unlicensed group homes in michigan

<> The first, a six-state study on elder abuse in RCFs conducted by Hawes & Kimbell (2010) for the U.S. Department of Justice found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Further details on findings from the environmental scan can be found in Appendix B. A wide range of specific concerns about unlicensed care homes were identified in this study, including improper management of residents' medications; unsafe, unsanitary, and inadequate living environments; failure to adequately feed residents; and monetary theft of benefits. Findings from the interviews suggest that the majority of unlicensed care home residents in the metro Atlanta area have severe and persistent mental illness and are highly vulnerable to exploitation. State investigators from the Bureau of Licensing and Regulatory Affairs inspected the home in October and found that Carter was violating the law. Our state services support residents, businesses, and visitors to the Great Lakes state. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. nmpV[0VM.T1B2L3qHY' w|Z?paTjSy`6GEk1BL67d.VX7dNO!7hj. Calvin Leslie agreed to a sentence of 10 to 25 . (2015) Assisted living provider resources: Unlicensed facilities. Notably, most key informants said the operator of a licensed home may also operate one or more unlicensed homes, often in the same neighborhood and often in collaboration with friends or family members. In this study we sought to identify: Characteristics of unlicensed care homes and the residents they serve. What federal and state policies affect the supply and demand of unlicensed care homes? The majority of key informants reported that unlicensed care homes primarily, though not exclusively, serve individuals with severe and persistent mental illness. There were no reports of varying frequencies of unlicensed facilities between urban and rural areas. Providing unsafe housing conditions, including overcrowding of resident rooms, housing many more residents in bedrooms than is allowed by state licensure regulations, housing residents in storage sheds, basements, and attics that were unsafe, unsanitary, and made egress difficult for frail or disabled residents. Strategies for Addressing Conditions in Unlicensed Care Homes, 6.1. Maryland, Nevada, and Florida: The National Ombudsman Reporting System noted an increase in unlicensed care homes in these states, but no unlicensed care reports from any state provided evidence on the prevalence of unlicensed care. 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. 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. 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. This makes it difficult, if not impossible, for residents to leave the facility, a difficulty sometimes exacerbated by limiting residents' access to their funds, to the facility phone, and, as noted above, by locking residents in their rooms or the facility. In this section, we summarize results of the literature review and interviews with SMEs and key informants. 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. 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. 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. Miami Herald.Retrieved from http://www.miamiherald.com. However, we did not hear any specific examples of this from the state or local level. 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. Retrieved from http://www.phlp.org/wp-content/uploads/2011/03/PCH_manual-for-advocates-Feb-20071.pdf. 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. Group Child Care Home (GCCH) License Other charges included: murder, sex trafficking, sexual abuse from staff or other residents who were registered sex offenders, racketeering, forced labor, and fire setting by residents with severe and persistent mental illness. 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. 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). And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. Atlanta Journal-Constitution. Care must be provided in a private home where the licensee is a permanent resident and household member. SMEs and key informants discussed a number of factors that may have an effect on the supply of and demand for unlicensed care homes. Some key informants described frustration with the lack of monitoring and lack of jurisdiction by the licensing offices to access or track legally unlicensed care homes. There was not much attention paid to the original sources who identified an unlicensed facility, but in some articles or media reports, the case came to light due to a death that occurred in the facility that had to be investigated, neighborhood complaints of numerous vans, ambulances or police cars at the home, or calls from concerned family members about the status of a resident. Licensing is the process by which the Department of Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS) regulates adult foster care group homes. In several cases at both the state and local level, unlicensed facilities were reported to authorities or licensure offices by the operators of licensed facilities. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. 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). These are Alaska, Arizona, Arkansas, Connecticut, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New York, North Dakota, Ohio, Oregon, South Dakota, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Several states (California, Pennsylvania, Maryland, and Mississippi) publish notices of how and where to report unlicensed care facilities, which implies that these states may be experiencing problems with unlicensed homes. Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. Funds are being allocated to relocate residents out of unlicensed residential care. In Georgia, efforts are now under way to provide workshops for law enforcement that clarify the new laws about unlicensed care homes and how law enforcement and agencies, such as aging and licensure can work together to identify and investigate crimes against at-risk adults and prepare the necessary components for successful prosecutions. Key informants indicated financial exploitation in unlicensed care homes is an area for future research. Strategies to Address Unlicensed Care Homes. Although the scope of our research was limited--involving a small number of interviews with subject matter experts (SMEs) and interviews with informants in three communities in three states--the findings have relevance for national, state, and local policies and practices and for future research. *Z A house at East Tamara Costa Court where Calvin Leslie, not photographed, was renting it is seen on Wednesday, Dec. 18, 2019, in Las Vegas. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. Anne Arundel County Fire Department, Millersville, Maryland. Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. 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. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. Strategies for identifying illegally unlicensed care homes. One key informant estimated this hospital served 3,700 patients at its peak. At the local level, one key informant estimated that members of the Allegheny PCRR, along with the state licensing office, have investigated approximately five illegally unlicensed personal care homes in their specific geographic region over the past two years. Lax enforcement in personal care homes. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential care homes. Detecting, investigating and addressing elder abuse in residential long-term care facilities. If the SSA implements this requirement, it could become a potential source for identifying unlicensed care homes. The study by Hawes & Kimbell also provided reasons operators do not seek licensure, including: inability to meet fire safety codes (e.g., installing sprinklers), lack of state supplemental payment for SSI residents or Medicaid waiver funds (which can be restricted to licensed facilities), and avoidance of inspections and sanctions/fines for not meeting state regulation. In addition to the church-affiliated home described above, examples of the types of places where unlicensed homes operate included an old elementary school as well as single family homes in residential neighborhoods. Finally, in some states, SMEs and the environmental scan identified legally and illegally unlicensed residential care homes that were referred to as boarding homes or board and care homes. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified the ten states that spent the highest percentage of their LTSS expenditures on HCBS and the ten that spent the least. Estimate of 2-year cost of implementing HB216. 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. Two key informants mentioned that changes to the state's Medicaid Personal Care Services program had a direct impact on available funding for group homes that serve individuals with mental illness. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds; Vermont exempts small private-pay homes. Monograph for the National Institute of Justice, U.S. Department of Justice. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Retrieved August 6, 2015 from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/requirements-for-home-and-community-settings.pdf. We found reports of Medicaid fraud in unlicensed care homes in Florida and Nevada between 2009 and 2014 involving charges of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility (National Association of Medicaid Fraud Control Units, n.d.). Indeed, results from the National Survey of Residential Care Facilities indicate that only 40% of licensed RCFs admit individuals with behavior problems, and just 55% admit individuals with moderate to severe cognitive impairment (Greene et al., 2013). An official website of the United States government. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. An operation needs to be licensed under Act 368 as a home for the aged (HFA) if it provides room and board and supervised personal care to 21 or more unrelated people who are 55 years of age or older; or if operated as a distinct part of a licensed nursing home, can be provided to fewer than 21 residents. Specific concerns included: Managing resident medications improperly. State regulations govern whether ombudsmen can access and advocate for residents in unlicensed care homes; thus ombudsmen may be limited in their ability to serve on these teams. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. R One key informant from Pennsylvania spoke about the difficulty in handling reports of neglect or abuse in legally unlicensed care homes: "we will have repeated incidences, or alleged incidences [at legally unlicensed residential care homes] and we don't report to anyone [any agency or the state] either. 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. Characteristics of Residents and Unlicensed Care Homes. 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. Understanding Supplemental Security Income SSI benefits, 2015 edition. In Pennsylvania informants described a public education campaign including advertisements warning people about placing their loved ones in unlicensed care homes. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS. Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. 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. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements or other rooms, given buckets for toilets, and had their benefit checks taken from them. Alabama's APS agency estimated that there were more than 200 unlicensed homes in the state, in contrast to their 400 licensed facilities. Informants noted that unlicensed care homes vary in their appearance and condition. Additionally, states may implement public awareness campaigns to support identification of unlicensed care homes. 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." Ombudsman programs are not adequately involved. Based on our exploratory research, we found that a number of factors may have an effect on the demand for unlicensed care homes. 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. First Responders: EMS, Firefighters, and Police. Indeed, many key informants emphasized that they only knew about unlicensed care homes because of complaints being made about them. Both the information we collected about unlicensed homes in the literature review and that which we collected through interviews mostly paint a negative view of these settings. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. 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. Homes for the aged provide continuous "supervised personal care" to adults older than 55, according to Michigan's public health code. In Michigan, residential care homes that provide room, board, supervision, and protective oversight, but not personal assistance with ADLs or medication assistance (residents can contract out for personal care), are not required to be licensed. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes. 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). A 58-year-old man pleaded guilty to elder abuse on Tuesday for operating an unlicensed group home where about eight tenants lived without heating. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. It is important to note that we do not know whether the types of financial exploitation and abuse described by the SMEs and key informants occur in both legally and illegally unlicensed care homes, or how commonplace they are. Group Home: Individuals can choose to reside in a licensed or unlicensed group home with 2-5 other individuals. Some key informants described illegally unlicensed personal care homes as filthy and potentially filled with rodents and insects; they also noted that these homes are unsafe structures that could be condemned. Retrieved from http://www.azdhs.gov/als/hcb/index.htm. Agencies have inadequate resources or authority. To address unlicensed care homes, states commonly use a strategy that includes penalty systems that fine operators as a way to try and close illegally unlicensed 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. The Adult Foster Care Act (PA 218 of 1979) and the Public Health Code (PA 368 of 1978) provides the Department's authority to establish these rules. . But several judges in metro Detroit like to appoint Public Administrators as professional guardians for adults who are considered legally incapacitated.. For many such individuals, their only options may be unlicensed facilities or homelessness. 