Guest Blog: Language Matters: Texas Boarding House-Group Home-Assisted Living Facilities
Marc S. Gold, Sellers Dorsey Senior Consultant
September 16, 2015
Any abuse (A), neglect (N), or exploitation (E) to another human being is horrible. Something inside of us recoils when we hear of anyone harming another individual – especially one with a disability.
The recent number of incidents impacting different types of community residential centers is especially concerning. This is in part because what happens in one setting impacts each of the other categories of community residential living:
- group homes (GH)
- board and care (BHC)
- assisted living facilities (ALFs)
To many in the community and in the media, each of these settings sound alike and the terms, interchangeable. However, each term has a real legal connotation, which may or may not be covered by statute, rule promulgation, or policy statement. More important, how the state regulates each community residential setting will totally depend on its legal definition. This is confusing to most of us because, in general, we don't care what a particular setting is called, as long as all individuals residing there are free from A/N/E and treated fairly as a human being.
But when bad things happen to one type of setting, the media seems to immediately attribute the root problems to all settings. This is inaccurate and unfair to the different types of residential homes; it makes it feel like all community homes are dangerous.
So what are the major types of community settings that are receiving attention these days?
Board and Care
Board and Care provides room and board and a few minor services. They are not regulated by the state.
In 2009, the TX Legislature passed HB 216 (81st Legislature, Regular Session, 2009), creating Health and Safety Code 254. The Health and Human Services Commission developed model standards for BHCs; however, compliance with HB 216 was never mandatory. The model standards remain totally voluntary for a municipality to adopt. This means there may or may not be regulation of board and care homes in your areas.
Board and Care provides very low level services and usually takes an individual’s SSI or SSDI check in lieu of payment. These individuals really have few options and are vulnerable to the good integrity of the provider. Often these individuals have a behavioral health issue.
Group Homes
GH are often thought of in the context of individuals with intellectual and developmental disabilities and as one option under the Home and Community Based Services waiver (HCS).
These home serve 3 or 4 individuals in a community home with round the clock service staff and are regulated under the HCS rule base.
These homes are surveyed annually unless there is a significant change in the home.
Assisted Living Facilities
ALF by definition are sometimes the most difficult to understand. To be licensed as an ALF, one must serve 4 or more unrelated individuals who have no relationship to the provider/owner. The ALF must provide more than cursory services like assistance with activities with daily living (helping a person to eat, walk, use the bathroom).
An egregious situation can happen when: (1) the provider/ operator operates the ALF by meeting the criteria but not actively seeking a license from the Department of Aging and Disability Services (DADS), or (2) the ALF does not meet the standards as laid out in Health and Safety Code 242.
There are many ALFs that are being operated without a license, and no one should be living there. With the lack of DADS/ state staff, it is impossible to find every unlicensed ALF in Texas. They move often and change address.
The other issue is a licensed ALF not abiding by the rules that govern its contract with DADS.
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People immediately want to say that all community living is dangerous when they hear a number of these stories in a short amount of time. This is not true. Community living can be wonderful for those who choose to live in a GH, BCH, or ALF. Like everything else with the health and human services system, though, there are bad providers, a lack of regulation for Board and Care homes, and insufficient regulatory coverage.
It is the duty of the state to ensure that all Texans understand the different types of community living and who would best thrive in particular settings, and to provide the adequate protections for residents.
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About Marc
Marc Gold is currently a Senior Consultant with Sellers Dorsey and leads projects involving long-term services and supports including managed long-term services and supports. Mr. Gold spent thirty years in the Texas health and human services systems, the last 9 on the DADS executive staff, responsible for the Texas Promoting Independence Initiative.
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