Which states have had an increase or decrease in the number of unlicensed care homes and why? 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. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. Schneider, C., & Simmons, A. 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. Several informants reported that it is common for the operator of an unlicensed care home, or representatives designated by the care home operator, to serve as the representative payee for the residents. This generally creates a care ratio of three guests to one care provider. When you sign up for email updates, you are giving your information to both HHSC and to Granicus. Arizona Department of Health Services. Retrieved from http://www.ajc.com. In other types of residential care, if the care is arranged or managed by the owner, manager, or staff of the building, home, or community, then the facility must be licensed. Monograph for the National Institute of Justice, U.S. Department of Justice. The same held true, with one exception (Georgia), for the top ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island, Alabama, Tennessee, Georgia, New Hampshire, Massachusetts, and Delaware. One key informant stated that one in four residents of Allegheny County are over age 60, and that this population presents a growing need for affordable residential care homes. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. As noted by one SME, unlicensed care homes that provide good care and a safe environment may intentionally not be brought to the attention of state agencies nor be reported by these agencies when they learn of these homes: "We do receive reports, about 6 months ago someone wrote to me about their mother who was getting care in an unlicensed homeshe was getting wonderful care, she wasn't going to report it. 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. 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. 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. Several SMEs and key informants noted that individuals who had only SSI to pay for care have few options for housing and care, and often end up in unlicensed care homes. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners. The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified ten states that spent the highest percentage of their LTSS expenditures on HCBS and those that spent the least. Characteristics of Residents and Unlicensed Care Homes. Perils in personal care homes. Some interviewees reported that unlicensed care home operators sometimes run homes in more than one state, across state borders to avoid arrest, and may be trafficking residents across state borders as well. In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. 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). This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. One interviewee, who interacts with residents of unlicensed care homes on a daily basis, estimated that for every licensed personal care home in Georgia there is one unlicensed care home. Health, Safety, and Sanitary Conditions. In Pennsylvania, facilities providing or arranging for housing, food service, and one or more personal care needs for four or more unrelated adults must be licensed as personal care homes. In multiple interviews, unlicensed care home operators were described as being involved in human trafficking, and also were specifically noted by APS and law enforcement officials to traffic residents across state lines, specifically into Florida and Alabama, to avoid legal action in Georgia. PHC providers must be licensed as a Home and Community Support Services Agency (HCSSA) within the category of Licensed Home Health Services, Licensed and Certified Home Health Services, or Personal Assistance Services and have a contract with HHSC to provide PHC services. Two key informants spoke about the lack of oversight of these homes and the concern for the well-being and safety of their residents. (Producer). The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes, both intentionally and unintentionally. Unlicensed assisted living facilities. Hancock, L. (2007). A review of state regulations around long-term care ombudsmen could reveal gaps and opportunities in how ombudsmen can access and advocate for residents in unlicensed care homes. need for senior care services and the choice of a facility is an One key informant stated that if a call comes in and the name of the care home that is being reported is unknown, then the next step is to call the state licensure office. Costs for operating a licensed personal care home can include state fees for licensure, structural renovations or changes to meet required building codes, paying for staff to be on-site 24 hours per day, and paying for and providing adequate staff training. Officials with the Texas Department of Family and Protective Services said they removed 25 people from the home a week ago in the 200 block of FM 723. . An operator with this population mix can avoid licensure because each agency is only responsible for the residents that are enrolled in their program or waiver. During site visits, key informants reported that owners of licensed care homes often report operators of unlicensed care homes to authorities. 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. references to products, services or publications do not imply the It is worth noting that this research activity would require developing an operational definition of "unlicensed residential care home," since definitions vary considerably across and sometimes within states, as some focus on services offered, some on size, and some on the characteristics of the residents. 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. Barry, R., Sallah, M., & Miller, C. (2011). In the states we visited, a common theme across interviews was that addressing quality in illegally unlicensed care homes tends to focus on shutting down the operations.

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