Although we heard about a range of conditions in illegally unlicensed homes, including neglect, abuse, and financial exploitation, it is unclear whether this is the norm or whether the findings are skewed because of the types of key informants we interviewed. *Z Both states use a penalty system to fine operators for illegal operations. Complaints can also be received by fax, letter, or email. (n.d.). She had on the same clothes every day, it was for a week, said Klavinger. Michigan Agency Michigan Department of Licensing and Regulatory Affairs, Bureau of Community Health Systems, Adult Foster Care and Homes for the Aged Licensing Division Contact Ashley Harris E-mail HarrisA29@michigan.gov Phone (866) 856-0126 or (517) 284-9700 Key informants also noted that unlicensed care homes may serve mixed populations within the same home (e.g., elderly residents as well as individuals with severe and persistent mental illness). In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. Having buildings that were infested with bedbugs, other insects, and rodents. Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. Additionally, agencies such as The National Disability Rights Network's Protection and Advocacy Agency (NDRN P&A) could potentially use representative payee data to identify unlicensed care homes. Maryland, Nevada, and Florida: The National Ombudsman Reporting System noted an increase in unlicensed care homes in these states, but no unlicensed care reports from any state provided evidence on the prevalence of unlicensed care. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. However, several SMEs and key informants noted that some unlicensed care homes are good and provide a clean, safe environment for individuals who might otherwise be homeless. 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. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements/rooms, given buckets for toilets, and had their benefit checks stolen from them (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds, noting that Vermont, like Massachusetts, exempts small private-pay homes. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. 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. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. Some states allow them to assist with medication storage but not with ADLs. In Michigan, a group home must be licensed if the owner receives compensation for providing personal care, supervision, and protection, in addition to room and board to people who are. In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. A Homes for the Aged (HFA) provides 24-hour room, board, and supervised personal care to: 21 or more unrelated, non-transient individuals 55 years of age or older. Resident Case Mix. (2015) Assisted living provider resources: Unlicensed facilities. Abuse, Neglect, and Financial Exploitation, 3.4. 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. Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). 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. 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. Operators seizing the residents' food stamps and selling them for cash. Fraud reports have been filed with the U.S Department of Housing and Urban Development for the misuse of funds to send users from Puerto Rico to unlicensed rehabilitation centers in the United States. These findings highlight a set of potentially serious problems and issues. 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 the following. One interviewee estimated that licensed personal care homes used to reserve 50% of their beds for individuals who only had SSI benefits and now this amount has decreased to fewer than 25%, leaving SSI recipients with fewer licensed options. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. Education: Statewide or Interagency. This, they fear, could lead owners to operate illegal unlicensed personal homes. Group homes generally charge less than larger assisted living communities, in . In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. Before sharing sensitive information, make sure youre on a federal government site. They also noted that, despite receiving payment for room, board, and services, some unlicensed care home operators provide subpar or poor quality accommodations and services to residents. 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. First Responders: EMS, Firefighters, and Police. 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. Most of the literature we found referenced problems in and the prevalence of unlicensed residential care homes prior to 2009, or addressed abuse and exploitation of adults living in licensed facilities. 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. nmpV[0VM.T1B2L3qHY' w|Z?paTjSy`6GEk1BL67d.VX7dNO!7hj. 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 team conducted brief vetting calls with the second subset of SMEs to determine their appropriateness for an interview; if they were not deemed appropriate, they were asked whether they knew of any other potential interviewees. 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)? State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. In some cases they avoid licensure by holding themselves out as not providing services or housing residents that would require a license under state law. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. 20 or fewer individuals 55 years of age or older that is operated in conjunction with and as a distinct part of a licensed nursing home. What types of reports of mistreatment do the agencies receive? Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes, 6.4. Texas Legislative Budget Board. 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. U.S. Department of Health and Human Services As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. 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. No positive literature was found, which, as noted earlier, may be reflective of the fact that nothing is published about these places unless they are discovered because they are being investigated for poor care or resident exploitation or abuse. 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. Very little was mentioned about elderly residents living in unlicensed homes; only one informant reported that unlicensed adult care homes may serve a mixed population (e.g., elderly residents in addition to residents with mental illness). 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. Presumably, this led to an increase in need for LTSS for these populations. Multiple key informants spoke about a reduction in the number of Dom Care homes in the state and how this reduction may also give rise to illegally unlicensed personal care homes. It is important to learn if such abuses and frauds are limited to a small number of communities or if they are more widespread. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. Specific concerns raised by SMEs and site visit informants are highlighted in this section. The fact that four people should have been receiving personal care services made the home eligible for licensure as a residential care home--not the fact that three people were receiving the services (which would make it under the legal limit). Both the information we collected about unlicensed homes in the literature review and that which we collected through interviews mostly paint a negative view of these settings. https://dev.michigan.local/som/json?sc_device=json. 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. Lists of both known illegal and potentially (identified but not yet confirmed) illegal operations are maintained by APS and the local ombudsman who lead the team. It is now a misdemeanor to operate an unlicensed RCF. 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. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. Locking residents in rooms or chaining the doors at night to prevent residents from leaving the facility, which imprisoned residents and placed them at risk in case of fire. Demographic trends are placing an increasing number of older persons at-risk for needing residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. Klavinger says he was outraged when Glover-Hogan moved Plummer into an unlicensed group home in Warren -- a home that was operating illegally as an Adult Foster Care facility. 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). Group Home: Individuals can choose to reside in a licensed or unlicensed group home with 2-5 other individuals. Intellectual and Developmental Disabilities The monthly rates for I/DD residents are based on a support needs assessment. They can fine the operator directly which may lead to the unlicensed care home being forced to shut down. These local and regional offices--as well as ombudsmen and other national, state, and local advocacy groups--receive complaint calls from a variety of sources including residents' family members; members of the general community such as neighbors or other providers; and medical and service providers (e.g., hospital or clinic doctors, nurses, social workers) who interact with residents inside and outside of unlicensed homes. One interviewee estimated that at its peak, this hospital served 3,700 patients. Savchuk, K. (2013). 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