unlicensed group homes in michigan

North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. 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. The State of Michigan does not license assisted living . 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. 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). Residential care homes that are legal often serve as covers for or conduits to illegal homes. There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. Poor quality of care, instances of physical abuse, toxic combinations of medication, and use of stun guns, were also reported (National Association of Medicaid Fraud Control Units, 2015). Listen Live HERE! Call in number 917-388-4520 Although this regulation reduced the number of legally unlicensed care homes and reduced their capacity to three or fewer residents, many key informants in Pennsylvania noted that this had the unintended consequence of spurring many more illegally unlicensed care homes to open. The issue of financial exploitation is described in detail in Section 3.3.2. 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). Licensing rules for family child care homes can be found in Sections 400.1901-400.1963 of the Michigan Administrative Code. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. NBC News 4, Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-of-Abusing-and-Neglecting-Kamara-Zanaib-268343912.html. x][o~ ^/o{)u4M!"KH336jTp87O[Gdz>;OW~|mZ~Nf/OeT61J4IX>b]}X The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions. None of the reports provided evidence on the prevalence of unlicensed care homes in these states or the magnitude of the issue statewide. 200 Independence Avenue, SW He said, well youre supposed to and I can name several violations right off the top, said Klavinger. We found little published information about unlicensed residential care homes; in fact, the scan revealed that most of the literature about conditions in RCFs covered licensed residential care or were about unlicensed care staff. Some operators use homes that do not meet personal care home building code regulations; for example, the home may lack proper ramps for wheelchair access. First, there is a lack of information about the effect of various state and national policies on the vulnerable individuals the policies were designed to protect and whose well-being they were intended to enhance. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. 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. Audio podcast. Abuse, Neglect, and Financial Exploitation, 3.4. The state has started training sessions to educate law enforcement and first responders about unlicensed care homes, and these education efforts may contribute to the state's ability to identify unlicensed personal care homes. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. 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. Key informants included representatives from the state licensure office. endobj 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. Resident Case Mix. Retrieved from http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf. Although the residents who were moved out of this hospital may have been relocated to licensed facilities when the hospital closed, the fact that such institutional settings are no longer an available option may have encouraged unlicensed care homes to open. 3.5.3. Retrieved from http://www.miamiherald.com. One woman was marketing heavy to the hospitals, and taking them to the licensed facilities, and then moving them to the unlicensed facilities, in result to those types of facilities. Adult Foster Care If the illegally unlicensed personal care home can be deemed unsafe, code enforcement has the authority to condemn the building and shut the illegal operation down. Interviewees pointed to financial incentives related to managing SSI recipients' checks as one specific motivator. 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. Another motivation to operate an unlicensed care home, equally mentioned by key informants, relates to costs directly associated with meeting building code requirements specified in the regulations. This report describes the methods used to conduct the study, summarizes the information learned from an environmental scan and the results from interviews with subject matter experts (SMEs) and site visits, discusses implications of the findings and, based on the study findings, offers recommendations for future research on unlicensed care homes. In some instances, these places may be certified or otherwise listed at a local level, but they may not be monitored by the state for quality and safety issues. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. 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. 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. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. Although limited in scope, the study provides foundational information about unlicensed care homes based on a narrow review of the literature and the reports of select SMEs and key informants in three states. Available at http://www.ncjrs.gov/pdffiles1/nij/grants/229299.pdf. Troubled residents languish in flophouses. Education: Statewide or Interagency. Three states (District of Columbia, Maryland, and Mississippi) have no minimum bed size for licensure, implying that some residential care homes can be lawfully unlicensed. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. Strategies used to address health, quality and safety issues in unlicensed care homes. The Allegheny County PCRR has sent letters to hospitals and their discharge planners informing them about known illegally unlicensed personal care homes to which they should not discharge patients; however, according to two key informants, discharges to these homes have continued. All of the key informants shared their perspectives about what is driving the closure of personal care homes. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or states. We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes. 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. nmpV[0VM.T1B2L3qHY' w|Z?paTjSy`6GEk1BL67d.VX7dNO!7hj. As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. After a legal challenge this fall, Mrs. Plummers son and cousin are now her guardians, and she is now living at home with relatives. He also noted that they were not currently using the system in this way, and that it is mostly used to note unsafe locations (e.g., places known for drug trafficking and drug use, or for having dangerous dogs). 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. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. These included: (1) tracking individuals' public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. SMEs and key informants consistently noted that many low-income individuals cannot afford licensed facilities, which makes the less expensive unlicensed care home an attractive option, and thus contributes to the existence of unlicensed care homes. One key informant shared that, as part of such a campaign in 2012, advertisements were placed in metropolitan areas warning the public against placing people in illegally unlicensed personal 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. According to key informants from APS and law enforcement, care home operators and residents crossing state borders poses several challenges that make it difficult to ensure the safety of residents and address the criminal activities of the operators. But there are homes providing room, board, and personal care that either fall outside the bounds of the state licensure requirements or are deliberately avoiding state licensure requirements. Social Security Administration. 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. 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. While many key informants stated that illegally unlicensed personal care homes primarily serve adults with a wide spectrum of mental health disorders, they also noted that some of the residents in unlicensed care homes are frail and elderly individuals. QX;zI!({?^2'hy^xe(z>! Assisted Living Facility (ALF) - Residence for at least 3 unrelated adults, at least 80% of whom are age 55 or older. Key informants also cited the process of discharging patients from hospitals in Allegheny County as a potential source for linking individuals with illegally unlicensed personal care homes. 