I'm not going to report it. 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. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. Miami Herald. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. Some of these places are legally unlicensed, while others operate without a license illegally. Additional research on unlicensed care homes will be valuable to build our understanding of the role--intended or unintended--of these places in our long-term services and supports systems, and the policies affecting it. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. Furthermore, some key informants noted that some unlicensed homes fail to provide or arrange treatment for residents' conditions in order to avoid bringing the attention of authorities. Key informants included representatives from several agencies, including the state Healthcare Facility Regulation (HFR) and APS offices, local fire departments, local and state law enforcement and ombudsmen, and a church-affiliated provider of day services used by individuals who live in unlicensed care homes. 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. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Emily Rosenoff, at HHS/ASPE/DALTCP, Room 424E, H.H. In Allegheny County we interviewed key informants from APS, and local ombudsmen and placement coordinators from the local Area Agency on Aging (AAA) who work directly with licensed and unlicensed personal care homes, as well as other staff from a local disability advocacy agency and a local fire department. States have a variety of options for reducing the prevalence of both legally and illegally unlicensed residential care homes, such as changing regulations and coordinating across agencies to address these homes. Discussions with SMEs and key informants explicitly differentiated between legally and illegally unlicensed care homes only minimally, but the opinion of SMEs and key informants we interviewed seemed to be that state efforts to address legally unlicensed care homes should focus on monitoring and improving quality, whereas state efforts to address illegally unlicensed care homes should be on identifying these homes and shutting them down. Unlicensed homes to face more state scrutiny. Improper medication assistance and management were most commonly noted by key informants as problematic; informants were concerned that operators or staff of illegally licensed care homes may not be properly trained in medication management and administration. As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. Adult Foster Care Few of the investigations focus solely on financial exploitation. 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. <>/Metadata 112 0 R/ViewerPreferences 113 0 R>> The objective of the literature review was to identify current information (2009-2014) on both legally and illegally unlicensed RCFs and to inform the conduct of SME interviews and site visits to communities in three states. Greene, A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. For example, SMEs indicated that law enforcement investigators have discovered operators of unlicensed homes with scores of electronic cards for food stamp benefits that belonged to current and former residents. But after a family friend told the Oakland County Probate Court that Plummer was having memory loss, court records show a Judge appointed a Southfield attorney as a co-guardian. Study findings should be viewed in light of these limitations. Florida can impose fines of up to $1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). If the facility does not close, law enforcement (not the state licensure offices) fines the illegal operation $50 for the first offense and $500 for each additional offense. One woman was marketing heavy to the hospitals, and taking them to the licensed facilities, and then moving them to the unlicensed facilities, in result to those types of facilities. In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. Several key informants discussed the role hospitals and hospital discharge planners potentially play in referring patients to unlicensed care homes. Licensure offices and other agencies or organizations respond to complaints made by concerned citizens, including family members and friends of residents, neighbors of unlicensed care home operators, health care providers serving unlicensed care home residents, firemen, ambulance services, police, and licensed care home operators. Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. Typically, the reports refer to physically or mentally disabled adults, some with disease specific conditions, or just described as mentally ill or elderly. Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. At least two states have demonstrated that coordinated efforts can effect changes to laws and policies and create at least initial disincentives or barriers to the operation of illegally unlicensed care homes. Settings Note: Home Help services cannot be approved if a client is residing in a licensed or an unlicensed foster care home. In addition, one key informant stated that penalties for operating unlicensed care homes are similar to only a Class C offense, which is "equivalent to fishing without a license." 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. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. The advocacy agency also collects information about whether the operators own more than one unlicensed care home. It is now a misdemeanor to operate an unlicensed RCF. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. Media reports described operators that continued to operate after their licenses expired or were revoked. Some of these homes also serve mixed populations (e.g., elderly residents as well as individuals with severe and persistent mental illness). Our search of state AG reports of unlicensed RCFs identified only six cases of successful prosecutions in New York, Nevada, Florida, and California for operating a residential care home without a license--and in several cases, gross neglect in these homes. Atlanta Journal-Constitution. 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 He called Glover-Hogan, and said did you visit? He noted that residents with disabilities in unlicensed homes were at risk during fires and natural disasters such as tornados, hurricanes, and severe storms. 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. 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. Below we present a sample of the varying state definitions of lawfully unlicensed and illegally unlicensed residential care homes. Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential 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. Miami Herald. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. Currently, 46 states provide some type of SSP (SSA, 2015). For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. 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. Tobia's report (2014) described residents of unlicensed facilities as vulnerable older adults with "hard to place" mental health and paroled individuals who are warehoused. Qualitative Health Research, 14(4), 478-495. An AFC Small Group Home is at least three but not more than 12 residents. Several key informants mentioned that hospital discharge planners sometimes discharge patients to unlicensed care homes (described in more detail in Section 4), and as such they might be a potential source for compiling a list of these homes. 48317. 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.) (2011). Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. 8"r7GrAg 365o){11c>9c)T:/V;Mi/nf>b-agH3z=r+Bb0a^0 XPX;.GbJ\ ^koLs%t)+#&l. 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