Beware the Risks of Unregulated Care Our Judgment on Boarding Homes?
As noted on the cover, in the last several years, our firm has had the unfortunate experience of representing grieving families whose loved ones have died from neglect after being discharged by South Carolina hospitals to “boarding homes.” Oftentimes, if the patient is over the age of 18, this discharge is made without notice to a mentally ill patient’s family. While some suggest that a boarding home is akin to an assisted living facility, these boarding homes are anything but. What is a boarding home? The South Carolina Department of Health and Environmental Control (DHEC) characterizes a boarding home as a facility that provides room and board to people who are not related but does not provide assistance with the resident’s activities of daily living. Activities of daily living include such things as assisting a patient with medications, arranging medical appointments, or helping with daily tasks such as grooming and bathing. As soon as a facility crosses the line by providing any assistance with these activities, it then qualifies as a community residential care facility/assisted living facility under DHEC regulation. Assisted living facilities are closely regulated by DHEC, which has certain requirements for staffing, employee qualifications, training, medication management, and living conditions. How do assisted living facilities differ? Assisted living facilities are also required to be licensed by DHEC, insured, and subject to regular and random inspections by DHEC inspectors. However, boarding homes are not required to be licensed by DHEC and require only a business license from the local town or county. Boarding homes are not regulated by DHEC in any fashion and are often uninsured. Boarding homes usually house people who have been deemed disabled by the Social Security Administration due to mental illness or other health conditions. In exchange for residence, boarding home operators can require that the
operator becomes the resident’s Social Security “payee.” Once a third party becomes a Social Security recipient’s “payee,” that individual or business then receives the monthly Social Security payments directly. Boarding home operators often house 8–10 residents in a single building. The operators then receive an average of $1,000 in disability benefits per month per resident, deposited directly into their bank accounts by the federal government each month. Unscrupulous boarding home operators can move two single-wide mobile homes onto a piece of rural property and then collect $20,000–$30,000 in monthly income on behalf of the residents. Unfortunately, the lack of DHEC oversight can result in extreme and inhumane living conditions. Real problems arise when hospital social workers, who are often dealing with bed shortages in mental health inpatient units but are hesitant to discharge a patient out the front door of the hospital, discharge their patients to these boarding homes. A physician recently described how boarding home operators hang around hospital lobbies, explaining that they have vacancies and hoping to get referrals from hospital staff — much in the way unlicensed cab operators hang out at the baggage claim at LaGuardia Airport hoping to get new customers. Not surprisingly, the conditions within these boarding homes often lead to tragic consequences for the residents, particularly if a patient is discharged into this environment in an unstable mental condition. If you receive a call from a hospital social worker on behalf of a mentally ill friend or relative, make sure you inquire about the status of any facility to which discharge has been recommended. You can take some comfort if a community residential care facility or assisted living facility is recommended, but be very careful if a boarding home is suggested. Just as you would not want your loved one to ride through New York in an unlicensed cab, you would not want that same individual in a facility not licensed and regulated by DHEC.
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