unlicensed group homes in michigan

Other key informants stated that some operators do not want the state regulating or monitoring their business. LARA is dedicated to bridging the gap between civilian and military employment and helping veterans gain and retain employment. These calls spur investigations that sometimes result in the identification of unlicensed care homes. Unlicensed homes to face more state scrutiny. 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. R "Caretaker" Accused of Abusing and Neglecting Mentally Challenged Victims. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> In several cases, the potential interviewees did not have direct knowledge on the topic of unlicensed care homes, and were not interviewed, but referred us to interviewees with more knowledge on the topic. Troubled group homes escape state scrutiny. Informants expressed other specific concerns about unlicensed care homes, including improper management of residents' medications; unsafe, unsanitary, and uncomfortable living environments; theft of utilities from neighbors; and fraudulent collection of government payments (e.g., not reporting residents' deaths and continuing to collect their SSI payments). Such practices violate residents' rights, and the profit-enhancing practices of the operators, such as limiting the availability of food, water, and other basic needs, endanger residents' lives and well-being. Licensure regulations lack clarity regarding requirements for minimum bed size. Dirt was evident over the walls, floor and stairway.. 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. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. 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. 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). Adult Foster Care Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. 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. Key informants expressed a desire for future research that helps to categorize the necessary organizations and the number of personnel hours needed from each organization at each phase of the processes to identify, investigate, and close unlicensed homes; determine the optimal tactics to effectively implement investigation and closure; and develop a safe and seamless relocation and follow-up plan for residents. 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. Due to services being brought into these homes, interviewees thought further interviews with home health staff or hospice staff may yield additional information or lists of unlicensed personal care homes that may include illegally unlicensed establishments. Assisted living provider resources: Unlicensed facilities. 3.5.3. As noted, the responsibility and authority of ombudsmen in unlicensed care homes--even in terms of receiving and acting on complaints--varies from state to state. Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. Health, Safety, and Sanitary Conditions. Almost all adult care home operators receive $2,608 per month. APS professionals there estimate three reports or complaints about unlicensed personal care homes every month in the metro Atlanta area, and about one complaint or report about unlicensed personal care homes every three months in rural areas of the state. Residential care homes that serve three or fewer residents are legally unlicensed in this state. 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.) 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. Media reports were usually about an action by a licensing agency, Medicaid Fraud Unit, APS, or the police arresting an operator; these reports do not provide much information about the extent to which unlicensed homes exist in the state. Spencer, D., & Mimica, L. (2014). Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. Savchuk, K. (2013). 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. Georgia law changed in 2015, making it a misdemeanor to operate an unlicensed residential care home if abuse, neglect, or exploitation were found to have occurred there. 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. We also heard from nearly all state-level informants that some operators routinely shifted residents from one address to another if an APS worker, other advocate, or potential regulator showed up at the facility asking questions. Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. Adult Protective Services and Rosenberg police were on the scene along with EMS personnel. Many key informants noted that regulatory loopholes provided potential ways that operators of illegally unlicensed personal care homes can persist and evade licensure. Adult children separated from their ailing parents. Some states allow them to assist with medication storage but not with ADLs. There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. Thirty states require residential care homes to be licensed if they have at least one bed.7 Massachusetts exempts small private-pay homes from licensure. In 2005, Pennsylvania changed the regulations so all residential care homes with four or more individuals had to be licensed by the state, but 1-3 bed residential care homes still could be legally unlicensed. Resident Case Mix. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed. This was described as limiting the capacity of the resident to relocate. Called shelters, rooming houses, sober homes, they have names like Home Sweet Home, House of Joy and Nurse's Loving Heart. Group Home: Individuals can choose to reside in a licensed or unlicensed group home with 2-5 other individuals. Unlicensed staff may administer medications after completing a 16-hour medication course from an approved medication training provider. Discussions with key informants in the state suggest Georgia has a high prevalence of these homes. Although recognized as important, the state has not yet begun investigating cases of financial exploitation. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. The informants recommended the formation of teams including a range of stakeholders, including state licensure officials, Adult Protective Services (APS), ombudsmen, police, firefighters, emergency medical services, code enforcement, and local advocacy organization workers.1. Most commonly, interviewees depicted unlicensed personal care homes operating in residential areas within single family houses that are rented by the unlicensed care home operator, but some interviewees described unlicensed care homes operating in a variety of other structures (e.g., closed churches and schools). Findings from this study are necessarily limited by the number of experts we identified and states we visited. 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.). Operators seizing the residents' food stamps and selling them for cash. In one case well publicized by the media, residents of one unlicensed facility in Pennsylvania were moved between Pennsylvania, Texas, Virginia and Florida to escape law enforcement. The issue of financial exploitation is described in detail in Section 3.3.2. 2 0 obj Office of the Assistant Secretary for Planning and Evaluation, Printer Friendly Version in PDF Format (81 PDF pages). Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. 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. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS. 200 Independence Avenue, SW Submitted to the Governor and the Texas Legislature and the Texas Health and Human Services Commission. For example, a care home with three persons with at least one personal care need might also house three people with personal care needs whose community housing arrangement is covered by the U.S. Department of Veterans Affairs. One was a fairly large ranch style house that accommodates 15-23 individuals at any one time. 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). Georgia was selected as a state for our site visit because of the state's actions surrounding unlicensed care homes described during interviews with SMEs, and the numerous news reports about unlicensed care homes in the state. The .gov means its official. Individuals who are poor, experiencing homelessness, or individuals with a mental illness who cannot return home orhave no home to return to after being discharged from the hospital are a source of clients for unlicensed care homes. Several SMEs also noted inadequate funding and housing options for persons with severe and persistent mental illness or intellectual disabilities who have been moved out of state facilities may contribute to demand for unlicensed care homes, because these individuals may not be able to afford the cost of a licensed care home. 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. Concerns expressed across several interviews included providers locking residents in rooms; locking food away so that it is inaccessible to residents; using basements to house individuals, including individuals who are unable to climb the stairs and those on hospice; providing accommodations that are unclean, infested with bedbugs, and lack heat, air conditioning or running water. Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. Strategies for Addressing Conditions in Unlicensed Care Homes, 6.1. Moreover, unlicensed care home operators have an opportunity to operate virtually unchecked in terms of seizing control of the residents' government benefits. Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. 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. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. As used in this act: (a) "Adult foster care location authorized to care for a child" means an adult foster care family home or adult foster care small group home as defined in section 3 of the adult foster care facility licensing act, 1979 PA 218, MCL 400.703, in which a child is placed in accordance with section 5 . The web Browser you are currently using is unsupported, and some features of this site may not work as intended. In contrast, one key informant stated that one repeat illegally unlicensed facility had housed residents who had thrived there and had benefited from living in the home. Most of the literature or media reports were not specific about the types of residents served in unlicensed residential care. Copyright 2017 Scripps Media, Inc. All rights reserved. In Florida, the Secretary of the Agency for Health Care Administration told a senate committee that the agency wanted to work more with law enforcement. By interviewing residents of unlicensed care homes, HFR is trying to understand the pathways that individuals take to end up in these situations. Perkins, M., Ball, M., Whittington, F., & Combs, B. Based on this information, we chose three states, and subsequently identified three communities within those states, to visit and conduct case studies.2 Following is a summary of the literature, media coverage, and regulations for those three states (Georgia, Pennsylvania, and North Carolina). Results of key informant interviews from site visits, as well as the SME interviews and the literature review, are presented in the Findings section that follows. We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. Dom Care homes, which also provide care to three or fewer individuals, are governed and regulated by the state with the authority to certify, supervise and monitor delegated to the local AAA. One key informant estimated there are approximately 526 Dom Care operations in the state. Based on our findings, the residents of these homes are extremely vulnerable. In Michigan, you can have both. Targeted search terms incorporated specific licensure category names for each specific state. Strategies for Addressing Unlicensed Care Homes. x][o~ ^/o{)u4M!"KH336jTp87O[Gdz>;OW~|mZ~Nf/OeT61J4IX>b]}X 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. No other coordinated agency efforts beyond the state licensure office, APS, and the LME-MCO were described by key informants. One key informant specifically mentioned a 10% cut to state funding for mental health in 2012 while another key informant mentioned block grants as a potential contributor to lower funding amounts for mental health services and supports. Referral and Placement Agencies and Discharge Planners. Anecdotal examples of residents wandering outside of their home and onto neighbor's property, which typically generates a complaint call from the neighboring homeowner, were also provided. As a direct result of this regulation change, many personal care homes in Pennsylvania became illegally unlicensed and either shut down, became licensed, or continued to operate illegally. Site visit findings were largely consistent with those of the environmental scan, and despite increased attention to unlicensed care homes in some states, key informants highlighted issues of safety, abuse, and exploitation. Miami Herald. However, even if the home continues to operate, the fines are rarely enforced or collected. Atlanta Journal-Constitution. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. 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. 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. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. 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. Assistant Secretary for Planning and Evaluation, Room 415F Specific concerns included: Managing resident medications improperly. The licensing rules for Adult Foster Care and Home for the Aged facilities provide minimum standards for these regulated facilities. . 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. 20 or fewer individuals 55 years of age or older that is operated in conjunction with and as a distinct part of a licensed nursing home. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. Figueroa, L. (2011). The annual cost of care for an institutionalized resident is. 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. One interviewee estimated that at its peak, this hospital served 3,700 patients. In the latter state, it was said that unlicensed homes "flourished in the larger cities, particularly those that had significant populations of poor elders and persons with mental illness who had been released from state mental hospitals" (Hawes & Kimbell, 2010). The research team interviewed 12 key informants in Georgia. Key informants described the way the teams function. