Why are Licensing Bodies Leery of the Unlicensed Group Home?

Across America we house and serve a number of populations in small communities called group homes.  Licensing designations and requirements vary.  In Florida you have the Adult Family Care Home where the owner lives with and cares for residents.  This same model in Michigan is called the Adult Foster Care Family Home.  Then you have specialized designations such as the Veterans Medical Foster Home so the classifications can be somewhat all over the map.  (Click Here for details regarding the VA Medical Foster Home)

Some of these models are heavily regulated for the protection of residents.  Licensing ensures that staff is properly trained, medications are properly handled, those with certain criminal convictions are not in key positions, etc.  Yet some homes operate without a license.  How so?

In some jurisdictions, where there is a separation of ownership between the entity providing the physical structure and the entity providing the care – and the line is clear – licensing can be avoided depending upon the needs of the population.  Often if it appears the population requires 24/7 assistance and/or supervision then licensing may still be required or there has to be a break of some type affecting how many hours per day the residents are served under that roof.

Lately, licensing bodies have become increasingly concerned about the unlicensed model and in at least fourteen, (14) states including Michigan have begun a massive effort to shut down these homes.  Following our curiosity we took the time to speak with someone from the Michigan Department of Human Services to ask why the seemingly added attention was prevalent.  You will find his points interesting.  He relates:

1. Unlicensed homes have become havens for those who who do not qualify to complete the licensing process.  This includes convicted felons whose convictions are not known to resident representatives and some of these felonies are for violent crimes and other serious offenses such as narcotic trafficking.
2. Unlicensed homes are not being measured for staff competence.  The State government is not aware and often cannot verify if the staff has been trained in medication administration, health & safety, resident rights, food safety or personal care safety.  As a result you are totally relying upon the guidance of the owner who may or may not be committed to a quality managed environment.  This places the safety of residents at risk and creates a needed partnership between licensing, Adult Protective Services and sometimes the Circuit Court to close the home.   (He cited an instance where a 47 year-old mentally ill man died from heart failure in the presence of 2 employees in an unlicensed home who had never attended a CPR class)
3. Employees in unlicensed homes are not typically fingerprinted and are not subjected to the FBI or State Police background checks employees are subjected to in a licensed home.
4. Unlicensed homes more and more are being ran by those whose licenses have been revoked.  Some of these revocations have occurred due to owners not qualifying to operate them under good moral character statutory requirements.  Once this happens some who previously ran licensed homes decide to stay in familiar territory and operate an unlicensed model and take the same disregard for authority and best practices to the new venture.  When this happens, no one wins.
5. In unlicensed homes physical plant requirements are often ignored.  Flame producing equipment may not be secured behind fire doors and properly vented, furnaces not inspected, ramps not in place for wheelchair users, etc.  There can be a history of shortcuts.  (He cited one instance where 2 male employees took a wheelchair bound man up 5 stairs into the home daily.  There was no ramp in place as licensing would have required)
6. Unlicensed homes rarely carry the required worker’s compensation or liability insurance coverage, leaving residents and their representatives unprotected and unable to secure compensation in the event of an act of negligence or abuse.

To be fair licensed homes have their share of poor operators and operational problems and not every unlicensed home is mismanaged and not every felon hates authority and rules.  However, without the regulatory hammer hanging over the home, (which a licensed home has to answer to) where is the assurance that best practices and high standards will even be considered?  While some reform would be a good thing in many areas especially as it relates to felons who have proven – post conviction – that their lives are managed within the law, one does wonder if state governments who fear being caught up in unending litigation, would simply prefer these homes did not exist.

Smart operators who for whatever reason refused to submit to the licensing process are diversifying.  Many who love the idea of caring for others have established private duty home care agencies, companionship services for those with dementia and even child care oriented programs, as others take the managerial lead.  So maybe its the consumer of these services who has to ask the right questions about not only corporate governance and owner backgrounds but regulatory compliance.  States appear to be on a mission and so should families of group home residents to assure quality and safety in all residential care environments.

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Related articles:

Group home closing in Rhode Island

Reports of Abuse in Group Homes

Illegal Group Home Ignoring Medical Needs

Residents in Unlicensed Homes Left in Unsafe Conditions

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