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EN Some key informants described illegally unlicensed personal care homes as filthy and potentially filled with rodents and insects; they also noted that these homes are unsafe structures that could be condemned. Balancing a rewarding career with the ability to have a high-quality lifestyle is important. According to findings from these interviews, there are a few different pathways into unlicensed care homes, including unlicensed homes receiving residents directly from hospital discharges, representatives of unlicensed homes picking up residents from homeless shelters, and owners of licensed facilities taking residents to unlicensed homes. 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. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. Key informants noted that it is important to know the history of Pennsylvania's personal care home regulation changes in order to understand why and how the state has addressed illegally unlicensed personal care homes. This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. Unlicensed care homes are not required by law to open their doors to the state licensure office because the state licensure office does not have the legal authority to enter them. 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. In addition, investigations by Georgia law enforcement officials indicated that there is considerable fraud with respect to SSI, Social Security, residents' personal needs allowances, Medicare and Medicaid, and the food stamp program. There exists confusion over the authority of other agencies. Many key informants regarded the closing of Mayview State Psychiatric Hospital in 2008, which was located in Allegheny County, as an important factor contributing to the gap of services and affordable housing available for individuals with mental health diagnoses. In Iowa, legislation to restrict the actions of some operators of large licensed assisted living facilities to recategorize or redefine themselves as a "residence," (e.g., boarding home) that does not require licensure was proposed but did not pass. Presumably, this led to an increase in need for LTSS for these populations. 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. Two key informants noted that they only see the worst cases of illegally unlicensed personal care homes, so they could not offer examples of adequate or good care that may occur in those they do not investigate. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. Per state regulations, residential settings providing room, board and personal assistance with three or fewer residents who have at least one personal care need do not meet the requirements for licensure as a personal care home and are legally unlicensed. Findings indicate that a variety of policies may have an impact on the supply of and demand for unlicensed care homes. 2 0 obj If youre interested in a career that allows you to make a difference, check out the state of Michigan career portal for a list of current openings in state government. The group home was unsafe, authorities said. State informants did not provide information on the services provided in the unlicensed care homes stating that that the sample of unlicensed care homes they see is too small to make an accurate approximation of the conditions. So you have a document that you want to show me indicating that its unlicensed, asked Glover-Hogan. 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. Klavinger says his grandmother, 80-year-old Mary Helen Plummer, had lived on her own for years. Hospital discharge planners are not required to check the licensure status of the place to which they are discharging patients, and often discharge them to unlicensed homes. (2011). Clarisse Carter runs Due Season Residential Services LLC, the unlicensed group home in Warren. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. Discussions with key informants in the state suggest Georgia has a high prevalence of these homes. New stringent eligibility criteria for state plans to cover services in group homes serving persons with mental illness have reportedly made it financially difficult for the adult care homes and group homes to continue operating, and some have reportedly been forced to close. Examples of financial exploitation described by key informants include the operator becoming a resident's representative payee and then withholding a resident's money, and pocketing profits while providing inadequate care and services or no services at all. Glover-Hogan said going forward, she will do more research, and she said often when she initially places wards, she does not have access to any of their funds yet, which can make placement extremely difficult. This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. These included: (1) tracking individuals' public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. In some states, residents can pay for their own personal or medical care in an unlicensed facility. Please note a group home for adults may require a Home for the Aged or Adult Foster Care Home license if the level of care provided at the facility meets the licensing requirements of one of these license types, see the Department of Licensing & Regulatory Affairs, Bureau of Community & Health Systems. 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. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. Some state have too few inspectors to detect and investigate allegations about unlicensed homes and too little time and manpower to bring a prosecutable case to the AG's office. Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. AS800397501. Multiple key informants spoke about the significant impact of the closure of this hospital in Allegheny County and the western part of the state as it relates to the possible continued proliferation of illegally unlicensed personal care homes. The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. Pennsylvania: In 2012, the Secretary of the Department of Public Welfare stated that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly.". ", 3.4.2. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. 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. 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. Retrieved from http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. 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. One SME explained that the operators sell the food stamps for cash. Although these complaint systems are not specifically designed to identify and track unlicensed care homes, some states use the complaint systems in this way. In Georgia, informants talked about the Abuse, Neglect and Exploitation Workgroup, which is led by the Georgia Bureau of Investigation and is comprised of individuals from several state, local and federal agencies. According to a six-state study conducted by Hawes & Kimbell for the U.S. Department of Justice (National Institute of Justice) in 2010, when seriously substandard quality, neglect or abuse were discovered in unlicensed facilities, some closed the home in question but shifted residents to other legally or illegally unlicensed care homes to avoid detection or penalties. In the latter state, it was said that unlicensed homes "flourished in the larger cities, particularly those that had significant populations of poor elders and persons with mental illness who had been released from state mental hospitals" (Hawes & Kimbell, 2010). Strategies for Addressing Unlicensed Care Homes. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. As a result, 3,000 individuals with mental illness were transitioned into community-based supported housing. There are three ways to file a LARA report with the State of Michigan. While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. Given the types of key informants interviewed for this study, and the limited viewpoints captured, more information is needed to understand the characteristics of unlicensed care homes and the residents they serve. I'm not going to report it. Miami Herald. Key informants recommended several tactics to address poor quality in unlicensed care homes, but the overall strategy consistently discussed was to shut down these homes. It smelled, she didnt look like her hair was brushed. A house at East Tamara Costa Court where Calvin Leslie, not photographed, was renting it is seen on Wednesday, Dec. 18, 2019, in Las Vegas. 