Abusive Unlicensed Care Homes Are ‘Hidden In Plain Sight’ In America, Researcher Says

After completing a year-long study on unlicensed care homes in the United States, researchers are recommending among other things further investigation, more oversight and new ways to locate homes where they say “egregious crimes” are being committed against the elderly, disabled and mentally ill.

The independent, non-profit research firm, RTI International, completed the exploratory study and report for the Office of Disability, Aging and Long-Term Care Policy and the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services (HHS) following reports by media, first responders, family and others that situations of abuse and neglect were occurring in unlicensed care homes in America.

Researchers reported to HHS that key informants and subject matter experts interviewed for the study commonly described the conditions in these 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 expert pointed out that “many unlicensed care home cases are analogous to human trafficking, such as when residents are held against their will and then moved from one location to another to avoid detection; however, the current federal definition of human trafficking specifies that the trafficking is done for the purpose of labor or sex, and not for the collection of public benefits (U.S. Department of State, 2015).”

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).”

And while researchers admitted there are some homes providing good care at a fair cost, “…what we heard most of were relatively extreme cases of abuse, neglect and exploitation. While not all unlicensed care homes are illegal or pose a threat to low income seniors and individuals with mental illness, many are places where egregious crimes appear to be committed by staff,” said Michael Lepore, Ph.D., RTI senior health policy and health researcher and author of the report.

Lepore and his fellow researchers concluded that unlicensed care home facilities pose serious potential risks for seniors, and that individuals with mental illness and older adults with disabilities are particularly vulnerable to potential abuse.

Michael Lepore, Ph.D., RTI senior health policy and health researcher.(Photo Courtesy of RTI International)

Lepore specializes in researching long-term care services, especially services for older people residing in nursing homes, assisted living facilities and other residential care settings in the United States and internationally. He leads a wide range of research including the development and implementation of quality measures and reporting programs, the improvement of specialized services for people with dementia and their caregivers, and the analysis of federal and state Medicaid policies influencing access to and use of home- and community-based services.

Currently, Lepore is helping launch the Centers for Medicare and Medicaid Services’ skilled nursing facility quality reporting program and providing expert technical guidance on dementia care to the Administration for Community Living and its state and community-based grantees who are implementing programs to improve their dementia capability.

Informants reported concerns that many unlicensed care homes were not meeting even minimal standards of service including personal care service and medication supervision. “Conditions in UCHs were commonly but not exclusively depicted as unsafe, unclean and unsupportive of health and well-being. Some interviewees made it clear that clean and safe UCHs that provide good care exist. However, these ‘good’ places were overshadowed by the ‘bad’ ones during our interviews and in the literature,” the report states.

Still, Lepore is hopeful, and his team offered recommendations to HHS. “Our findings suggest that states may need to pay particular attention to ensuring the availability of sufficient and affordable licensed residential care facilities or other supportive housing options that offer person-centered care in a safe and appropriate environment,” he said.

Other suggestions researchers offered include:

  • Additional research on unlicensed care homes to build understanding of the role–intended or unintended–of these places in long-term services and supports systems and the policies affecting it.
  • Further investigation of unlicensed care home operators actively recruitming residents from hospital psychiatric units and shelters.
  • Finding new ways to locate unlicensed and/or illegal care homes.
  • Improving oversight of discharge practices from hospital psychiatric units as well as stronger admissions practices of the licensed facilities as they are not accepting the people who often end up in unlicensed care home.
  • Increasing access to licensed residential care facilities for low-income individuals in order to help decrease the demand for unlicensed care homes.
  • Finding strategies for making vulnerable elderly, disabled and mentally ill individuals  beneficiaries of Medicaid so their ability to pay could be addressed.
  • Assist the unlicensed care facilities that are providing good care with becoming licensed.
  • Corroboration between states on how each independently identifies and monitors its facilities.

Because unlicensed care homes can be anywhere, it might be that we actually should be our brother’s keeper, Lepore said. “These unlicensed care homes often are operating in individual single-family homes in residential neighborhoods. These homes could be in anybody’s neighborhood. They are hidden in plain sight,” Lepore said.

The report suggested states implementing “public awareness campaigns to support identification of unlicensed care homes.” Pennsylvania, for example, 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.

Additionally, friends, neighbors and family can be vigilant in identifying the following suspicious scenarios:

  • Residents in the same clothing every time they see them.
  • Stolen electricity and utilities from neighbors’ houses.
  • Possibly licensed care givers as fronts to unlicensed care homes.
  • Back houses can be a visual sign of additional residents or an unlicensed setting.

Lepore said it is often through “complaints by neighbors that these places are identified.”

To read more about what researchers at RTI found in their study, click here.

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