Unlicensed care homes in the United States: a clandestine sector of long-term care

ABSTRACT

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 17 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies, and practices that might influence UCH prevalence are discussed.

KEYWORDS:

• Residential care
• long-term care
• mental health
• licensure
• regulation

Acknowledgments

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services sponsored this project under contract #HHSP23320100021WI. The final report for the ASPE project (Greene et al., 2015) is a primary source for this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This work was supported by the Office of the Assistant Secretary for Planning and Evaluation [#HHSP23320100021WI].