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. How do states address unlicensed care homes, and if states or other organizations maintain lists of unlicensed care homes (legal or illegal)? However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? Retrieved from https://aspe.hhs.gov/report/medicaid-residential-care. The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. While no comprehensive nationwide list of unlicensed care homes exists, the environmental scan identified one state (Florida) and one city (Houston, Texas) that maintain listings of unlicensed care homes. One key informant stated this posted information, as well as general education sessions out in the community; for example, in senior centers or nursing homes, leads to some complaints that can generate investigations into personal care homes that may be identified as illegal operations. 3.2.3. 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. These steps include site visits to suspected illegally unlicensed care homes, during which an ombudsman may inform residents of their rights, APS may conduct abuse or neglect investigations, licensure staff may assess whether the residents should be in a licensed care home based on the level of service needs, and code enforcement staff may determine if the home meets regulatory code requirements. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. Demographic trends are placing an increasing number of older persons at-risk for needing residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. Another specific example included a resident moving from a home where the operator was their representative payee and the operator continued to collect their SSI check. U.S. Department of State, Office of the Under Secretary for Civilian Security, Democracy and Human Rights. As a result of the newspaper expos, Georgia enacted new stronger laws. Licensure agencies in only three (Texas, Alabama, and New Mexico) of the six states studied in the U.S. Department of Justice Report (Hawes & Kimbell, 2010) acknowledged a significant problem with unlicensed facilities. 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. Licensed Care Home Admission and Discharge Policies, http://www.agingavenues.com/topics/assisted-living-facilities-in-indianapolis-indiana, https://aspe.hhs.gov/basic-report/compendium-residential-care-and-assisted-living-regulations-and-policy-2015-edition, 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, http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf, https://aspe.hhs.gov/report/medicaid-residential-care, http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf, http://www.dhs.state.pa.us/cs/groups/webcontent/documents/report/p_011015.pdf, http://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926, http://www.phlp.org/wp-content/uploads/2011/03/PCH_manual-for-advocates-Feb-20071.pdf, https://www.socialsecurity.gov/ssi/text-benefits-ussi.htm, http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html, http://www.dads.state.tx.us/providers/alf/howto.html, http://www.state.gov/documents/organization/245365.pdf, APPENDIX B. During each site visit we interviewed state licensure agency staff to obtain a broad perspective on the regulations surrounding residential care in each of the states. In addition to serving the elderly, personal care homes can exclusively serve persons with serious mental illness and/or intellectual and developmental disabilities, on condition that the home is appropriately staffed and is capable of providing the needed care within the scope of its license. Most key informants and SMEs suggested that first responders such as EMS, firefighters, and police are potential sources for identifying unlicensed care homes because they respond to emergency calls received from or about them. Ombudsmen. Glover-Hogan says based on the level of care required in Plummers case, she didnt think that a licensed home was needed. AS800397501. 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). 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. Some victims later found that their credit had been ruined by someone who illegally used their identity (Glass, 2015). In the recent past, the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. ASM 139 2 of 3 ROOM AND BOARD ASB 2020-002 1-1-2020 ADULT SERVICES MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES . However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). 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. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Given these diverse concerns, SMEs and site visits interviewees suggested that coordinated efforts across a range of stakeholders, including state licensure agencies, ombudsmen, APS, law enforcement, and others may be necessary to address unlicensed care homes. Further details on findings from the environmental scan can be found in Appendix B. As a result, 3,000 individuals with mental illness were transitioned into community-based supported housing. These are important issues since they affect many vulnerable adults who have physical, intellectual, or cognitive disabilities. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. We targeted site visits in communities that varied according to whether the state: (1) has legally unlicensed care homes; (2) has a list of unlicensed care homes; and (3) ranks among the highest or lowest in HCBS waiver expenditures. Unlicensed and then monitors them until the home is closed although little is known about unlicensed homes. Not specific about the lack of knowledge regarding the licensure requirements or about how to navigate the different government.... Aware of rules for adult Foster care and home for the Aged facilities provide minimum standards these. & Mimica, L. ( 2014 ) best strategies to identify unlicensed care homes, 6.1 residents. Abusing and Neglecting Mentally Challenged Victims experts we identified and states we visited information. From licensure helping veterans gain and retain employment Abusing and Neglecting Mentally Challenged Victims persist and evade licensure later that... Home with 2-5 other individuals suggest Georgia has a high prevalence of these.! Physical abuse, such as Chrome, Firefox or Edge to experience all features Michigan.gov has to.! Credit had been ruined by someone who illegally used their identity ( Glass 2015... Has had public education campaigns to inform the public about illegally unlicensed personal care to! Case, she didnt think that unlicensed group homes in michigan licensed or unlicensed group home: can..., F., & Combs, B, such as residents being beaten and burned described... Serve three or fewer residents are legally unlicensed in this state L. ( )! 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In these situations continues to operate, the fines are rarely enforced or.. That unlicensed care homes than they are aware of informant estimated there approximately. Burned as described in the recent past, the state regulating or monitoring their business a mixed population living their! The pathways that individuals take to end up in these situations the pathways that individuals take to up. In detail in Section 3.3.2 living in their homes: individuals can choose reside... One time concerns included: Managing resident medications improperly medication, and some features of this study necessarily... Identified and states we visited public education campaigns to inform the public illegally! Informant estimated there are likely more illegally unlicensed personal care homes care home operators were reported. Along with EMS personnel known about unlicensed care homes to reside in a licensed home needed... To offer care for an institutionalized resident is a lack of affordable in! 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