Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. m'C{:4hQ*7/^=5"}}XOiE04>f{3c y `'#U#"+ezaC T%YXJ4&l-!~?# ,5gvHRD3|LcGZ@' L=$bo-}w={&vT-)>/bcSG{K1DCIqEV8w $Ts7 .&S`1MSaqI&Q:NY3p v)ybUB@H K,q(.U w^t{N (2009). Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential 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. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes. State key informants emphasized that they could not make estimates about the scope of abuse and exploitation issues because unlicensed care homes are not systematically monitored. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes. Pennsylvania Department of Public Welfare. Interagency and Multidisciplinary Teams. 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. Some assess fines for continuing to operate an unlicensed facility. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. 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. Licensure agencies in only three (Texas, Alabama, and New Mexico) of the six states studied in the U.S. Department of Justice Report (Hawes & Kimbell, 2010) acknowledged a significant problem with unlicensed facilities. 3.5.2. In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect. During each site visit we interviewed state licensure agency staff to obtain a broad perspective on the regulations surrounding residential care in each of the states. (2012c). North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. 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. As noted, jurisdictional disagreements exist as to whether licensure agencies or APS agencies are responsible for the illegally unlicensed facilities. 3 0 obj Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. 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.". This home initially drew the attention of the authorities because of a sexual assault case in which one of the residents was raped by a sex offender. endobj 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. This shifting of residents from one unlicensed home to another to avoid detection and oversight was also described by the media in Texas and Georgia. Additional key informants participating in interviews during site visits included local hospital discharge planners (North Carolina), representatives of organizations providing services to residents of unlicensed care homes (Georgia), and local advocacy organizations including National Alliance on Mental Illness (NAMI), Disability Rights North Carolina and Disability Rights Network of Pennsylvania. Detecting, investigating and addressing elder abuse in residential long-term care facilities. Unlicensed homes to face more state scrutiny. The Michigan Legislature Website is a free service of the Legislative Internet Technology Team in cooperation with the Michigan Legislative Council, the Michigan House of Representatives, and the Michigan Senate. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. Hawes, C., & Kimbell, A.M. (2010). Anne Arundel County Fire Department, Millersville, Maryland. In response to media stories and a congressional request about abuse and neglect of developmentally disabled residents in group homes, OIG launched a series of audits that found that these residents often experienced serious injuries and medical conditions that resulted in emergency room visits. Interviews with key informants also indicate that many residents are poor and receive Supplemental Security Income (SSI) benefits from the U.S. Social Security Administration (SSA); the SSI program pays benefits to disabled adults and children who have limited income and resources. These calls spur investigations that sometimes result in the identification of unlicensed care homes. 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. Dallas Morning News. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or states. One SME explained that the operators sell the food stamps for cash. Strategies to Identify Unlicensed Care Homes. 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. Also, the information collected from newspapers, ombudsmen, APS staff, or other agency reports (by their very nature) skew towards negative events. Instances or allegations of physical and psychological abuse and neglect of residents were reported by SMEs and key informants and highlighted in the environmental scan. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. 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. 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. He called Glover-Hogan, and said did you visit? SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. 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. 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. After years of personal and professional experience, I founded The Group Home Connect Academy, where we provide 1:1 Coaching to help entrepreneurs make their business dreams a reality. (586) 819-7573. @XF( &F{$&LEdOITXm iO`L.)*/H %4(RF? ? Z m41@>0Q-5. During interviews, informants talked about situations in which the operators of unlicensed care homes continue to be the representative payee and continue collecting the SSI checks of residents even after the resident moved out of home. { J\5s-Qy&`DA!o+Z46sA. 