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. (n.d.). As with health and safety concerns, the environmental scan and interviews conducted with SMEs and key informants revealed myriad concerns about abuse, neglect and financial exploitation. As described earlier, some of our key informants noted that hospital discharge planners knowingly discharge these individuals to unlicensed care homes to alleviate the immense pressure they are under to facilitate quick patient turnover, and some hospitals reportedly will pay unlicensed care homes to admit these individuals. Also, new HHS Centers for Medicare and Medicaid Services (CMS) policies on waivers and where waiver services may be provided may alter the prevalence of legally and illegally unlicensed care homes across the nation. Another strategy is the creation and involvement of interagency and multidisciplinary teams at the state and local levels, which based on our key informant interviewsappears to be a successful strategy. Charlene Glover-Hogan is a Public Administrator, a lawyer appointed by Michigans Attorney General to handle probate estates after someone dies. The report, which is public record, tells Clarisse Carter that she has been providing adult foster care, and says any person who provides foster care for 24 hours a day, 5 or more days a week, for 2 or more consecutive weeks for compensation without a license is in violation of [Public] Act 218.. State licensure offices primarily depend on complaints via phone calls3 that come first to a local county APS or regional licensure or monitoring office. However, several SMEs and key informants noted that some unlicensed care homes are good and provide a clean, safe environment for individuals who might otherwise be homeless. Interviewees had varying opinions on the causes for Dom Care homes closing. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. Finally, as noted later in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or being unnecessarily institutionalized. Strategies for Addressing Conditions in Unlicensed Care Homes, 6.1. The closure of large mental health institutions and concomitant transition of previously-institutionalized individuals with severe and persistent mental illness to community-based care settings, such as legally unlicensed care homes. Retrieved from http://www.ajc.com. (2015). We also heard of operators not reporting the death of a resident to SSA so the operator could continue collecting the resident's checks from the government. Schneider, C., & Simmons, A. The LME-MCO oversees contract services in a four county area. These homes often serve very vulnerable individuals such as individuals with serious mental illness or other disabilities, or older adults with functional limitations and limited financial resources. For example, one SME from a state licensure office reported that their database does not include information on whether the call pertains to a licensed or unlicensed care home. However, we did not hear any specific examples of this from the state or local level. 52ND STREET HOME. LARA is proud to be recognized as a Veteran-Friendly Employer committed to military veteran recruitment, training and retention practices. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes. Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. For many of these individuals, their only option may be unlicensed facilities. Calvin Leslie agreed to a sentence of 10 to 25 . MACOMB. In response, the legislature has appropriated $260,000 to relocate residents identified as living in unlicensed care homes. Interview findings indicate that a key element of a successful strategy is collaboration across multiple agencies. 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. Another key informant suggested that it would be key to involve the LME-MCO because they cover a four county area and must receive calls that are about unlicensed 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. This implies that the LME-MCO does not always check licensure status before coordinating services in unlicensed group homes. Texas: A 2007 media report, outside the scope of this review but important to mention, notes that city officials in Dallas estimated that there were at least 350 unlicensed, unregulated board and care homes that house 2,500 people across the city, and likely there were more than that (Hancock, 2007). Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. Additionally, some of what we heard about policies that affect demand for and supply of unlicensed care homes was based on the opinions of the individuals interviewed and may not be representative of others' views, and we do not have data to support these viewpoints. Group homes generally charge less than larger assisted living communities, in . Key informants stated that many illegally unlicensed personal care homes they investigate are being operated by repeat offenders who have done this in the past; these same operators just open new illegally unlicensed personal care homes once they are found out. Savchuk, K. (2013). He called Glover-Hogan, and said did you visit? 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. Klavinger says his grandmother, 80-year-old Mary Helen Plummer, had lived on her own for years. This key informant also noted that the residents frequently transition in and out of the home, as is often the case with illegally unlicensed personal care homes. Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. As noted above, placement agencies work with Allegheny County hospitals and discharge planners, therefore these agencies may also have lists that include illegally unlicensed personal care homes. I'm not going to report it. 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). Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont, Alaska, Minnesota, and Oregon). 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. For example, in Georgia it recently became a misdemeanor to operate an unlicensed care home,therefore we aimed to speak with law enforcement officials who had been involved in the process of investigating unlicensed care homes. This became evident during discussions with informants in Pennsylvania and Georgia; it has also been reported in the literature, as we found in the environmental scan. We would strongly try to encourage the courts and educate the courts on that, to make sure that those guardians and placing agencies are placing them in a proper setting, said Horvath. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. The agencies do not typically get complaints from residents inside the home, although if the home is bringing in services such as home health or hospice nurses, those outside agency staff could file reports that result in the identification of an illegally unlicensed personal care home. 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. 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). Interview findings also suggest that research is needed on the best strategies for identifying unlicensed care homes and effectively closing them down. The base rate is $982.46. However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). 4GEMS ADULT FOSTER CARE. Interagency and Multidisciplinary Teams. 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. Three reports are worth noting separately. We also heard suggestions from some SMEs and state stakeholders for improving safety and quality. One strategy recommended by key informants to address unlicensed care homes is to change the regulations to reduce the number of unlicensed care homes that operate legally. This is evidenced by the number of reports and complaints received about unlicensed personal care homes, the number of hours spent by law enforcement officials on investigating unlicensed personal care homes, and the estimates given of the numbers of unlicensed care homes that are operating in the state (reported by one informant as one unlicensed care home for every licensed home). 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. 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. 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