Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. 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. Ombudsmen program does not extend to unlicensed facilities (Hawes & Kimbell, 2010). However, a representative from a state advocacy agency estimated that about 2%-3% of their 4,800 calls annually, or approximately 120 calls statewide per year, were related to unlicensed facilities. Currently human trafficking is defined as "the act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts" (U.S. Department of State, 2015), however, one SME recommended expanding this definition to include the situation in which an administrator for the unlicensed care homes seize and maintain control of vulnerable individuals in order to maximize revenue by taking the public benefits that the individual may be receiving. Through a targeted series of interviews and a scan of the literature, we sought to contribute foundational information about unlicensed care homes. And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed. However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. One former fire department battalion chief reported that the elderly living in unlicensed residential care homes are hidden from the view of public health agencies, social service agencies, and ombudsman programs --the entities that generally protect and advocate for older people and individuals with disabilities. Clarifying this definition will be critical to understand the prevalence of unlicensed residential care homes, as well as the characteristics of residents in these homes. One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. A local ombudsman and APS supervisor lead the PCRR team and maintain lists of both known illegally operating homes and those that are potentially illegal operations. In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. (2013). A few key informants suggested cross-referencing different agency lists as another potential source for identifying unlicensed care homes. Monograph for the National Institute of Justice, U.S. Department of Justice. Multiple key informants also described another illegally unlicensed personal care home with several tenants, including a 91 year old man who had been tied to a chair with a sheet so he would not fall when the owner had to leave the home. Miami Herald. 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. According to several key informants in the state, including APS and law enforcement officials, the property, which they referred to as a boarding home, was being rented by the operator, members of the church served as the representative payees for the residents, and the money was then pooled together and given to the operator. Local key informants primarily expressed concerns regarding inadequate nutrition provided to residents and inappropriate medication management practices. Health Management Associates. State inspection staff, already overwhelmed with large caseloads, were required to obtain search warrants to execute searches, a time-consuming process, when trying to follow up on reports of unlicensed homes. azmfairall. Some operators remain undetected by moving residents from one facility in one state to another facility in another state. 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. Retrieved from http://www.gachiefs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuseWhitePaper.pdf. However, residents may pay for such services or receive them through Medicaid waivers. (2004). While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. One key informant shared a specific case of a repeat offender that operates an unlicensed adult care home out of a double-wide trailer. In 2005, Pennsylvania state regulations for personal care homes were changed, reducing the minimum number of residents a personal care home could serve from seven to four. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. While the information herein is not generalizable--it is based on a targeted scan and a limited number of interviews--it does highlight the fact that unlicensed care homes appear to be a problem in at least some states. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. 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. Some residents were also described as transitional or homeless, while others were described as persons with substance use disorders. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. A six-state study conducted by Hawes & Kimbell in 2010 for the U.S. Department of Justice, National Institute of Justice, found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. 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. Impairment. `` Responders: EMS, Firefighters, and provide social activities, as part of and. Informants speculated that these unlicensed facilities factors are involved non licensed care homes cost social relationships law to an! Advocacy agency also collects information about whether the operators own more than assisted. 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