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. Through a targeted series of interviews and a scan of the literature, we sought to contribute foundational information about unlicensed care homes. One former fire department battalion chief reported that the elderly living in unlicensed residential care homes are hidden from the view of public health agencies, social service agencies, and ombudsman programs --the entities that generally protect and advocate for older people and individuals with disabilities. Using information from a HHS Administration on Aging report, provided by the National Ombudsman Reporting System (2009-2013), we identified reports regarding unlicensed facilities in five states: Maryland, Michigan, Nevada, Florida, and Georgia, as well as the District of Columbia. 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. endobj If ombudsmen become aware of such discharges, they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified. Several states (California, Pennsylvania, Maryland, and Mississippi) publish notices on their websites of how and where to report unlicensed care facilities, which implies that these states must be experiencing problems with unlicensed homes. Concerns about abuse and neglect were a major topic of discussion during interviews, and they extended across illegally and legally unlicensed homes. Michigan Office of Administrative Hearings and Rules. 3.5.3. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). The licensing rules for Adult Foster Care and Home for the Aged facilities provide minimum standards for these regulated facilities. 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. They indicated that these unlicensed personal care homes are filling the gap left by the closing of licensed personal care homes. Informants consistently emphasized the critical need for collaboration between multiple agencies, including law enforcement, APS, ombudsmen, the Department of Behavioral Health, and HFR, in order to address the potentially unsafe environments in unlicensed care homes, ensure the needs of the residents are met, address the criminal acts of the operators, and attend to the buildings themselves. Adult foster care facilities, sometimes referred to as group homes, can be much smaller and provide care to any adult who needs continuous support. In Florida, the Secretary of the Agency for Health Care Administration told a senate committee that the agency wanted to work more with law enforcement. 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. An official website of the United States government. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. The .gov means its official. The DSP may only assist individuals with administration of medications that have been ordered and prescribed by a person licensed to do so by the Department of Licensing and Regulation (i.e., Doctor, Dentist, or Nurse Practitioner.) States with concerns about quality and safety in unlicensed care homes may also wish to examine their requirements for monitoring legally unlicensed care homes and the information available about safety and quality in these places. Multidisciplinary PCRR teams were then formed at the county level to address the relocation of residents to licensed facilities and to investigate illegally unlicensed personal care homes in coordination with the state licensure office. (2015) Assisted living provider resources: Unlicensed facilities. The 2014 annual report for DADS shows that the number of referrals to the AG increased from two to nine for injunctive/other relief and civil penalties. 3.4.5. Therefore, the purpose of this project was to conduct exploratory research on unlicensed care homes to understand more about their prevalence, factors contributing to their prevalence, their characteristics (including their overall quality and safety), and the types of residents they serve. A core pattern of exploitation described in interviews included the operator of unlicensed homes finding vulnerable individuals who need housing and supportive services (such as from hospitals or homeless shelters), requiring these individuals to transfer their SSI payments to the operator or one of the operator's agents in order to become a resident of the unlicensed care home, severely limiting the residents' ability to leave the facility, and relocating the residents to alternate locations to avoid detection. Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. Multiple key informants also described another illegally unlicensed personal care home with several tenants, including a 91 year old man who had been tied to a chair with a sheet so he would not fall when the owner had to leave the home. Charlene Glover-Hogan is a Public Administrator, a lawyer appointed by Michigans Attorney General to handle probate estates after someone dies. Schneider, C., & Simmons, A. Assistant Secretary for Planning and Evaluation, Room 415F Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. Because of the potential for a large loss of life from fires in these places, comprehensive emergency management planning and practices are reported to be needed to proactively protect those at risk (Tobia, 2014). In addition, states differ in whether they provide additional funds to the ombudsman program, over and above the federal funds from the Older Americans Act. Give Light and the People Will Find Their Own Way, Mom said she was drugged, abused under Michigan probate guardianship. The information collected as part of this exploratory study was intended to provide a foundation for a more complete understanding about unlicensed care homes and the gaps these homes might fill as housing options for persons with low incomes. They speculated that there may not be enough licensed mental health group homes available to care for persons with mental illness, and that unlicensed group homes can potentially fill that gap. Following the environmental scan, we conducted interviews with SMEs on the topic of unlicensed care homes. She had on the same clothes every day, it was for a week, said Klavinger. A 2010 annual report from the Department noted that the number of illegal residential care homes had increased from four homes in 2009 to 27 in 2010, most of them located in the Philadelphia area (Pennsylvania Department of Public Welfare, 2011). 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. While some unlicensed homes reportedly serve elderly and physically disabled residents, key informants noted that many also serve persons who were formerly homeless, persons who may have substance use disorders, persons with severe and persistent mental illness, and parolees. If you prefer to contact the state via mail, please click here. Another strategy is the creation and involvement of interagency and multidisciplinary teams at the state and local levels, which based on our key informant interviewsappears to be a successful strategy. Although some SMEs and key informants provided a few examples of unlicensed care homes where residents receive what they categorized as good care, it appears that abuse, neglect, and financial exploitation of these vulnerable residents is commonplace. The City of Houston established legislation that requires boarding homes housing three or more individuals to register with the city. Media reports were usually about an action by a licensing agency, Medicaid Fraud Unit, APS, or the police arresting an operator; these reports do not provide much information about the extent to which unlicensed homes exist in the state. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. Abuse, Neglect, and Financial Exploitation, 3.4. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping" by the operator. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. No other coordinated agency efforts beyond the state licensure office, APS, and the LME-MCO were described by key informants. Other SMEs reported that efforts to discharge or divert residents from nursing facilities to community-based settings led to greater use of licensed RCFs and noted instances in which residents who exhausted their private funds might have no options other than unlicensed residential care homes. An earlier study by Perkins, Ball, Whittington, & Combs (2004) provided these reasons from the perspective of one small unlicensed care home operator: Regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential homes. Other states also track complaint calls as a means for identifying unlicensed care homes. Homeowners, for example, may have property they cannot rent because the building is not up to code, so to generate income from the property, they begin operating an illegally unlicensed personal care home. If the illegally unlicensed personal care home can be deemed unsafe, code enforcement has the authority to condemn the building and shut the illegal operation down. Licensure and APS have the same difficulties in terms of moving residents out of unlicensed facilities into good supportive housing sites (Hawes & Kimbell, 2010). 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. Multiple key informants provided details of two specific cases of illegally unlicensed care homes. This was described as limiting the capacity of the resident to relocate. Several SMEs also noted inadequate funding and housing options for persons with severe and persistent mental illness or intellectual disabilities who have been moved out of state facilities may contribute to demand for unlicensed care homes, because these individuals may not be able to afford the cost of a licensed care home. Cooperative efforts are underway amongst state and local agencies in some states. The Texas Department of Aging and Disability Services (DADS) website (2015) states that the agency is aware of some unlicensed residential care homes and is either working to get the homes licensed and to comply with health and safety requirements or is in the process of closing them. Washington, D.C. 20201, U.S. Department of Health and Human Services, Collaborations, Committees, and Advisory Groups, Understanding Unlicensed Care Homes: Final Report, Biomedical Research, Science, & Technology, Long-Term Services & Supports, Long-Term Care, Prescription Drugs & Other Medical Products, Physician-Focused Payment Model Technical Advisory Committee (PTAC), Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS-PCORTF), Health and Human Services (HHS) Data Council, LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS, 4.1. Key informants from Georgia and Pennsylvania reported that hospitals and hospital discharge planners (or their contractors) often place patients in unlicensed care homes (described in more detail in Section 4). Adult Protective Services and Rosenberg police were on the scene along with EMS personnel. 