff may determine if the home meets regulatory code requirements. Absent assistance from the ombudsman or other support in finding affordable licensed care options, unlicensed care homes may be the only option these individuals have. Second, the findings highlight the need for federal and state agencies to determine the nature and scope of financial fraud being committed by operators of unlicensed residential care homes. Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. For complaints against Health Care Facilities, please contact the California Department of Public Health, Licensing and Certification Division. Many residents in unlicensed care homes receive SSI, and some residents may qualify for waivers to provide long-term care services in HCBS. For example, a care home with three persons with at least one personal care need might also house three people with personal care needs whose community housing arrangement is covered by the U.S. Department of Veterans Affairs. In either case, while states regulate and provide some level of monitoring and oversight of licensed care homes, state and local oversight of unlicensed care homes can be minimal or non-existent, and these facilities provide questionable care and services. The recent changes to state regulations for community living arrangements are also reportedly becoming more favorable toward independent living, which may lead to an increase in the number of unlicensed facilities. First, try to resolve minor concerns or differences with the provider. Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. Ombudsman programs are not adequately involved. As a resident of a licensed residential care or unlicensed room and board facility, you have all the rights guaranteed by the Constitution of the United States and by the State of California. (2012b). (2015) Assisted living provider resources: Unlicensed facilities. 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. 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. 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. 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). Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. 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. 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. Many interviewees mentioned monetary motivations of operators as one factor. Strategies used to address health, quality and safety issues in unlicensed care homes. Media reports described operators with licensed facilities who also operated a series of unlicensed homes in secret. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. (n.d.). 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. 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. 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. A private residence, a care facility or an employer might offer room and board. Many publications also focused on quality of care or other issues related to unlicensed care staff. 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. Residential care homes that serve three or fewer residents are legally unlicensed in this state. In California, all leases and rental agreements must include an implied warranty of habitability, which means the landlord must make repairs to keep the room livable. There is no regulation covering rates. Schneider, C., & Simmons, A. For instance, they may start by caring for one resident, and gradually take in more individuals without realizing there are state regulations governing homes caring for two or more unrelated adults. From our review of states' regulatory information on licensed residential care categories during the development of the sampling frame for the 2014 National Study of Long-Term Care Providers, and our review of ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy (2015), we found that 30 states require residential care homes to be licensed if they have at least one bed. 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. They noted that some unlicensed care homes provide good care; however, SMEs and other informants consistently reported substantial concerns about neglect, unmet health needs, unsafe and unsanitary conditions, abuse, financial exploitation, false imprisonment, and moving residents to different care homes across communities and states to evade detection. The cookie is used to store the user consent for the cookies in the category "Analytics". Every licensed home must, by regulation, provide care and supervision to its residents. 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. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. 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. Are you hunting for a board-and-care facility for a relative? The information collected as part of this exploratory study was intended to provide a foundation for a more complete understanding about unlicensed care homes and the gaps these homes might fill as housing options for persons with low incomes. One key informant also emphasized that the limited monitoring of legally unlicensed care homes limits the state's ability to identify and subsequently address any issues of quality or safety in these settings. Key informant interviews were conducted in three communities across three states: Allegheny County, Pennsylvania; Atlanta, Georgia; and Raleigh/Durham, North Carolina. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. Several key informants expressed concern about neglect of the health needs of residents because of too few or inadequately trained staff, particularly in regard to the care of residents who have severe and persistent mental illness and need monitoring of their conditions and reactions to medications. It is now a misdemeanor to operate an unlicensed RCF. Unlicensed care homes commonly will accept these individuals and many market themselves to discharge planners. Complaints can also be received by fax, letter, or email. Some legislatures made it a felony to operate an unlicensed care home. 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. 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. However, even with those limitations, we know that in the communities we visited, there were significant health and safety concerns for residents, as well as concerns about financial exploitation and government fraud. Fiscal note, 81st legislative regular session. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. In California, the basic principles of landlord-tenant law apply to room-and-board facilities. Licensure staff only learnabout the unlicensed residential care homes when someone reports them. Overall, key informants were able to provide little information about the prevalence of illegally unlicensed care homes (henceforth referred to as unlicensed care homes); informants we spoke with at both the state, local licensure office and APS reported that they do not currently systematically monitor or track unlicensed care homes. 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. Miami Herald. Multiple key informants discussed the impact that policy changes regarding community-based care have had on unlicensed care homes in their communities, including state efforts to comply with the Americans with Disabilities Act (ADA) requirements. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. 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). The facilities are homelike environments that offer adult mental health clients and supervised group living experience. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state. In some states, residents can pay for their own personal or medical care in an unlicensed facility. Allegheny County was specifically chosen as the site visit community because of their currently active PCRR team, which continues to address illegally unlicensed personal care homes. Potential Data Sources or Listings of Unlicensed Care Homes, 5.3. General searchterms included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. She specializes in intellectual property, copyright and trademark law. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. At the local level, one key informant estimated that members of the Allegheny PCRR, along with the state licensing office, have investigated approximately five illegally unlicensed personal care homes in their specific geographic region over the past two years. She earned a Juris Doctor from the University of Arizona, College of Law. 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. However, the long-term placement of individuals after discharge to an unlicensed care home may be unstable, and no follow-up by the hospital with the patient after placement was described. Policies affecting the supply of and demand for unlicensed care homes. Some key informants noted that EMS personnel are a better source than firefighters to learn about unlicensed care homes in a community because EMS personnel respond to all emergency calls while firefighters do not.