unlicensed group homes in michiganunlicensed group homes in michigan

Although the majority of key informants described unlicensed care homes as unsafe environments where residents are abused, neglected, or exploited, it also was noted that some unlicensed care homes may provide quality care in safe and clean environments. Based on the collective feedback of a diverse group of key informants, unlicensed personal care homes appear to be prevalent and problematic in the state. 48317. Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. 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. 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. Managing the care needs of low-income board-and-care home residents: A process of negotiating risks. Furthermore, many licensed facilities are unwilling to admit or retain individuals with challenging behaviors. 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 that 30 states require residential care homes to be licensed if they have at least one bed. Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. Carder, P., O'Keeffe, J., & O'Keeffe, C. (2015). Study staff screened each of the collected articles, blogs, and reports to identify relevant material for review. Which agencies get involved when addressing unlicensed care homes? Pennsylvania Department of Public Welfare. Social Security Administration. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. After a legal challenge this fall, Mrs. Plummers son and cousin are now her guardians, and she is now living at home with relatives. 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. Referral and Placement Agencies and Discharge Planners. Two of our three site visit states aimed to enhance awareness of poor and inadequate unlicensed care homes by increasing education for the public and key stakeholders: Pennsylvania held a statewide education and marketing campaign to inform the public about unlicensed care homes, and Georgia conducted training sessions to educate law enforcement and first responders about these homes. Interviews with key informants also indicate that many residents are poor and receive Supplemental Security Income (SSI) benefits from the U.S. Social Security Administration (SSA); the SSI program pays benefits to disabled adults and children who have limited income and resources. First Responders: EMS, Firefighters, and Police. 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. However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. 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. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. As a result, we also examined HCBS expenditures in a select number of states. Following the development of the initial list of SMEs, we divided the list into two categories: (1) a subset of individuals identified as "key experts" who would be prioritized for interviewing because we determined they had relevant information related to unlicensed care homes; and (2) individuals identified as "potential experts" who would first be vetted to determine their level of knowledge about unlicensed care homes. Strategies for Addressing Unlicensed Care Homes. 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. States with concerns about quality and safety in unlicensed care homes may also wish to examine their requirements for monitoring legally unlicensed care homes and the information available about safety and quality in these places. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. (2012a). Licensure regulations lack clarity regarding requirements for minimum bed size. Licensure and APS have the same difficulties in terms of moving residents out of unlicensed facilities into good supportive housing sites (Hawes & Kimbell, 2010). 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. By taking control of the resident's benefits, the operator controls the resident's funds, and should be using those funds for room and board and other beneficiary expenses. In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect. Media reports described operators that continued to operate after their licenses expired or were revoked. 4GEMS ADULT FOSTER CARE. In the past few years, Georgia has developed an interagency task force including law enforcement and social services agencies which has trained and prepared many staff to deal with these homes. There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited financial resources. There are three ways to file a LARA report with the State of Michigan. The State of Michigan does not license assisted living . Concerns remain that agencies do not have the resources to monitor and follow through with the appropriate actions (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the facility remains closed and has not reopened in another location) for the unlicensed facilities. Indiana: An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. AS800397501. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. Based on our findings, the residents of these homes are extremely vulnerable. However, even with those limitations, we know that in the communities we visited, there were significant health and safety concerns for residents, as well as concerns about financial exploitation and government fraud. <> 52ND STREET HOME. Although we attempted to conduct interviews with operators of unlicensed care homes on our site visit states, we could not identify or gain access to any. The process requires that adult foster care licenses are in compliance with the rules for adult foster care group homes. In Michigan, you can have both. 722.622 Definitions. Schneider, C., & Simmons, A. 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). 2 0 obj 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. Dirt was evident over the walls, floor and stairway.. QX;zI!({?^2'hy^xe(z>! 