'Clandestine' facilities pose risks for residents: study

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Michael Lepore, Ph.D.
Michael Lepore, Ph.D.

Unlicensed residential care facilities could pose serious risks for older adults, including physical, financial and emotional exploitation, abuse and neglect, according to a newly published study.

Demand for such facilities is increasing at a time when some geographic areas may have a shortage of licensed facilities that are accessible to low-income individuals and as the government seeks non-institutional, home- and community-based settings for older adults with physical and mental disabilities, Michael Lepore, Ph.D., and colleagues wrote in the Journal of Aging & Social Policy.

Mandated admissions parity and increased admission of older adults with mental health and other behavioral disorders to licensed residential care facilities could stem demand for the unlicensed facilities, Lepore, a senior health policy and health services researcher at RTI International in Research Triangle Park, NC, told McKnight's Senior Living. The changes would require action by state or federal lawmakers as well as operators.

“This is an opportunity for government advocacy to increase Medicaid rates, which can help increase access to licensed residential care facilities,” he said. 

Lepore and colleagues studied unlicensed care homes by conducting a literature review, interviewing 18 subject matter experts and additional stakeholders, and visiting sites in Georgia, North Carolina and Pennsylvania. Conditions at unlicensed homes, can be “unsafe, unclean, and unsupportive of health and well-being,” they found, although not all unlicensed facilities are of low quality.

Some additional steps that quality senior living operators can take to increase demand for their facilities, Lepore said: 

  • Educate hospital discharge planners. “Hospital discharge appears to be a key juncture in individuals' care trajectories that leads them to unlicensed care homes, so more awareness for hospital discharge planners may be warranted,” he said.
  • Assist local first responders and ombudsmen by providing placement and services for individuals who formerly lived in unlicensed homes.
  • Open community doors for greater community engagement. Licensed as well as quality legal but unlicensed communities could hold events to which hospital discharge planners and the long-term care ombudsman are invited, Lepore suggested.
  • Make sure you know the license requirements for residential care. In some states, it's legal to operate an unlicensed residential care facility, but in others it's not. “Illegally unlicensed care homes that are good are often illegally unlicensed because they are not aware of licensure requirements,' Lepore said. “They can work with their state licensure agencies to become licensed.”

Unlicensed homes do “have the potential to fill an important gap in the long-term services and supports system,” said Angela Greene, deputy director of RTI's Aging Disability and Long Term Care Program and director of the study on which the manuscript is based. “Additional research is needed to learn more about why these operators choose to be unlicensed and how widespread is the fraud and abuse in unlicensed care homes,” she said.

The paper is titled “Unlicensed care homes in the United States: a clandestine sector of long-term care.”

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