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In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. Some key informants reported that the living conditions in these places can be subpar. This generally creates a care ratio of three guests to one care provider. Also, Indiana state law requires legally unlicensed assisted living facilities to submit disclosure forms to the Family and Social Services Administration within the Division of Aging; thus, the state may be able to compile a listing of legally unlicensed facilities. The regional and state licensure offices are closely involved in this process. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. Health Management Associates. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. Many key informants and SMEs suggested that discharge planners face difficulty placing residents in licensed care homes because these homes often do not accept patients who only have SSI (or otherwise have little money), and they often will not accept individuals with a history of mental illness, substance abuse, or those who are homeless. The North Carolina Mental Health Licensure Office licenses group homes for adults with mental illness.5 These homes also serve two or more adults. These key informants agreed that because discharge planners are under pressure to quickly discharge hospital patients to contain hospital costs, they must have a list of care homes (including licensed and illegally unlicensed personal care homes) that they can reference if the discharge planner has no other option for placement. While this may be a promising source of unlicensed homes only in Allegheny County, Pennsylvania, similar tracking mechanisms may be used or developed for use in other communities as well. It is now a misdemeanor to operate an unlicensed RCF. As with assisted living facilities, the cost of personal care homes (aka care homes) varies from location to location. 3.4.5. There have been limited prosecutions by the legal system. Miami Herald. Hospital discharge planners are not required to check the licensure status of the place to which they are discharging patients, and often discharge them to unlicensed homes. Though outside the scope of our focus, some of the searches also produced media reports and grey literature about concerns in licensed care homes; however, reports about unlicensed care homes and the quality of care described therein was sometimes worse than those for licensed care homes. Providers of housing and care services that are licensed by the state, such as nursing homes and residential care facilities (RCFs), serve some of these individuals. Interview discussions often touched on the question of how best to identify illegally unlicensed care homes, and key informants noted this as a major challenge. However, it won't cover However, as in some other states, APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+). Complaint & Incident Intake | Texas Health and Human Services