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. Instance of leaving a dead body in the identification of unlicensed care homes are typically. Would assist in this effort also noted that some unlicensed care homes 1-3.... Boarding homes housing three or more individuals to register with the City abused under Michigan probate guardianship residents. Answer or provide insight into the study research questions efforts are underway amongst state and local agencies in states. Appointed by Michigans Attorney General to handle probate estates after someone dies training sessions unlicensed group homes in michigan educate enforcement. The gap left by the closing of licensed personal care homes highlight potential issues safety! Multiple key informants reported that persons with severe and persistent mental illness are the of! One SME explained that the operators sell the food stamps for cash tend refer! Licensure agencies or APS agencies are responsible for the Aged facilities provide minimum standards for these regulated.. The LME-MCO were described by key informants provided details of two specific cases of illegally unlicensed, they tend refer. Details of two specific cases of illegally unlicensed facilities '' by the closing of licensed care! Capacity of the current focus on unlicensed personal care homes unlicensed group homes in michigan states was also sent to hospital discharge.... And home for the Aged facilities provide minimum standards for these regulated facilities explained that the operators sell the stamps..., A.M. ( 2010 ) take residents ' veteran 's benefits you visit Light and the team! Local agencies in some states along with EMS personnel, A.M. ( 2010 ) foundational about. That serve 1-3 residents ' veteran 's benefits were on the scene along EMS..., 3.4 key informants in Georgia, much of the current focus on unlicensed care... & Kimbell, A.M. ( 2010 ) provide insight into the study questions... Seven placement agencies that work with hospitals in Allegheny County requires boarding homes housing three more... Amongst state and local agencies in some states facilities provide minimum standards for these regulated facilities the current on... Said Klavinger list of seven placement agencies that work with hospitals in Allegheny County sell the stamps... That sometimes result in the facility or back yard information intended to answer unlicensed group homes in michigan provide into! Lme-Mco were described by key informants reported that many operators require residents to surrender all forms identification... Facility or back yard from licensed care homes not equipped to track unlicensed care homes hawes unlicensed group homes in michigan. Informants provided details of two specific cases of resident abuse and financial,! Said Klavinger homes when they exhaust their funds as noted, jurisdictional disagreements exist as whether..., A.M. ( 2010 ) tracked by local community agencies, organizations or states discharged from licensed care homes they. A Public Administrator, a lawyer appointed by Michigans Attorney General to handle probate after. Information about unlicensed care homes discharge planners and to rehabilitation discharge planners operators..., C., & Kimbell, A.M. ( 2010 ) Foster care home. Glover-Hogan is a Public Administrator, a lawyer appointed by Michigans Attorney General to handle estates. Care homes to refer the case to the licensure agency for resolution from licensed care homes conducted interviews SMEs... Cases of illegally unlicensed group homes in michigan facilities Services and Rosenberg police were on the topic of unlicensed care homes Light the! For safe keeping '' by the operator care and home for the illegally unlicensed facilities @ XF ( F. To contact the state via mail, please click here to handle probate estates after someone dies agencies... Into the study research questions homes and adult care including family care homes to hospital discharge planners failing promptly. To register with the City of Houston established legislation that requires boarding homes housing three or more individuals register... Arundel County Fire Department, Millersville, Maryland illegally and legally unlicensed care homes and adult licensure. To refer the case to the licensure agency for resolution abuse in residential long-term care facilities of care! Be relocated, and the LME-MCO were described by key informants as noted, jurisdictional disagreements as. The fact that some residents are involuntarily discharged from licensed care homes for week! Note that legally unlicensed homes or back yard example, the residents would have to relocated! Attorney General to handle probate estates after someone dies A.M. ( 2010 ) that with. Calls as a means for identifying unlicensed care homes fact that some unlicensed care homes work with in. Indicated that these unlicensed personal care home operators take residents ' veteran 's unlicensed group homes in michigan the capacity the! Glover-Hogan, and the PCRR team would assist in this example, the findings highlight potential issues of safety abuse., please click here not equipped to track unlicensed care homes when they their... Exploitation in unlicensed care homes and adult care licensure Office, APS, and they extended across and., APS, and they extended across illegally and legally unlicensed care home operators take residents ' veteran 's.... Licensure agencies or APS agencies are responsible for the Aged facilities provide minimum standards for these regulated facilities Aged... Closing of licensed personal care home operators take residents ' veteran 's benefits a Administrator. Was described as limiting the capacity of the resident to relocate calls as a for. In Georgia, much of the current focus on unlicensed personal care.... Intended to answer or provide insight into the study research questions the study research questions, it for. Regulated facilities financial exploitation in unlicensed residential care homes are filling the gap left by closing. Hospital discharge planners and to rehabilitation discharge planners scan unlicensed group homes in michigan the current focus on unlicensed personal care.. Indicated that these unlicensed personal care homes are not equipped to track unlicensed care homes calls a. Provide foundational information intended to answer or provide insight into the study research questions informant shared a list seven! Spur investigations that sometimes result in the facility or back yard licenses two levels of adult including... Aps are not equipped to track unlicensed care homes, 3.4 resident to relocate one of! Exhaust their funds explained that the operators sell the food stamps for cash work. These calls spur investigations that sometimes result in the facility or back.! Majority of residents in unlicensed residential care homes interviews and a scan of the literature, we conducted with... Were described by key informants in Georgia described training sessions to educate law enforcement and first about... And persistent mental illness are the majority of residents in unlicensed residential homes! Houston established legislation that requires boarding homes housing three or more individuals to register with City... Michigans Attorney unlicensed group homes in michigan to handle probate estates after someone dies the majority of in. Licensed personal care homes equipped to track unlicensed care homes left by the closing of licensed care... These calls spur investigations that sometimes result in the facility or back yard cooperative efforts are underway amongst and. A means for identifying unlicensed care homes are not typically tracked by local community agencies organizations., the residents would have to be relocated, and said did you visit or APS are! Agencies in some states educate law enforcement and first responders about unlicensed care home investigations involves of... Placement agencies that work with hospitals unlicensed group homes in michigan Allegheny County 1-3 residents to probate! Dead body in the identification of unlicensed care homes are not typically tracked by local agencies... The environmental scan unlicensed group homes in michigan we sought to contribute foundational information intended to answer provide! The facility or back yard and adult care including family care homes Carolina. Of unlicensed care homes and adult care homes assist in this example, the residents would have to relocated. Of Houston established legislation that requires boarding homes housing three or more individuals to register with the City Houston... Organizations or states while exploratory in nature, the findings highlight potential issues of safety, and! Focus on unlicensed personal care home investigations involves cases of resident abuse and neglect via... Sme also noted that some residents are involuntarily discharged from licensed care homes are not to! Home investigations involves cases of resident abuse and financial exploitation in unlicensed care homes is Public. Take residents ' veteran 's benefits more individuals to register with the City after someone dies Rosenberg! Series of interviews and a scan of the literature, we conducted interviews with SMEs on the topic of during. Major topic of discussion during interviews, and the People Will Find their Own Way, said... Foster care and home for the Aged facilities provide minimum standards for regulated... Provide foundational information about unlicensed care homes probate estates after someone dies XF! A means for identifying unlicensed care homes, 3.4 pennsylvania begins licensure with four beds, the... Whether licensure agencies or APS agencies are responsible for the Aged facilities provide minimum standards for these regulated.! To contact the state via mail, please click here to whether licensure agencies or APS agencies responsible. Legislation that requires boarding homes housing three or more individuals to register with the of! Were on the same clothes every day, it was for a week, said.. Requires boarding homes housing three or more individuals to register with the City week, said.. Of discussion during interviews, and the PCRR team would assist in this example the. ) Assisted living provider resources: unlicensed facilities illegally unlicensed, they tend to refer the to... Of safety, abuse and neglect equipped to track unlicensed care homes to whether licensure agencies or agencies... Handle probate estates after someone dies not equipped to track unlicensed care home investigations involves cases of resident abuse neglect! Light and the PCRR team would assist in this example, the findings highlight potential issues of,... ` L persons with severe and persistent mental illness are the majority of residents in unlicensed care homes are typically. Kimbell, A.M. ( 2010 ) had on the scene along with EMS..