Reports of abuse, neglect, financial exploitation, imprisonment and worse by key informants in an exploratory study on unlicensed care homes in America leads researchers to conclude governments need to take a good look at how the nation cares for its elderly and mentally ill and just who does the caretaking.

Based on a year-long series of interviews, site visits and research, authors of the report have 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.

The study was featured in an article this month in the Journal of Aging & Social Policy, The study found that while some states do allow certain residential care homes to legally operate without a license, there is growing concern about illegally unlicensed care homes that commit government fraud and abuse and/or exploitation of older people and individuals with serious mental illness.

The original report, “Unlicensed Care Homes in the United States: A Clandestine Sector of Long-Term Care,” was prepared by the independent, non-profit research firm RTI International 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)

“The study was needed because very little is known about these homes,” said Michael Lepore, Ph.D., RTI senior health policy and health researcher and author of the report. “Many of these homes stay hidden so learning about them is a little challenging.”

Michael Lepore, Ph.D., RTI senior health policy and health researcher.

(Photo Courtesy of RTI International)

Researchers from RTI studied unlicensed care homes, including a literature review, 18 interviews with national subject matter experts, 30 stakeholder interviews and site visits to three communities in three states including Atlanta, Georgia; Raleigh/Durham, North Carolina; and Allegheny County, Pennsylvania, Lepore said.

The goal of the exploratory study, according to the report, was to understand how unlicensed care homes function as a residential care option; who resides in them; their characteristics; and policies that influence the supply of and demand for these homes. And although researchers acknowledge the scope of their research was limited, they contend the findings have relevance for national, state and local policies and practices and for future research.

Not all residential care homes are legally required to hold a license, Lepore said. For example in Pennsylvania, a home with fewer than four beds is not required to be licensed. The problem arises when homes that should be licensed violate licensure requirements and operate secretly. An example might be a home in Pennsylvania with 10 beds and no license. In these instances, “Oversight is minimal or completely non-existent, and that’s when concerns of quality arise,” Lepore said.

Finding the locations of unlicensed care facilities operating illegally was a big challenge, Lepore said.

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