Cooperative efforts are underway amongst state and local agencies in some states. Ombudsmen reported increasing numbers of RCFs operating without a license in both Maryland and Nevada. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. It was noted that many sheriffs and District Attorneys do not want their resources to go to cases of this nature unless serious and numerous complaints lead them to believe the group home is a major problem. In 2012, the state mandated that large adult care homes (seven or more beds) housing only individuals with mental illness had to close because they were considered institutional settings. In Michigan, residential care homes that provide room, board, supervision, and protective oversight, but not personal assistance with ADLs or medication assistance (residents can contract out for personal care), are not required to be licensed. However, we did not focus on these populations in the interview. The first, a six-state study on elder abuse in RCFs conducted by Hawes & Kimbell (2010) for the U.S. Department of Justice found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. In multiple interviews, unlicensed care home operators were described as being involved in human trafficking, and also were specifically noted by APS and law enforcement officials to traffic residents across state lines, specifically into Florida and Alabama, to avoid legal action in Georgia. "The California Room & Board Advisory Coalition is committed to enriching the quality of life of those in the communities we serve while maintaining the highest level of advocacy for providers and consumers. Barry, R., Sallah, M., & Miller, C. (2011). The majority of key informants reported that unlicensed care homes primarily, though not exclusively, serve individuals with severe and persistent mental illness. Miami Herald. Alabama's APS agency estimated that there were more than 200 unlicensed homes in the state, in contrast to their 400 licensed facilities. Tobia, M. (2014). Lax enforcement in personal care homes. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety, or appropriateness of those other environments.
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