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

Benefits Trafficking: human trafficking of older adults and adults with disabilities

An emerging type of trafficking is targeting overlooked at-risk adults. Benefits Trafficking is the systematic recruitment, harboring, neglect, and financial exploitation of elder and disabled adults who receive government benefits such as Social Security, Veteran's Benefits, Medicaid, and Medicare. Traffickers often pose as kind-hearted individuals offering to provide care for at-risk adults in an in-home setting. Once recruited, at-risk adults are stripped of their government benefits, held against their will, moved from location to location, and denied basic needs such as food, clothing, and adequate shelter. While Benefits Trafficking is a basic civil rights violation issue, it is also a growing public health issue. Victims of Benefits Trafficking are often the forgotten at-risk adults who have fallen through the cracks of various mental health systems, are unhoused, and no longer have a social support system in place. This area of human trafficking is unresearched and its prevalence is largely unknown outside of the few entities working in this space. This paper focuses mainly on raising awareness of Benefits Trafficking and suggestions for future funding and research initiatives.

Victimization in Unethical Unlicensed Small Residential Care Homes in the United States: The Case for Whole System Disruption

In the United States, small residential care homes provide affordable community-based care for disabled older adults. Also called adult foster care homes, residential care facilities, group homes, or board and care homes, small residential care homes are typically private, small businesses operating in single-family dwellings that provide round-the-clock care in a home-like setting in residential neighborhoods. While most states license small residential care homes they also exist, legally and illegally, as unlicensed and unregulated operations. The quality of care in some unlicensed and unregulated small residential care homes can be questionable. Disabled older adults are targeted and victimized by unethical small residential care home operators for financial gain. This commentary highlights the need for whole system disruption to end victimization in unethical unlicensed and unregulated small residential care homes through case studies of the abuse and neglect of residents living in unethical unlicensed operations and recommends ambitious goals centered on reducing secondary financial gains and medically neglectful practices. These recommendations are at federal, state, and local levels, and include creating a federal definition of small residential care homes, increasing and coupling government incomes with state registration and employee misconduct registry checks, increasing oversight and assessment, improving temporary guardianship processes, providing avenues for reporting abuse, and developing older adult fatality review teams.

The legal violence of care: Navigating the US health care system while undocumented and illegible

Medical sociologists widely conceptualize illegality as a social determinant of health, implicating immigration law but not health care law in immigrant health disparities. Contributing to an emerging literature on legal violence in the context of health care, I explore how the Harris Health System in Houston, Texas legally affects low-income undocumented migrants' lives as they seek care. Drawing on eleven months of ethnographic and interview research with migrants and volunteers at a community-based organization, I argue that the health care system legally exacerbates migrant vulnerability in particular ways. Clerical staff follow medical protocol to deny migrants care on the basis of legibility (i.e., a photo ID), not legality (i.e., legal status), resulting in two classifications of illegality - what I term legible and illegible illegality. The former keeps migrants visible to the state but offers potential care, and the latter legally relegates migrants to the exploitative conditions of informal home care and/or a protracted state of suffering where, for many, death is the only recourse. This research shows that without substantive health reform, health practitioners - physicians, social workers, clerical staff, and home care workers - play an (in)direct role in shaping and normalizing immigrant health disparities.

The Coronavirus and the Risks to the Elderly in Long-Term Care

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.