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What populations do unlicensed care homes serve? For example, as part of interviews with SMEs, we asked them to recommend potential key informants to meet with during site visits. Finally, a peer-reviewed publication by Perkins, Ball, Whittington, & Combs (2004) provides insights into why an operator continues to operate an unlicensed care home. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. Additionally, interviewee discussions revealed a lack of ombudsman involvement in unlicensed care homes, which is another area for future research. 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. Residential Care providers must be licensed as an assisted living facility and have a contract with the Texas Health and Human Services Commission. Pay the required license fee. Key informants did not offer any information on potential ways to identify unlicensed care homes or existing databases of these places. Glass, I. Lists of both known illegal and potentially (identified but not yet confirmed) illegal operations are maintained by APS and the local ombudsman who lead the team. Key informants in metro Atlanta also indicate that the state conducts interviews with residents during investigations and closures of unlicensed home to gain a better understanding of how individuals end up in these 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. 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. Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. As described by the majority of key informants, the primary motivation to maintain an unlicensed care home is to maximize profit. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant. Though it is outside the time period of our environmental scan, the case study describes how regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential care homes. In some states, facilities that provided room, board, and "control and security of medication" could be legally unlicensed. example, if your mother requires skilled care, Medicare will cover However, Legally Unlicensed Residential Care Homes Are Possible in Several States. The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. In several cases at both the state and local level, unlicensed facilities were reported to authorities or licensure offices by the operators of licensed facilities. Interviewees had varying opinions on the causes for Dom Care homes closing. Policies affecting the supply of and demand for unlicensed care homes. One key informant from Pennsylvania spoke about the difficulty in handling reports of neglect or abuse in legally unlicensed care homes: "we will have repeated incidences, or alleged incidences [at legally unlicensed residential care homes] and we don't report to anyone [any agency or the state] either. The research team interviewed 12 key informants in Georgia. Retrieved from http://www.state.gov/documents/organization/245365.pdf. Source: 26 TAC 553.5 (c) (1)- (4) 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). Medicare does not cover the cost of personal care homes. C., & Barry, R. (2011).Neglected to death, part 2: Assisted-living facility caretakers unpunished: 'There's a lack of justice.' However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment (SSP). Using information from a HHS Administration on Aging report, provided by the National Ombudsman Reporting System (2009-2013), we identified reports regarding unlicensed facilities in five states: Maryland, Michigan, Nevada, Florida, and Georgia, as well as the District of Columbia. In this section, we summarize results of the literature review and interviews with SMEs and key informants. Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. The inability or unwillingness to provide appropriate care for residents at an affordable cost also was noted by key informants as a motivator to not pursue licensure. 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. The fact that four people should have been receiving personal care services made the home eligible for licensure as a residential care home--not the fact that three people were receiving the services (which would make it under the legal limit). Retrieved August 6, 2015 from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/requirements-for-home-and-community-settings.pdf.