What is the scope of concerns in unlicensed care homes, including quality of care, safety, sexual or physical abuse, and financial exploitation concerns? Assisted living provider resources: Unlicensed facilities. Much of the information we gathered from the environmental scan, from SME interviews, and from site visit informants raises concerns about the conditions experienced by residents in unlicensed residential care homes. 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. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. Site visit locations were based on the information gathered in the environmental scan, SME interviews, and a review of residential care regulations. A six-state study conducted by Hawes & Kimbell in 2010 for the U.S. Department of Justice, National Institute of Justice, found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. This is evidenced by the number of reports and complaints received about unlicensed personal care homes, the number of hours spent by law enforcement officials on investigating unlicensed personal care homes, and the estimates given of the numbers of unlicensed care homes that are operating in the state (reported by one informant as one unlicensed care home for every licensed home). Officials with the Texas Department of Family and Protective Services said they removed 25 people from the home a week ago in the 200 block of FM 723. . Primary Home Care (PHC) | Texas Health and Human Services See http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf. Although the scope of our research was limited--involving a small number of interviews with subject matter experts (SMEs) and interviews with informants in three communities in three states--the findings have relevance for national, state, and local policies and practices and for future research. Properly complete and submit the license application. State and federal government websites often end in .gov. Medicaid Supplemental Payment & Directed Payment Programs, Click here for news, information letters (ILs) & provider letters (PLs), Contact Information for Eligibility Operations Provider Contract Management (PDF), Community Services Regional Contacts for your region, Texas Administrative Code, Title 40, Part 1, Chapter 46: Contracting to Provide Assisted Living and Residential Care Services, Texas Administrative Code, Title 40, Part 1, Chapter 49: Contracting for Community Services, United States Code, Title 42, Chapter 7, Subchapter XIX, 1396, United States Code, Title 42, Chapter 7, Subchapter XX, 1397-1397f, List of Excluded Individuals and Entities, Medicaid for the Elderly and People with Disabilities, HHSC Publishes IL 2022-33 Records Retention and Contact Information After Contract Termination, HHSC Publishes Payment Rates for Residential Care Personal Attendant Services (IL 2022-06), Quality in Long-Term Care 2021 Conference Available Free On Demand, HHSC Publishes Acceptable Documentation for a Criminal History Check for Contractors (IL 2021-48), COVID-19 Vaccine Status Not a Requirement for Services, 2022 Cost Report and 2022 or 2023 Accountability Report Training Information, Contract and Fiscal Compliance Monitoring Implementation of Enhanced Monitoring, Records Retention and Contact Information After Contract Termination, Payment Rates for Residential Care Attendant Services, 2021 Cost Report and 2021 or 2022 Accountability Report Training Information, Acceptable Documentation for a Criminal History Check, Handling of Sensitive Personal Information and Breach Notification, Cost/Accountability Report and 2021 Accountability Report Training Information, 2019 Cost Report and 2020 Accountability Report Training Information, Supervision of/assistance with or direct administration of medication, Information regarding eligibility criteria: contact, Nursing or other services: contact one of the. Personal menus for special diets. 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. 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. 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. To accomplish this we conducted an environmental scan, including a review of the peer-reviewed and grey literature and interviews with SMEs. The Allegheny County PCRR has sent letters to hospitals and their discharge planners informing them about known illegally unlicensed personal care homes to which they should not discharge patients; however, according to two key informants, discharges to these homes have continued. 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. Few of the investigations focus solely on financial exploitation. Having buildings that were infested with bedbugs, other insects, and rodents. Elder Options of Texas - A Home Care & Senior Housing Directory 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. We did not find any report where a government agency was proactive and discovered the case on its own initiative or because of routine monitoring of unlicensed residential care homes. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. These key informants agreed that because discharge planners are under pressure to quickly discharge hospital patients to contain hospital costs, they must have a list of care homes (including licensed and illegally unlicensed personal care homes) that they can reference if the discharge planner has no other option for placement. lists. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. supervision, assistance with activities of daily living and Due to services being brought into these homes, interviewees thought further interviews with home health staff or hospice staff may yield additional information or lists of unlicensed personal care homes that may include illegally unlicensed establishments. rehabilitation and nursing home care. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. The environmental scan did not yield peer-reviewed publications or reports about unlicensed residential care in North Carolina. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. Texas Legislative Budget Board. Because of licensure standard variations, for example, homes that were legally unlicensed in Texas (e.g., adult foster care homes with five or fewer beds) were required to be licensed in California and Oregon. Newspaper and media reports generally focus on what they view as the dramatic; the positive aspects of unlicensed care homes are often omitted from these reports. Since 2009, this business for sale has been serving the senior community and families in the region. 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. Medicare is more often used to pay for a skilled nursing facility 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. Tracking Public Benefits and Representative Payees. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. California, Pennsylvania, Maryland, and Mississippi publish notices of how and where to report unlicensed care homes, which implies that these states may be experiencing problems with unlicensed homes. (2004). 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. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or states. We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limited the scope of our findings. Understanding Supplemental Security Income SSI benefits, 2015 edition. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. This may include the mobile non-ambulatory persons such . One state, Pennsylvania, begins licensure with four beds, but the state has locally certified Dom Care homes that serve 1-3 residents. 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. As a result of the newspaper expos, Georgia enacted new stronger laws. Strategies for Addressing Conditions in Unlicensed Care Homes, 6.1. What types of reports of mistreatment do the agencies receive? 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). Another motivation to operate an unlicensed care home, equally mentioned by key informants, relates to costs directly associated with meeting building code requirements specified in the regulations. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. Operators seizing the residents' food stamps and selling them for cash. Of the approximately 1,400 complaints received by APS each year, an estimated 20% pertain to unlicensed personal care homes. 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. As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. Residential Care | Texas Health and Human Services Based on this information, we chose three states, and subsequently identified three communities within those states, to visit and conduct case studies.2 Following is a summary of the literature, media coverage, and regulations for those three states (Georgia, Pennsylvania, and North Carolina). Types of Assisted Living Facilities - Texas residence most often within a subdivision that provides personal These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. Though outside the scope of our focus, some of the searches also produced media reports and grey literature about concerns in licensed care homes; however, reports about unlicensed care homes and the quality of care described therein was sometimes worse than those for licensed care homes. Strategies to Address Unlicensed Care Homes. One key informant described a recent (2015) case of human trafficking in which a care home operator who was closing a home was explicitly selling residents for $100 each to other personal care home operators. Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential care homes. Finally, as noted later in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or being unnecessarily institutionalized. At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. Of these, three were determined to be unlicensed care homes. Safety issues affect local fire departments. 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. However, while SMEs reported variability in licensure requirements and the authority, responsibility and funding of ombudsmen agencies with respect to unlicensed homes, there is very little information available about legally unlicensed homes, including the characteristics of residents, their care and service needs, and their preferences. Site visit findings were largely consistent with those of the environmental scan, and despite increased attention to unlicensed care homes in some states, key informants highlighted issues of safety, abuse, and exploitation. However, the effectiveness of these strategies in monitoring or otherwise addressing the prevalence of unlicensed care homes is unknown. Interviewees had varying opinions on the causes for Dom Care homes closing. In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect.