The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices. Along with funding to cover relocation of residents, this legislation empowers state and local multidisciplinary teams to collaboratively plan and coordinate efforts to identify, investigate, and pursue any necessary regulatory enforcement or legal action against unlicensed facilities. For example, in Allegheny County, Pennsylvania, informants noted that the closure of Mayview Psychiatric Hospital in 2008 resulted in the displacement of persons with mental illness. Interview findings indicate that a key element of a successful strategy is collaboration across multiple agencies. In addition to the $100 per resident per day fine placed levied against unlicensed facilities, a representative of the state reported that the Georgia legislature has added operating an unlicensed personal care home, which is a criminal offense, to the list of crimes that make it impossible to apply for a license to operate a personal care home. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. In contrast, a key informant stated that complaints of physical and mental abuse are the issues that most often draw attention to unlicensed care homes. In Maryland, licensure is not required for a provider who serves individuals who are dependent on the provider for room, board, and control and security of their medication but do not need assistance with any ADL. Monograph for the National Institute of Justice, U.S. Department of Justice. Currently, 46 states provide some type of SSP (SSA, 2015). Key agencies and team members involved in local or state teams to address unlicensed care homes include APS, ombudsmen, building code enforcement, social workers and first responders such as EMS, police, or firefighters, and other representatives from local advocacy groups such as Disability Rights. As described by all informants, complaint systems are the most common strategy used for a state or locality to become aware of unlicensed care homes. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. One key informant described the selling of residents from an unlicensed care facility located in a house. Having buildings that were infested with bedbugs, other insects, and rodents. 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. 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. Types of Assisted Living Facilities - Texas 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. Key informants were divided in their opinions on the motivations for operating illegally unlicensed personal care homes. However, as recently as 2013, the number had decreased to ten enforcement actions. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. 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. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements/rooms, given buckets for toilets, and had their benefit checks stolen from them (Schneider & Simmons, 2012a; Schneider & Simmons, 2012b; Schneider & Simmons, 2012c). Her e-mail addresses is: Emily.Rosenoff@hhs.gov. A few strategies exist in the state for addressing illegally unlicensed personal care homes. 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). According to several key informants in the state, including APS and law enforcement officials, the property, which they referred to as a boarding home, was being rented by the operator, members of the church served as the representative payees for the residents, and the money was then pooled together and given to the operator. We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes. 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. Three reports are worth noting separately. what is the first step. A facility that advertises or represents via verbal communication that it provides personal assistance is required to make personal services available to its residents. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. Source: 26 TAC 553.5 (c) (1)- (4) 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. (2012). 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. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. (2013). 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. In response, the legislature has appropriated $260,000 to relocate residents identified as living in unlicensed care homes. Positive Actions by States to Improve Oversight of Unlicensed Facilities. 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. Interagency and Multidisciplinary Teams. Benefit), may be available to help pay for room and board. Key informants mentioned that state funding and regulatory mechanisms specific to Pennsylvania had a direct influence on the state's capacity to address illegally unlicensed personal care homes. One key informant estimated that approximately 25 cases are investigated annually, with about half that number determined to be illegally unlicensed personal care homes. In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. Some residents were also described as transitional or homeless, while others were described as persons with substance use disorders. However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. As a result of the newspaper expos, Georgia enacted new stronger laws. Several informants reported that it is common for the operator of an unlicensed care home, or representatives designated by the care home operator, to serve as the representative payee for the residents. endorsement or approval of such websites, products, services or Allegheny County was specifically chosen as the site visit community because of their currently active PCRR team, which continues to address illegally unlicensed personal care homes. Other states also track complaint calls as a means for identifying unlicensed care homes. Typically, the reports refer to physically or mentally disabled adults, some with disease specific conditions, or just described as mentally ill or elderly. One key informant reported that during the investigation of this home, it also was discovered that the operator was taking the residents' food stamps. As noted in earlier sections, many unlicensed care home residents receive federal SSI benefits, and many unlicensed care homes receive these benefits directly through the SSI representative payee program. All About Unlicensed Caregivers in the Home | Relias 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. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. 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). As noted in Section 3.4.1, one SME from an advocacy organization in Pennsylvania noted that they log specific information concerning names and dates into an Excel spreadsheet once a complaint has been lodged against an illegally unlicensed care home. What information exists reflects a concern about the conditions under which residents in these places live. To accomplish this we conducted an environmental scan, including a review of the peer-reviewed and grey literature and interviews with SMEs. the costs of assisted living (personal care homes) or long-term 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. 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. 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. In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect. 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. According to the regulations, some states also allow residential care homes to be legally unlicensed if they have 1-2 beds. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. Tobia, M. (2014). Senior Care & Assisted Living Services South Carolina Assisted Living Facilities, Care Homes, Senior Housing $249,000. Specific concerns raised by SMEs and site visit informants are highlighted in this section. Nevada stated that no interagency procedures were in place to handle complaints about unlicensed board and care homes in a timely and efficient manner (Ryan, personal communication). Findings indicate that a variety of policies may have an impact on the supply of and demand for unlicensed care homes. This was described as limiting the capacity of the resident to relocate. We also heard suggestions from some SMEs and state stakeholders for improving safety and quality. First Responders: EMS, Firefighters, and Police. In one court case, the judge deemed a "boarding house" as an unlicensed residential care home because only three of the six people renting rooms received personal care from the owner's licensed home care agency, even though four actually needed those services. Some SMEs noted that many licensed facilities are unwilling to admit or retain individuals with severe and persistent mental illness, intellectual disabilities, or challenging behaviors.

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