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. MACOMB. However, we did not focus on these populations in the interview. The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices. These legally unlicensed residential care homes are exempt from licensure because they do not provide 24-hour supervision, though residents may be receiving intermittent skilled nursing care, and help with ADLs, medication administration, and social activities. 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. State and Local Policies Related to the Supply and Demand for Illegally Unlicensed Care 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. 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. Centers for Medicare and Medicaid Services. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements or other rooms, given buckets for toilets, and had their benefit checks taken from them. 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 Adult Foster Care Act (PA 218 of 1979) and the Public Health Code (PA 368 of 1978) provides the Departments authority to establish these rules. One of the SMEs shared comments from ombudsmen that the numbers of unlicensed homes in some states are increasing, while in other states, they reported that they had not heard about unlicensed care homes. Retrieved from http://www.miamiherald.com. . Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. What is the scope of concerns in unlicensed care homes, including quality of care, safety, sexual or physical abuse, and financial exploitation concerns? A Homes for the Aged (HFA) provides 24-hour room, board, and supervised personal care to: 21 or more unrelated, non-transient individuals 55 years of age or older. Key informants in Pennsylvania speculated that owners of legally unlicensed care homes may have direct experience operating an illegally unlicensed home or know someone operating one, and therefore may be able to help identify unlicensed homes or their operators. 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. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development, and is responsible for major activities in policy coordination, legislation development, strategic planning, policy research, evaluation, and economic analysis. In addition, the APS staff in Pennsylvania had recent communications with local hospital discharge coordinators informing them about known illegally unlicensed care homes and asking them not to discharge patients to these settings; however, key informants noted that hospital discharge planners continue discharge individuals to known unlicensed care homes. She said no. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. Michigan Office of Administrative Hearings and Rules. Some residents were also described as transitional or homeless, while others were described as persons with substance use disorders. Finally, as noted in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or unnecessarily institutionalized. The North Carolina Mental Health Licensure Office licenses group homes for adults with mental illness.5 These homes also serve two or more adults. 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. 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. 8"r7GrAg 365o){11c>9c)T:/V;Mi/nf>b-agH3z=r+Bb0a^0 XPX;.GbJ\ ^koLs%t)+#&l. In some states, residents can pay for their own personal or medical care in an unlicensed facility. In Iowa, legislation to restrict the actions of some operators of large licensed assisted living facilities to recategorize or redefine themselves as a "residence," (e.g., boarding home) that does not require licensure was proposed but did not pass. Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. The average rate is $1,200 to $3,000. Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). The information focused on specific cases, but not on how many of these places exist in these states. 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." Key informants described the regulatory agency's ability to work with an operator of an illegally unlicensed personal care home to help facilitate the home obtaining licensure. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. 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. Some key informants noted that EMS personnel are a better source than firefighters to learn about unlicensed care homes in a community because EMS personnel respond to all emergency calls while firefighters do not. Michigan Agency Michigan Department of Licensing and Regulatory Affairs, Bureau of Community Health Systems, Adult Foster Care and Homes for the Aged Licensing Division Contact Ashley Harris E-mail HarrisA29@michigan.gov Phone (866) 856-0126 or (517) 284-9700 We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants. Providers of housing and care services that are licensed by the state, such as nursing homes and residential care facilities (RCFs), serve some of these individuals. In many cases, the cost of care in other settings is too high for what individuals with severe and persistent mental illness can able to afford on their SSI stipend. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. They capture key variables such as the name and any aliases of the illegally unlicensed care home; the owner's name and whether they own more than one unlicensed care home; the licensure status (formerly licensed, never licensed, operating illegally); and any relevant information about the complaint (e.g., investigation dates, or dates any residents were moved/relocated). In one court case, the judge deemed a "boarding house" as an unlicensed residential care home because only three of the six people renting rooms received personal care from the owner's licensed home care agency, even though four actually needed those services. Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. 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. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. The environmental scan and SME interviews informed state selection for site visits. Facilities providing or arranging for housing, food service, and one or more personal services for two or more unrelated adults must be licensed by the state as a personal care home. Most key informants noted that hospital discharge is a critical juncture at which individuals can be directed to, or end up in, unlicensed care homes. 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. Theft of government benefit checks (e.g., SSI, Social Security, food stamps, Medicaid, veteran's checks) was common, with one case in which operators diverted more than $790,000 to themselves. Call the Complaint Hotline at 800-882-6006 and make your report. 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. A core pattern of exploitation described in interviews included the operator of unlicensed homes finding vulnerable individuals who need housing and supportive services (such as from hospitals or homeless shelters), requiring these individuals to transfer their SSI payments to the operator or one of the operator's agents in order to become a resident of the unlicensed care home, severely limiting the residents' ability to leave the facility, and relocating the residents to alternate locations to avoid detection. In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety or appropriateness of those environments. In Michigan, a group home must be licensed if the owner receives compensation for providing personal care, supervision, and protection, in addition to room and board to people who are. While its not illegal for certain group homes in Michigan to operate without a license, when youre dealing with someone whos considered legally incapacitated, experts say most people in these situations do require care from a licensed facility. Other key informants stated that some operators do not want the state regulating or monitoring their business. Florida can impose fines of up to $1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). [12] State licensing for your facility is likely only the start of the process. Zoning Approval for Group Child Care Homes only (BCAL-3748). 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Notably, the strategy of responding to complaints limits the amount of information available about unlicensed care homes about which complaints are not made (i.e., possibly better quality homes). 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. (n.d.). According to the report, these warehoused residents are vulnerable older adults with "hard to place" mental health needs and paroled individuals. Strategies to Address Unlicensed Care Homes. (Hawes & Kimbell, 2010). In contrast, most key informants agreed that some operators start out with a smaller one to three bed legally unlicensed home and gradually end up caring for more residents, not realizing that doing so requires the home to be licensed. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. 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. Additional research on unlicensed care homes will be valuable to build our understanding of the role--intended or unintended--of these places in our long-term services and supports systems, and the policies affecting it. But after a family friend told the Oakland County Probate Court that Plummer was having memory loss, court records show a Judge appointed a Southfield attorney as a co-guardian. Key informants noted that it is important to know the history of Pennsylvania's personal care home regulation changes in order to understand why and how the state has addressed illegally unlicensed personal care homes. What information exists reflects a concern about the conditions under which residents in these places live. Assisted Living Facilities in Indianapolis, Indiana. Many interviewees mentioned monetary motivations of operators as one factor. Other states also track complaint calls as a means for identifying unlicensed care homes. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. If you seek a pleasant peninsula, look about you. Michigans official state motto holds many truths our state is a land of great splendors. As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.' Key informants also commonly described the conditions in unlicensed care homes as abusive, financially exploitative, and neglectful of residents' basic needs, and depicted situations that involved false imprisonment of the residents and repeatedly moving the residents from one facility to another, both within and across states, to evade law enforcement. One potential strategy suggested by an interviewee for proactively identifying unlicensed care homes is to hold community meetings to inform community members about unlicensed care homes, including ways to identify them and how to notify APS and licensure officials if they suspect an unlicensed home operation. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. Austin, Texas. Troubled residents languish in flophouses. Costs for bringing the building up to code to meet state regulatory requirements may be another reason why operators of care homes choose to remain unlicensed. 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. The base rate is $982.46. Owners of current small licensed personal care homes are also potential sources of information; they will be able to fully describe the monetary costs associated with licensure, and these costs appear to be one reason why some people choose to operate illegally. The team conducted interviews with key informants in each of these communities. "Caretaker" Accused of Abusing and Neglecting Mentally Challenged Victims. Cross-state human trafficking is another area for future research. Third, the findings suggest it is important to determine the nature and scope of abuse neglect and unsafe conditions experienced by people who have low incomes and physical and intellectual or cognitive disabilities. Leslie was arrested on multiple counts of abuse and. She was getting good care and it was something the mother could afford.

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