8 signs you've found an unlicensed board and care home 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. Fact: Room and Boards (R&Bs) are similar to independent living facilities due to the business setup by the owner which may be a privately-owned or operated 26-bedroom house that provides shared living accommodations for adults with limited disabilities. All of the key informants shared their perspectives about what is driving the closure of personal care homes. The landlord agrees to accept rent and in exchange gives the tenant exclusive use and possession of the property. Retrieved from http://www.dallasmorningnews.com. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. All states license residential care such as assisted living, and most states license small adult care homes, often referred to as adult foster care (Carder, O'Keeffe, & O'Keeffe, 2015). In Pennsylvania, one key informant noted that this assistance is given only to those operators who have opened their first illegally unlicensed care home without realizing they needed to be licensed; assistance is not provided for those who are repeat offenders. Three-bed residential care homes are lawfully allowed in at least one state. Two of our three site visit states aimed to enhance awareness of poor and inadequate unlicensed care homes by increasing education for the public and key stakeholders: Pennsylvania held a statewide education and marketing campaign to inform the public about unlicensed care homes, and Georgia conducted training sessions to educate law enforcement and first responders about these homes. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. We found little published information about unlicensed residential care homes; in fact, the scan revealed that most of the literature about conditions in RCFs covered licensed residential care or were about unlicensed care staff. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging. As a result of the newspaper expos, Georgia enacted new stronger laws. Other issues were identified during the subsequent sexual assault investigation, including abuse at the hands of the operator who beat the residents, false imprisonment in which individuals were locked inside rooms, and financial exploitation. We will however, treat all complaints with respect and make every effort to address concerns in a timely fashion providing written findings, conclusions, or next step recommendations to resolve the issue brought to the attention of our staff. Retrieved from http://www.ajc.com. That's what they're doing, targeting individuals with cognitive impairment.". Assisted Living Facilities in Indianapolis, Indiana. In addition, the APS staff in Pennsylvania had recent communications with local hospital discharge coordinators informing them about known illegally unlicensed care homes and asking them not to discharge patients to these settings; however, key informants noted that hospital discharge planners continue discharge individuals to known unlicensed care homes. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. 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. Media reports described operators that continued to operate after their licenses expired or were revoked. The Pennsylvania BHSL provides specific documentation to potential operators and consumers outlining situations that do not have to be licensed by the state. Some key informants described frustration with the lack of monitoring and lack of jurisdiction by the licensing offices to access or track legally unlicensed care homes. Retrieved from http://www.ajc.com. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). Currently human trafficking is defined as "the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts" (U.S. Department of State, 2015), however, one SME recommended expanding this definition to include the situation in which an administrator for the unlicensed care homes seize and maintain control of vulnerable individuals in order to maximize revenue by taking the public benefits that the individual may be receiving. The frequently reported act whereby the operator of an unlicensed home makes money from their control of vulnerable residents and moves these residents from one unlicensed care home to another to avoid detection, led one SME to refer to it as "human trafficking." Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. While many key informants stated that illegally unlicensed personal care homes primarily serve adults with a wide spectrum of mental health disorders, they also noted that some of the residents in unlicensed care homes are frail and elderly individuals. In 2011, only two such warrants were obtained. 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. I'm not going to report it. 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.). California state housing laws establish regulations for hotels, apartment houses and other facilities that provide room and board. In 2012, the state mandated that large adult care homes (seven or more beds) housing only individuals with mental illness had to close because they were considered institutional settings. Anne Arundel County Fire Department, Millersville, Maryland. First, try to resolve minor concerns or differences with the provider. 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. While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. 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. Those individuals who remained in the city were placed in day programs. In more extreme cases, other personal care homes have stopped accepting any persons whose sole source of income is SSI. 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. However, we did not hear any specific examples of this from the state or local level. Theft of government benefit checks (e.g., SSI, Social Security, food stamps, Medicaid, veteran's checks) was common, with one case in which operators diverted more than $790,000 to themselves. Called shelters, rooming houses, sober homes, they have names like Home Sweet Home, House of Joy and Nurse's Loving Heart. Texas and Georgia had numerous cases of unlicensed homes in deplorable conditions: infested with insects, lacking air conditioning or heat, residents sleeping on the floor, faulty wiring, no bathroom access, residents deprived of food or fed scraps, and theft of medications. Because an owner/operator does not provide care and supervision to tenants they are not required to possess a license to operate their facility. 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). For example, one key informant described a recent case of a representative payee in an unlicensed care home who was not managing a resident's money correctly, by providing food on a specific schedule and not providing it when the resident was hungry and requested food. However, key informants told us that often in these cases,the operator may have another building where the residents could be moved. In Allegheny County, key informants said that some hospitals use placement agencies to assist with difficult discharges (e.g., persons with severe or persistent mental illness, the homeless, or persons with little money). Costs for bringing the building up to code to meet state regulatory requirements may be another reason why operators of care homes choose to remain unlicensed. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes, 6.4. Key informants suggested interviewing individuals from other agencies to learn more about illegally unlicensed personal care homes or to obtain potential lists of illegally unlicensed personal care homes. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. This report describes the methods used to conduct the study, summarizes the information learned from an environmental scan and the results from interviews with subject matter experts (SMEs) and site visits, discusses implications of the findings and, based on the study findings, offers recommendations for future research on unlicensed care homes. If the facility is providing licensable services in an unlicensed setting, the state then sends a cease and desist letter, copying the LME-MCO and the local APS. ", 3.4.2. 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. 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. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. Atlanta Journal-Constitution. 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. 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. Positive Actions by States to Improve Oversight of Unlicensed Facilities. The cookies is used to store the user consent for the cookies in the category "Necessary". Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. One key informant indicated that this reduction is due to the increasing numbers of HCBS waivers giving potential Dom Care residents the option to live alone in apartments. By completing a new agreement, changes can be easily identified, and it also establishes a new annual period for when a Room and Board Residency Agreement needs to be completed. This American life, episode 554: Not it! In one state, Pennsylvania, three bed residential care homes are legally unlicensed. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. While no comprehensive nationwide list of unlicensed care homes exists, the environmental scan identified one state (Florida) and one city (Houston, Texas) that maintain listings of unlicensed care homes. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Indeed, results from the National Survey of Residential Care Facilities indicate that only 40% of licensed RCFs admit individuals with behavior problems, and just 55% admit individuals with moderate to severe cognitive impairment (Greene et al., 2013). Despite this lack of information about prevalence, we heard about many strategies for addressing the existence of unlicensed care homes and the conditions in them. This website uses cookies to improve your experience while you navigate through the website. This website uses cookies to improve your experience while you navigate through the website. The site is secure. 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. Key informant interviews focused on local context, state and local policies that may impact or affect the demand for unlicensed care homes, and informants' direct experiences with unlicensed care homes. Unscrupulous care providers are unlikely to obtain the proper licensing and hire qualified staff due to the cost. Having buildings that were infested with bedbugs, other insects, and rodents. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. Through a targeted series of interviews and a scan of the literature, we sought to contribute foundational information about unlicensed care homes. We heard stories from SMEs and site visit informants of operators recruiting vulnerable individuals from psychiatric wards of hospitals, from acute care hospitals through the hospital discharge planners, from homeless shelters, and directly from the street, similar to those we found in media reports (see Appendix B for details). See http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/c_102850.pdf.

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