For many of these individuals, their only option may be unlicensed facilities. One state key informant told us that the state licensure office is currently working on an amendment to add a graduated fine system which would increase fines overtime for those operators who are repeat offenders which could potentially serve as a deterrent to continuing illegal operations. Unlicensed homes to face more state scrutiny - ajc According to key informants, this graduated fine system is intended to be a "bigger hammer" to stop "belligerent repeat illegal operators. If the facility does not close, law enforcement (not the state licensure offices) fines the illegal operation $50 for the first offense and $500 for each additional offense. Very little discussion centered on improving the quality of unlicensed care homes. They are a leading provider of top-notch senior care and assisted living solutions. One way to collect this information to develop a frame of unlicensed care homes and conduct a small scale study of unlicensed care home operators. 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. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' Some states allow them to assist with medication storage but not with ADLs. 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 state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. They described this as an example of operators running unlicensed care homes strictly for the money. Her e-mail addresses is: Emily.Rosenoff@hhs.gov. Once an illegally unlicensed personal care home is identified, it is tracked at the local level to see if it has moved, or, in the case of closure, if it has reopened. New Jersey and Tennessee have a licensure category that specifies the maximum number of beds required for licensure, but not a minimum, which also implies that in these states some residential care homes may be legally unlicensed. 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). NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. Several states have taken steps in improve oversight of unlicensed facilities, often as a result of newspaper exposs on unlicensed residential care homes. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. One key informant explained how North Carolina regulations restrict ombudsman activity in unlicensed care homes, stating "our structure is pretty clear as far as the accountability," implying that the regulations make ombudsmen unaccountable for residents in unlicensed care homes. In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. One Florida media report estimated there were hundreds of congregate living facilities across the state that escaped state oversight because no agency regulates them (Savchuk, 2013). Although a coordinated, multidisciplinary effort appears necessary to comprehensively address unlicensed care homes, several key informants discussed the lack of ombudsman jurisdiction to access residents in unlicensed care homes. Another title, direct support professional, describes an unlicensed caregiver who helps clients with special disabilities. 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. dressing, using the toilet) for someone who's unable to fully One key informant also emphasized that the limited monitoring of legally unlicensed care homes limits the state's ability to identify and subsequently address any issues of quality or safety in these settings. 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. 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. Some continue to operate after their license expired or was revoked. The state's BHSL office also has the legal authority to act as an enforcement agency. Currently at the state level, the primary strategy used in Georgia to identify unlicensed care homes is through complaints, including complaints from neighbors, residents, residents' family members, and hospitals serving residents of unlicensed care homes. From our review of states' regulatory information on licensed residential care categories during the development of the sampling frame for the 2014 National Study of Long-Term Care Providers, and our review of ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy (2015), we found the following. Anne Arundel County Fire Department, Millersville, Maryland. 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." Specific concerns included: Managing resident medications improperly. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns. 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). Some operators remain undetected by moving residents from one facility in one state to another facility in another state. Traditionally, Medicare does not cover Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. In the first half of 2013, 37 other unlicensed homes had been identified. perform those activities without help. Retrieved from http://www.state.gov/documents/organization/245365.pdf. SENIOR LIVING - 55 Plus Apartments, Independent Senior Living, Affordable Apartments, Downsizing & Estate Sales, Moving Services, Locator Services Improper medication assistance and management were most commonly noted by key informants as problematic; informants were concerned that operators or staff of illegally licensed care homes may not be properly trained in medication management and administration. There exists confusion over the authority of other agencies. In either case, while states regulate and provide some level of monitoring and oversight of licensed care homes, state and local oversight of unlicensed care homes can be minimal or non-existent, and these facilities provide questionable care and services. Residents of unlicensed care homes are vulnerable adults. 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. If ombudsmen become aware of such discharges, they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities.
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