County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. In 2012, the state mandated that large adult care homes (seven or more beds) housing only individuals with mental illness had to close because they were considered institutional settings. Multiple interviewees suggested that it was important to quickly involve code enforcement and local health departments in efforts to close an illegally unlicensed personal care home. 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. 3.4.5. Pennsylvania was selected as a site visit location because of the state's past and current experiences with illegally unlicensed personal care homes. Assisted living provider resources: Unlicensed facilities. This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azmfairall, 2013). Licensure regulations lack clarity regarding requirements for minimum bed size. 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. With the passage of a new law in July 2012, it is a misdemeanor to operate an unlicensed personal care home, and if an unlicensed care home is linked to abuse, neglect, or exploitation, the violation is considered a misdemeanor. One issue that remains to be determined is the conditions or criteria by which such places constitute "unlicensed residential care homes." For example, home care aids are a very cost-effective way to give your loved one the support they need while living at home. The frequently reported act whereby the operator of an unlicensed home makes money from their control of vulnerable residents and moves these residents from one unlicensed care home to another to avoid detection, led one SME to refer to it as "human trafficking." Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. For instance, they may start by caring for one resident, and gradually take in more individuals without realizing there are state regulations governing homes caring for two or more unrelated adults. Care costs: residential care, nursing care, dementia care. Further, it is the responsibility of the owner to determine whether the home needs a license. We conducted an environmental scan primarily focused on information spanning a five year period from 2009 through 2014. Other Research Ideas Suggested by Subject Matter Experts or Individuals Interviewed in State Site Visits. 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. In other cases, the unlicensed facility simply ignores the law and operates below official "radar.". They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. 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. The AAA office, APS, Disability Rights Network, and state or regional licensure offices can receive complaints concerning resident care that may lead to the discovery of illegally unlicensed personal care homes. Her e-mail addresses is: Emily.Rosenoff@hhs.gov. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. Here are five scary facts about nursing home care: Fact #1: You could spend $96,000 a year on nursing home care. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. 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. While we were specifically told by two key informants that the LME-MCO can only contract mental health services and supports to licensed group homes, these same key informants also shared specific examples of the LME-MCO unknowingly contracting services to unlicensed group homes. Additionally key informants indicated that many unlicensed care home residents who receive SSI payments participate in Social Security's Representative Payment Program, whereby payments are managed by an individual or organization that is representing the beneficiary because the beneficiary is unable to manage the payments independently. They can fine the operator directly which may lead to the unlicensed care home being forced to shut down. Also, Indiana state law requires legally unlicensed assisted living facilities to submit disclosure forms to the Family and Social Services Administration within the Division of Aging; thus, the state may be able to compile a listing of legally unlicensed facilities. Barry, R., Sallah, M., & Miller, C. (2011). Illegally Unlicensed Residential Care Homes, 6.3. 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. 3.4.4. 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. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. He argued that comprehensive emergency management planning and proactive practices were needed to protect those at risk in unlicensed homes. First conviction is a lack of knowledge contributes to the number of experts identified. 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