Unlicensed care home facilities pose serious potential risks for seniors, new article reports

Individuals with mental illness and older adults with disabilities are particularly vulnerable to potential abuse


RESEARCH TRIANGLE PARK, NC—Some states allow categories of residential care homes to legally operate without a license.  However, there is growing concern about illegally unlicensed care homes that commit government fraud and abuse and/or exploitation of older people and individuals with serious mental illness.  A new article by RTI International, a leading non-profit research institution, describes the challenges several states face with unlicensed care homes. 

A key finding is that many seniors, those with serious mental illness, those with limited resources and other vulnerable populations find themselves unable to afford licensed residential care facilities and, as such, unlicensed home care may be the only residential care option available.

“While not all unlicensed care homes are illegal or pose a threat to low income seniors and individuals with mental illness, many are places where egregious crimes  appear to be committed by staff,” said Michael Lepore, Ph.D., RTI senior health policy and health researcher. “Our findings suggest that states may need to pay particular attention to ensuring the availability of sufficient and affordable licensed residential care facilities or other supportive housing options that offer person-centered care in a safe and appropriate environment.”

Other study findings suggest:

  • Some unlicensed care home operators actively recruit residents from hospital psychiatric units, and this should warrant further investigation
  • Because some states may have a shortage of licensed residential care facilities that are accessible to low-income individuals, unlicensed care homes may be the only residential care option available for low income people in those states

“Because unlicensed care homes have the potential to fill an important gap in the long-term services and supports system, 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,” said Angela Greene, deputy director of RTI’s Aging Disability and Long Term Care Program and director of the study upon which this manuscript is based. 

State laws and regulations about unlicensed care homes vary.  The study also showed some notable exceptions of unlicensed care homes that provide good care in a safe and clean environment.

This article is based on a qualitative study of unlicensed care homes, including a literature review, 18 interviews with national subject matter experts, and site visits to three states (GA, PA, NC) including 30 stakeholder interviews. The article was published in the Journal of Aging and Social Policy.