unlicensed personal care homes texas

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. what is the first step. From a county perspective, one ombudsman and housing officer estimated that perhaps there may be less than 20 lawfully unlicensed facilities and less than five illegally unlicensed, however Tobia's team found that there may be as many as 78 unlicensed care homes serving as many as 400 individuals in that county. Florida: A media report stated that in 2012 the licensure agency received more than 200 complaints about unlicensed activity and confirmed 62 were unlicensed--a 60% increase since 2010. Abuse, Neglect, and Financial Exploitation, 3.4. Key informants at the state level were able to provide estimates of the number of complaints they have received pertaining to unlicensed care homes, but not estimates of the number of unlicensed care homes. Cooperative efforts are underway amongst state and local agencies in some states. Traditionally, Medicare does not cover Several key informants reported that unlicensed care home operators "troll" the psychiatric wards of facilities like Grady Memorial Hospital, looking for residents. 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. Retrieved from http://www.miamiherald.com. Learn more in our Cookie Policy. Thus, we lack information about unlicensed care homes in moststates, and even in our study states there were no reliable counts of illegal unlicensed care homes. help cover the costs of residency but typically have long wait One key informant shared that, as part of such a campaign in 2012, advertisements were placed in metropolitan areas warning the public against placing people in illegally unlicensed personal care homes. The nature of health and safety concerns described by key informants were wide-ranging and often included neglect and the risk of death to residents. Florida publishes a listing but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. Tracking Public Benefits and Representative Payees. Key informants suggested interviewing individuals from other agencies to learn more about illegally unlicensed personal care homes or to obtain potential lists of illegally unlicensed personal care homes. Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). There are even different titles used to talk about caregivers, such as home care aides, homemakers, personal care assistants, and personal care aides. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. No Legally Unlicensed Residential Care Homes Are Allowed in Some States. They noted that some unlicensed care homes provide good care; however, SMEs and other informants consistently reported substantial concerns about neglect, unmet health needs, unsafe and unsanitary conditions, abuse, financial exploitation, false imprisonment, and moving residents to different care homes across communities and states to evade detection. Maryland, Mississippi, and the District of Columbia have no minimum bed size for licensure, implying that some residential care homes can be legally unlicensed. In addition to legally unlicensed residential care homes, there are a variety of places that operate illegally. 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. be physically and mentally capable of evacuating the facility APS provided this breakdown of where the residents were being taken: 13 to four different licensed personal. In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. The aging housing stock in Allegheny County was also a cause of concern for a few key informants, as it relates to the number of pre-existing buildings that cannot meet the state regulatory building code requirements for licensed personal care homes. The primary concern expressed about the unlicensed homes that were otherwise safewas that they might not be able to provide the level of care and services needed by the residents (e.g., medication supervision for residents with severe and persistent mental illness). 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. 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. We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants. personal are home) is a private 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). Although the majority of key informants described unlicensed care homes as unsafe environments where residents are abused, neglected, or exploited, it also was noted that some unlicensed care homes may provide quality care in safe and clean environments. HHSC determines a . Based on the information gathered, we determined key criteria for site visit location selection, including having good leads/contacts for identifying key informants in the state, and having geographic variation across states. Large Large facilities are defined as those with 17 residents or more. 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. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. Key informants noted that the possibility for theft from residents and from government programs also exits with the practice of operators taking control of residents' monthly income from SSA. Pennsylvania's BHSL and the North Carolina Adult Care Licensure Office and Mental Health Licensure Office will offer to work with unlicensed residential care homes to help facilitate licensure. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. Retrieved from http://www.dallasmorningnews.com. The North Carolina Office for Mental Health Licensure also licenses group homes for adults with developmental disabilities (5600B) and group homes for adults with substance abuse issues or chemical dependency. Ombudsmen program does not extend to unlicensed facilities (Hawes & Kimbell, 2010). Specific concerns included: Managing resident medications improperly. Residential Care providers must be licensed as an assisted living facility and have a contract with the Texas Health and Human Services Commission. As discussed earlier, Pennsylvania is a state that legally allows unlicensed residential care homes, if they serve three or fewer individuals. Multiple key informants also stated that interviews with small licensed personal care home operators may result in learning more about the motivations for operating an illegally unlicensed personal care home. 