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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.

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