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. Regardless of what they are called, this study focuses on places that provide room and board and sometimes provide personal care to two or more unrelated individuals, but whose operators are not licensed or certified by the state. A landlord must ensure that the room-and-board tenant has access to a working toilet, running water, trash disposal, natural light and proper ventilation for each room. Key informants included representatives from several agencies, including the state Healthcare Facility Regulation (HFR) and APS offices, local fire departments, local and state law enforcement and ombudsmen, and a church-affiliated provider of day services used by individuals who live in unlicensed care homes. Several key informants discussed the role hospitals and hospital discharge planners potentially play in referring patients to unlicensed care homes. The PCRR team shares the complaints they receive about potential illegally unlicensed personal care homes between the AAA, APS, Disability Rights Network, code enforcement and state licensure office. Some states allow them to assist with ADLs, but do not allow them to administer medication. Two interviews were completed with representatives from the Federal Government, seven with representatives from state agencies, three with representatives from policy organizations, one with a representative from a national advocacy group, and four interviewees were researchers knowledgeable about unlicensed care homes. After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. Based on the collective feedback of a diverse group of key informants, unlicensed personal care homes appear to be prevalent and problematic in the state. Key informants described instances of operators making money off of vulnerable residents in a variety of ways that involved theft from residents and theft from government programs. 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.". 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. For many of these individuals, their only option may be unlicensed facilities. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. Are you hunting for a board-and-care facility for a relative? However, unlicensed care homes, which provide room and board and some level of personal care services, but are notlicensed by the state, fill some of the gaps in the availability of housing and services for these populations. 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). 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. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). This cookie is set by GDPR Cookie Consent plugin. Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. Populations in Unlicensed Care Homes. They described this as an example of operators running unlicensed care homes strictly for the money. Another key informant suggested that it would be key to involve the LME-MCO because they cover a four county area and must receive calls that are about unlicensed care homes. 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. The rental agreement can be an oral agreement, periodic rental agreement or lease. Florida can impose fines of up to $1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. 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. PDF Adult Residential Facilities (ARFs) In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. Residents are not adequately fed, meal times may vary, and the nutritional quality of the food served may be poor. In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. This, they fear, could lead owners to operate illegal unlicensed personal homes. 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. None of the reports provided evidence on the prevalence of unlicensed care homes in these states or the magnitude of the issue statewide. CRBC does not maintain licensing or governing authority over the member facilities we recommend. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. The 10 study States were: California, Florida, New Jersey, Oklahoma, and Oregon in the extensive regulatory stratum and . 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). According to reports and state-level investigators, many of the residents in unlicensed homes are living on SSI or Social Security Disability Income. We also heard from nearly all state-level informants that some operators routinely shifted residents from one address to another if an APS worker, other advocate, or potential regulator showed up at the facility asking questions. Monitoring and Improving Quality in Legally Unlicensed Care Homes. Another interviewee suggested that it is becoming more difficult to recruit individuals to be Dom Care operators because of the competing demands on their time. Findings from the interviews suggest that the majority of unlicensed care home residents in the metro Atlanta area have severe and persistent mental illness and are highly vulnerable to exploitation. All key informants described how the Local Management Entity-Managed Care Organization (LME-MCO) oversees the provision of mental health services in Durham County. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. There was not much attention paid to the original sources who identified an unlicensed facility, but in some articles or media reports, the case came to light due to a death that occurred in the facility that had to be investigated, neighborhood complaints of numerous vans, ambulances or police cars at the home, or calls from concerned family members about the status of a resident. This cookie is set by GDPR Cookie Consent plugin. Health, Safety, and Sanitary Conditions. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. Tobia's report (2014) described residents of unlicensed facilities as vulnerable older adults with "hard to place" mental health and paroled individuals who are warehoused. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. 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. 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. As part of this study, we sought to identify potential data sources or listings of unlicensed care homes that may be useful in efforts to understand how widespread unlicensed care homes might be, and whether these settings can be identified for future research purposes, both in the states we visited and in other states. They deny services such as assistance with medication are being provided to residents, or assert they are only providing housing for alcoholics, ex-convicts or people with mental health issues to avoid having to become licensed. Unlicensed contracting is part of California's estimated annual $60 to $140 billion dollar underground economy. However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). PDF Residential Care/Assisted Living Compendium: California - ASPE Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). 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.