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. 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. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. As described in Section 2, to inform the selection of states for site visits, we looked closely at the information available for six states where the environmental scan or SMEs indicated unlicensed care homes likely exist. 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. Barry, R., Sallah, M., & Miller, C. (2011). Two key informants spoke about the lack of oversight of these homes and the concern for the well-being and safety of their residents. Legally Unlicensed and Licensed Care Home Operators. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. The Texas Department of Aging and Disability Services (DADS) licenses several types of assisted living facilities (ALFs): assisted living apartments (single-occupancy), residential care apartments (double-occupancy), and residential care non-apartments. Monitoring and Improving Quality in Legally Unlicensed Care Homes. 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. 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. Sallah, M., Miller. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. Key informant interviews were conducted in three communities across three states: Allegheny County, Pennsylvania; Atlanta, Georgia; and Raleigh/Durham, North Carolina. (2012a). Another concern expressed by some of the individuals interviewed was that even those unlicensed homes that were clean or free of neglect and abuse, commonly have safety hazards and do not meet the fire safety codes required of licensed facilities. Memory care, Parkinsons, ALS, Stroke, Alzheimers, Dementia and more. 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. Several reports noted that local law enforcement, EMS, and fire departments had frequent interactions with unlicensed residential care homes. These homes often serve very vulnerable individuals such as individuals with serious mental illness or other disabilities, or older adults with functional limitations and limited financial resources. 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. Absent assistance from the ombudsman or other support in finding affordable licensed care options, unlicensed care homes may be the only option these individuals have. Preventing residents from using the bathrooms after a certain time at night and providing buckets for residents to use rather than toilets. have. Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. 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. Populations Served and Conditions in Unlicensed Care Homes, 3.3. Operators of small care homes lack knowledge of licensure regulations and how to navigate the different government agencies, and there is a perceived lack of respect from government staff regarding the quality of care that non-professional staff can provide in these small residential care homes. 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. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents' basic needs. What federal and state policies affect the supply and demand of unlicensed care homes? 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. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. We also heard of operators not reporting the death of a resident to SSA so the operator could continue collecting the resident's checks from the government. Some operators use homes that do not meet personal care home building code regulations; for example, the home may lack proper ramps for wheelchair access. One of the SMEs shared comments from ombudsmen that the numbers of unlicensed homes in some states are increasing, while in other states, they reported that they had not heard about unlicensed care homes. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). Because of licensure standard variations, for example, homes that were legally unlicensed in Texas (e.g., adult foster care homes with five or fewer beds) were required to be licensed in California and Oregon. 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. This report describes the methods used to conduct the study, summarizes the information learned from an environmental scan and the results from interviews with subject matter experts (SMEs) and site visits, discusses implications of the findings and, based on the study findings, offers recommendations for future research on unlicensed care homes. Most key informants noted that hospital discharge is a critical juncture at which individuals can be directed to, or end up in, unlicensed care homes. They are a leading provider of top-notch senior care and assisted living solutions. Targeted searches of media reports in states with the lowest percentages (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield a higher number of reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). The biggest difference is that some personal care homes accept Medicaid to help cover the costs of residency. 3.4.4. unassisted. Ombudsmen. 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. However, the long-term placement of individuals after discharge to an unlicensed care home may be unstable, and no follow-up by the hospital with the patient after placement was described. Other estimates of the number of unlicensed care homes in the state range from 500 to 1,500 within one metropolitan area. Senior Care & Assisted Living Services South Carolina Assisted Living Facilities, Care Homes, Senior Housing $249,000. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. Of these, three were determined to be unlicensed care homes. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental issues to community-based care settings, such as legally unlicensed care homes. geographical location of the residential care home, as well as, Texas Department of Aging and Disability Services. (Hawes & Kimbell, 2010). Most key informants stated that many unlicensed care home operators receive the income from the SSA directly, either in the name of the resident or by requiring the resident to name the operator or someone else as a representative payee. While many key informants stated that illegally unlicensed personal care homes primarily serve adults with a wide spectrum of mental health disorders, they also noted that some of the residents in unlicensed care homes are frail and elderly individuals. Few of the investigations focus solely on financial exploitation. Residents of unlicensed care homes are vulnerable adults. (2013). In the first half of 2013, 37 other unlicensed homes had been identified. 