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)? A few interviewees agreed that in cases such as this, the operators are motivated by their desire to care for people; they are just not aware of the licensure requirements. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. 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 licensing rules for Adult Foster Care and Home for the Aged facilities provide minimum standards for these regulated facilities. One example, described by multiple key informants, looked like a nice physical environment and was affiliated with a local church, but the operator of the home was taking the residents' money while abusing, imprisoning, and exploiting them. (2012). 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. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. 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. In addition to legally unlicensed residential care homes, there are a variety of places that operate illegally. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. Retrieved from http://www.state.gov/documents/organization/245365.pdf. Most interviewees reported that the personal care home regulation change in 2005 caused a loss of small personal care homes due to the increased costs associated with meeting the standards set forth in the regulations. In 2012, the Secretary of the Department of Public Welfare noted that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly" (Pennsylvania Department of Public Welfare, 2012). Group homes generally charge less than larger assisted living communities, in . Populations in Unlicensed Care Homes. Licensing is the process by which the Department of Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS) regulates adult foster care group homes. Once an unlicensed care home is identified, the PCRR team works closely with the both the state and regional licensure offices to take the necessary steps to deal with the home. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. Those individuals who remained in the city were placed in day programs. If you want to see if a certain group home is licensed, please click here. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. However, site visit key informants and SMEs we interviewed were unaware of any such lists of unlicensed homes and could not identify existing methods for tracking them. However, according to interview participants, fines have had little impact on closing the homes, as they were often unenforceable and rarely paid. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. Retrieved from http://www.miamiherald.com. However, our key informants (including representatives of adult protective services, ombudsmen programs, and police and fire departments) were informed about unlicensed care homes only in response to complaints or emergencies, which may have biased their views of these homes. As with health and safety concerns, the environmental scan and interviews conducted with SMEs and key informants revealed myriad concerns about abuse, neglect and financial exploitation. 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. Estimates of the number of unlicensed RCFs, as detailed in this report, were in the hundreds in two states: one state estimated more than 200 unlicensed homes in contrast to their 400 licensed facilities; and the other state estimated more than several hundred unlicensed homes but noted there was no reliable count. 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. Boarding homes are allowed to provide the following services beyond room and board: light housecleaning, transportation, money management, and assistance with self-administration of medication, but no personal care service. I dont have anything indicating that that was the case, said Glover-Hogan. 1 0 obj HOUSTON - KPRC 2 recently reported on Blessed Hands Independent Homes, an unlicensed group home operating in southeast Harris County. 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. Although this might not be the case in other states, in this community it appears that rural police may be more helpful than those in urban areas in identifying unlicensed care homes. All of the key informants shared their perspectives about what is driving the closure of personal care homes. SMEs indicated that such reports can be used to identify unlicensed care home operators. (n.d.). There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. Informants said that many local sheriffs and District Attorneys are not supportive of following through to enforce penalties, nor do they press charges against the operators. Each of these agencies is able to address different elements of the complex situations that exist within unlicensed care homes, including the needs of residents, as well as issues with the building and any criminal acts of the operators. 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. By interviewing residents of unlicensed care homes, HFR is trying to understand the pathways that individuals take to end up in these situations. Characteristics of Residents and Unlicensed Care Homes. 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 mentally ill or disabled. From our review of the regulations, we identified that North Carolina likely has legally unlicensed care homes (e.g., boarding homes serving 4-5 residents who do not require 24 hour supervision), and we suspect that illegally unlicensed care homes also exist. Health, Safety, and Sanitary Conditions. Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. Miami Herald. Several states have taken steps in improve oversight of unlicensed facilities, often as a result of newspaper exposs on unlicensed residential care homes. 2. One key informant noted that the state or the LME-MCO can conduct follow-up to assess whether a facility that received a cease and desist letter does, in fact, close down. Other key informants stated that some operators do not want the state regulating or monitoring their business. As discussed earlier, Pennsylvania is a state that legally allows unlicensed residential care homes, if they serve three or fewer individuals. 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. 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). Anecdotal examples of residents wandering outside of their home and onto neighbor's property, which typically generates a complaint call from the neighboring homeowner, were also provided. Barry, R., Sallah, M., & Miller, C. (2011). That makes it difficult for the licensing agencies to understand what's going on because they don't have the information and aren't privy to it.". Interview findings indicate that a key element of a successful strategy is collaboration across multiple agencies. Study findings should be viewed in light of these limitations. Miami Herald. In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. 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. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Of these, three were determined to be unlicensed care homes. 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. 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. (2007).Personal care homes in Pennsylvania: A guide for advocates. They took her dignity from her, they took everything from her, said Peter Klavinger. With regards to the safety of unlicensed care homes, the majority of key informants agreed that the lack of clean and safe housing was a primary safety concern. State and Local Policies Related to the Supply and Demand for Illegally Unlicensed Care Homes. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. 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. State investigators from the Bureau of Licensing and Regulatory Affairs inspected the home in October and found that Carter was violating the law. After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. Hancock, L. (2007). Adult residential licensing, 2010 annual report: A report on licensed personal care homes. 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. Media reports described operators that continued to operate after their licenses expired or were revoked. Interagency and Multidisciplinary Teams. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. Retrieved from http://www.ajc.com. 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