2 0 obj Some of these places are legally unlicensed, while others operate without a license illegally. Local health departments can also get involved in trying to shut down illegally unlicensed personal 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. We then asked questions specific to the type of SME, including: What gaps unlicensed care homes may fill in the spectrum of long-term services and supports (LTSS)? 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. He said, well youre supposed to and I can name several violations right off the top, said Klavinger. 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. 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. Florida publishes a listing of unlicensed homes but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. Miami Herald. A follow-up story revealed that these unlicensed rehabilitation centers may have been selling the identities of the victims on the black market for as much as $2,500. 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. stream 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. 3.2.3. According to one key informant in the state, moving individuals from institutions for mental illness with an inadequate plan for housing these individuals has contributed to an increase in the numbers of people available for unlicensed personal care homes to serve, thus motivating the opening of unlicensed care homes. She had on the same clothes every day, it was for a week, said Klavinger. I dont have anything indicating that that was the case, said Glover-Hogan. 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. After discussions with ASPE, we identified three states and communities within each state as site visit locations: Atlanta, Georgia; Raleigh/Durham, North Carolina; and Allegheny County, Pennsylvania. Similarly, APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. 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. The LME-MCO oversees contract services in a four county area. In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. Regulatory changes and the role of multidisciplinary task forces (which are relevant to both legally and illegally unlicensed care homes) are described next, followed by a summary of the strategies discussed during interviews to identify and shut down illegally unlicensed care homes and to monitor and improve quality in legally unlicensed care homes. Some legislatures made it a felony to operate an unlicensed care home. Corporations, Securities & Commercial Licensing Bureau. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). The majority of examples of mistreatment included resident physical and emotional abuse, neglect, or financial exploitation. Very little was mentioned about elderly residents living in unlicensed homes; only one informant reported that unlicensed adult care homes may serve a mixed population (e.g., elderly residents in addition to residents with mental illness). In one state, Pennsylvania, three bed residential care homes are legally unlicensed. However, this likely is not a viable method for detecting the population of illegally unlicensed residential care homes. One of the key informants, who operatesa day program that serves many individuals who are residents of unlicensed care homes, also described the 20 year history surrounding the operation of unlicensed care homes. Two key informants thought that the ongoing statewide mental health reform, which began in 2002, has exacerbated issues related to the general lack of infrastructure and knowledge about needs of persons with mental illness. Those individuals who remained in the city were placed in day programs. Clarisse Carter runs Due Season Residential Services LLC, the unlicensed group home in Warren. 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. 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. Areas for future research and potential data sources related to unlicensed care homes. A local ombudsman and APS supervisor lead the PCRR team and maintain lists of both known illegally operating homes and those that are potentially illegal operations. In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. Rates for MHA residents range from $2,075 to $3,319 per month. Social Security Administration. The payments also vary considerably from state to state, and are quite modest in some states (e.g., from $46 to $100 per month). If the homes are closed and the residents' identification cards and personal paperwork are not able to be retrieved, this poses challenges for residents to get SSI payments and medications. A few interviewees agreed that in cases such as this, the operators are motivated by their desire to care for people; they are just not aware of the licensure requirements. 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. Policies affecting the supply of and demand for unlicensed care homes. However, site visit key informants and SMEs we interviewed were unaware of any such lists of unlicensed homes and could not identify existing methods for tracking them. Legally Unlicensed and Licensed Care Home Operators. Centers for Medicare and Medicaid Services. Intellectual and Developmental Disabilities The monthly rates for I/DD residents are based on a support needs assessment. They deny services such as assistance with medication are being provided to residents, or assert they are only providing housing for alcoholics, ex-convicts or people with mental health issues to avoid having to become licensed. Multiple key informants expressed concern about other state policies related to reductions in funding for mental health services and supports as potential contributors to a gap that illegally unlicensed personal care homes can fill. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' Pennsylvania Health Law Project and North Penn Legal Services. Below are examples from the environmental scan that provide some estimates of the number of unlicensed care homes: Maryland: A representative of the licensure agency estimated 500 unlicensed illegal assistive living facilities and noted the fine line between a boarding home and assisted living. 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. In some states, APS has very limited responsibility and involvement. 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. Texas Department of Aging and Disability Services. Aps agency estimated that there were no reports of varying frequencies of unlicensed care homes, 6.1 to assist personal. A sentence of 10 to 25 smes reported that unlicensed care homes is an area for future research many informants... 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