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. or home health care. Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse, Neglect and Exploitation. These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. 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). As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. Savchuk, K. (2013). 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. Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. Medicare is more often used to pay for a skilled nursing facility Illinois: A story released on the This American Life radio podcast described a scam where individuals with substance use disorders were sent from Puerto Rico to supposed rehabilitation centers in Chicago where they were to be provided with housing, food and counseling services, only to find themselves in crowded, unlicensed rehabilitation centers, their passports and other identifying information taken from them. extremely important decision. Although we attempted to conduct interviews with operators of unlicensed care homes on our site visit states, we could not identify or gain access to any. Troubled group homes escape state scrutiny. In California, assisted living services can be provided by a licensed home health agency in unlicensed publicly subsidized housing (low-income housing projects, apartment houses, retirement hotels, village models, and private homes). The new regulations were implemented to monitor and provide oversight of personal care homes with four or more residents, while reducing the number of homes that legally did not require licensure. 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. Very little discussion centered on improving the quality of unlicensed care homes. In Georgia, key informants also noted that hospitals directly discharge individuals to unlicensed care homes and some pay the first month of the resident's fees. They also noted that, despite receiving payment for room, board, and services, some unlicensed care home operators provide subpar or poor quality accommodations and services to residents. The biggest When HHSC has your information, it is subject to the HHSC privacy policy. There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. 3.4.3. The advocacy agency also collects information about whether the operators own more than one unlicensed care home. A coordinated, interagency, multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. 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. Audio podcast. In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. 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 an There are all sorts of assisted living and personal care homes to choose from when deciding which place would best suit your loved one. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. dressing, using the toilet) for someone who's unable to fully (2015). Thus, although our findings consistently highlight concerns about safety and quality, we cannot assess the generalizability of these findings and concerns, and our findings only minimally address unlicensed care homes that are safe and provide quality care. They indicated that these unlicensed personal care homes are filling the gap left by the closing of licensed personal care homes. Similarly, APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. Medicaid Supplemental Payment & Directed Payment Programs, Click here for news, information letters (ILs) & provider letters (PLs), Contact Information for Eligibility Operations Provider Contract Management (PDF), Community Services Regional Contacts for your region, Texas Administrative Code, Title 40, Part 1, Chapter 46: Contracting to Provide Assisted Living and Residential Care Services, Texas Administrative Code, Title 40, Part 1, Chapter 49: Contracting for Community Services, United States Code, Title 42, Chapter 7, Subchapter XIX, 1396, United States Code, Title 42, Chapter 7, Subchapter XX, 1397-1397f, List of Excluded Individuals and Entities, Medicaid for the Elderly and People with Disabilities, HHSC Publishes IL 2022-33 Records Retention and Contact Information After Contract Termination, HHSC Publishes Payment Rates for Residential Care Personal Attendant Services (IL 2022-06), Quality in Long-Term Care 2021 Conference Available Free On Demand, HHSC Publishes Acceptable Documentation for a Criminal History Check for Contractors (IL 2021-48), COVID-19 Vaccine Status Not a Requirement for Services, 2022 Cost Report and 2022 or 2023 Accountability Report Training Information, Contract and Fiscal Compliance Monitoring Implementation of Enhanced Monitoring, Records Retention and Contact Information After Contract Termination, Payment Rates for Residential Care Attendant Services, 2021 Cost Report and 2021 or 2022 Accountability Report Training Information, Acceptable Documentation for a Criminal History Check, Handling of Sensitive Personal Information and Breach Notification, Cost/Accountability Report and 2021 Accountability Report Training Information, 2019 Cost Report and 2020 Accountability Report Training Information, Supervision of/assistance with or direct administration of medication, Information regarding eligibility criteria: contact, Nursing or other services: contact one of the. Residents in need of medical assistance such as nursing care can pay for such care from an outside provider, and the facility does not have to be licensed as "assisted living." Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. Each of these factors is discussed in more detail in the sections that follow. For many such individuals, their only options may be unlicensed facilities or homelessness. Further, receipt of a complaint was the most commonly cited method to spur identification of an unlicensed care home. Future research could be conducted to describe the nature of ombudsman involvement in unlicensed care homes and how it differs across states. Marucha Hinds Jack Warden, Articles U