Board and Care:

Insufficient Assurances That Residents' Needs Are Identified and Met

HRD-89-50: Published: Feb 10, 1989. Publicly Released: Mar 10, 1989.

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In response to a congressional request, GAO reviewed board and care facilities for elderly and disabled adults, focusing on: (1) industry size; (2) the characteristics and needs of residents; (3) states' regulation and monitoring of facilities; and (4) the Department of Health and Human Services' (HHS) role in overseeing facilities.

GAO found that: (1) although a 1987 survey showed that there were approximately 41,000 licensed facilities serving elderly, mentally ill, and retarded persons, it was not possible to determine the number of persons living in such facilities; (2) facilities had difficulty in meeting the needs of mentally ill residents; (3) state inspections revealed serious problems in both licensed and unlicensed facilities, including physical and sexual abuse, unsanitary conditions, or lack of heat or medical care; (4) although the six states it reviewed had legal authority to close facilities or suspend their licenses, only three could deny or revoke licenses; (5) states had difficulty in closing substandard facilities because of a lack of alternative housing for residents, particularly those eligible for public assistance programs; and (6) HHS had limited responsibility to monitor states' compliance with a legislative amendment requiring them to establish and enforce standards and periodically inspect board and care facilities.

Matters for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: OBRA 1990 included a requirement for HHS to develop regulations that set minimum quality standards and compliance mechanisms for certain providers of care, including board and care operators. Further, in response to the HHS IG recommendation, HHS is establishing a board and care home task force to oversee its board and care initiatives.

    Matter: Congress may wish to direct HHS to conduct a comprehensive assessment of states' oversight activities for their board and care population. This assessment should determine the adequacy of: (1) licensing and regulatory requirements; (2) resources committed to their enforcement; and (3) efforts to identify whether residents' needs are being met.

  2. Status: Closed - Implemented

    Comments: OBRA 1990 included a requirement for HHS to develop regulations that set minimum quality standards and compliance mechanisms for certain providers of care, including board and care operators.

    Matter: Congress may wish to direct HHS to report to Congress findings and, if appropriate, recommendations as to: (1) subsequent steps needed to ensure the protection of board and care residents; and (2) changes needed to the Keys Amendment to make it more effective.

 

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