Three-bed residential care homes are lawfully allowed in at least one state. The Texas Department of Aging and Disability Services (DADS) licenses, certifies and surveys home and community support services agencies(HCSSAs)for compliance with state and federal laws and regulations. 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. These include tapping into fire/EMS databases to identify addresses of care homes that could be unlicensed, and tracking multiple SSI payments that go to a single representative payee at the same address. Key informants described a coordinated effort between the state licensure offices and the local group care monitoring office once there is recognition that a complaint call is about an unlicensed facility. According to one key informant, this illegally unlicensed care home had recently housed a mix of residents and family members, including four related family members (two children and two adults), two persons under the care of a local hospice, and one individual who was receiving methadone treatment. 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. 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. Types of Assisted Living Facilities - Texas However, key informants at the state said that operators of suspected unlicensed care homes usually do open their door for inspection. These legally unlicensed residential care homes are exempt from licensure because they do not provide 24-hour supervision, though residents may be receiving intermittent skilled nursing care, and help with ADLs, medication administration, and social activities. 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 many residents of unlicensed care home are Supplemental Security Income (SSI) beneficiaries. Texas Legislative Budget Board. in mind that in Texas they are licensed according to size, type and custodial or intermediary care. What populations do unlicensed care homes serve? with the activities of daily life (such as bathing, eating, What information exists reflects a concern about the conditions under which residents in these places live. As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. Troubled residents languish in flophouses. One-bed and two-bed residential care homes are lawfully allowed in several states. month; with dementia care costing Resident Case Mix. Living in a residential care home is often half the cost of Thus, unlicensed care homes close and leave one area of the city, but reopen in another area, contributing to the difficulty of identifying and permanently shutting down these places, while also disrupting the residents' access to day services and other community-based sources of support nearby the original care home location. This Isabel's Place Private Care Home - Senior Care, Private Care Home Findings from the environmental scan highlighted issues of safety, abuse, and exploitation in unlicensed care homes; however, the source material, including media reports, tend to highlight negative and sometimes sensational stories, which may or may not represent the norm in unlicensed care homes. SMEs indicated that such reports can be used to identify unlicensed care home operators. Cross-state human trafficking is another area for future research. While it is outside the scope of this project to investigate alternatives to unlicensed care homes, we speculate that increasing the supply of alternatives for affordable housing with services would reduce the market for unlicensed 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. in addition to private funds other programs such as the Veterans Aid and Attendance Benefits program may be available to help pay for room and board. Key informants in two states confirmed that some hospitals there contract with placement agencies that, in turn, place individuals in unlicensed care homes, particularly individuals with limited resources and mental health issues. Education: Statewide or Interagency. 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. care facilities. We also heard suggestions from some SMEs and state stakeholders for improving safety and quality. In Pennsylvania counties, a multidisciplinary team called the Personal Care Risk Reduction (PCRR) team helps to address illegally unlicensed care homes; thus we attempted to interview key informants involved in this process. 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. We completed 17 interviews with SMEs. Third, the findings suggest it is important to determine the nature and scope of abuse neglect and unsafe conditions experienced by people who have low incomes and physical and intellectual or cognitive disabilities. 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 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 strategy recommended by key informants to address unlicensed care homes is to change the regulations to reduce the number of unlicensed care homes that operate legally. Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. Those individuals who remained in the city were placed in day programs. Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. According to the key informant, these individuals were given one-way bus tickets out of the city under the stipulation that they never return. These findings highlight a set of potentially serious problems and issues. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. Currently at the state level, the primary strategy used in Georgia to identify unlicensed care homes is through complaints, including complaints from neighbors, residents, residents' family members, and hospitals serving residents of unlicensed care homes. Retrieved from http://www.miamiherald.com. We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limit the scope of our findings. 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. One prominent case required more than 40 people in law enforcement and social service agencies to investigate and close a home, find placements for the residents being displaced, and prosecute the violators. 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. Future research examining the role of hospital discharge planners and strategies to prevent discharge to unlicensed care homes appear warranted. Also, the information collected from newspapers, ombudsmen, APS staff, or other agency reports (by their very nature) skew towards negative events. Atlanta Journal-Constitution. Tracking Public Benefits and Representative Payees. Ultimately, several key informants acknowledged and emphasized that remaining unlicensed is lucrative if the care home operator successfully avoids detection by the authorities. Texas: A 2007 media report, outside the scope of this review but important to mention, notes that city officials in Dallas estimated that there were at least 350 unlicensed, unregulated board and care homes that house 2,500 people across the city, and likely there were more than that (Hancock, 2007). One key informant explained how North Carolina regulations restrict ombudsman activity in unlicensed care homes, stating "our structure is pretty clear as far as the accountability," implying that the regulations make ombudsmen unaccountable for residents in unlicensed care homes. In a Type A facility a resident must Media reports described operators with licensed facilities who also operated a series of unlicensed homes in secret. Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes.
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