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Report on Texas Boarding Houses H.B. 1168

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Report on Texas Boarding Houses H.B. 1168 Report on Texas Boarding Houses H.B. 1168 Submitted to the Governor and the Texas Legislature January 2009 Members of the 81st Texas Legislature, In compliance with House Bill (HB) 1168, 80th Legislature, Regular Session, 2007, the Texas Health and Human Services Commission (HHSC) contracted with Health Management Associates to prepare this report outlining methods for regulating boarding houses, including recommendations on clarifying the authority of and granting additional authority to counties and municipalities to establish health and safety standards for boarding houses. The report highlights issues for legislative consideration surrounding boarding houses in the state, primarily concerns surrounding the care and treatment of the aged, disabled and mentally ill. As indicated in the report, very few housing options are available for these individuals given their low income level. Boarding houses have developed as an alternative option to the lack of appropriate and affordable housing for these individuals. Despite filling that void, there is a considerable amount of concern for boarding house residents, particularly unsafe environments and access to personal care services. HMA has included fourteen recommendations in the report, grouped in three categories: strengthening housing options, strengthening enforcement and monitoring, and better education regarding boarding houses. One of the recommendations includes increasing the availability of Community-based Alternatives (CBA) waiver slots to allow for more Medicaid-funded assisted living options for these individuals. If more CBA slots were available, individuals would not need to rely on boarding houses and would be able to receive personal care services that they are currently unable to receive in boarding houses. In the report, HMA recommends that the Legislature create a new funding item that would provide housing stipends to mental health consumers. The stipend would act as a voucher that would give consumers choice among eligible facilities. The intended benefits of this recommendation would be to improve housing quality and increase overall capacity of safe, affordable housing options. In recommendation #2, HMA proposes that the Department of State Health Services maintain a registry of boarding house operators in the state. As discussed in the report, this recommendation is brought forward as a less expensive option than licensure while still providing a mechanism for the state to locate boarding homes. However, the report includes a caution that a registry may give consumers a mistaken perception that the state is regulating the quality of boarding houses. Additionally, due to the transient nature of boarding houses the report notes that a registry would be labor intensive to maintain. HB 669, 79th Legislature, Regular Session, 2005, created a task force which investigated boarding house registration and found that given the difficulty in identifying the establishments, registration could not be a comprehensive solution. HHSC stands ready to assist members of the legislature review this complex issue and work for a solution that will benefit Texans. = = Report on Texas Boarding Houses PRESENTED TO TEXAS HEALTH AND HUMAN SERVICES COMMISSION DECEMBER 16, 2008 HealthManagementAssociates 1 December2008 = TableofContents ExecutiveSummary...................................................................................................................................2 Background.................................................................................................................................................7 ProblemDefinition...................................................................................................................................11 StakeholdersAssessment........................................................................................................................19 Methodology.........................................................................................................................................19 Findings .................................................................................................................................................19 TheBoardingHouseDatabase...............................................................................................................24 Methodology.........................................................................................................................................24 Findings .................................................................................................................................................25 TheBoardingHouseInterviews ............................................................................................................27 Methodology.........................................................................................................................................27 Findings .................................................................................................................................................27 TypeEAssistedLivingFacilityInterviews..........................................................................................29 Methodology.........................................................................................................................................29 Findings .................................................................................................................................................29 OtherStates–BestPractices ...................................................................................................................31 Methodology.........................................................................................................................................31 Findings .................................................................................................................................................32 LocalOrdinances–Texas........................................................................................................................35 Methodology.........................................................................................................................................35 Findings .................................................................................................................................................35 DiscussionofKeyFindings ....................................................................................................................45 Recommendations....................................................................................................................................52 AppendixA–ListofAcronyms ............................................................................................................69 AppendixB–StakeholderInterviewList ............................................................................................70 DallasPoliceDepartment .......................................................................................................................71 AppendixC–BoardingHouseInterviewTool ...................................................................................72 AppendixD–StateandLocalProfiles .................................................................................................75 = HealthManagementAssociates 1 December2008 = ExecutiveSummary TheTexasHealthandHumanServicesCommission(HHSC)contractedwithHealthManagement Associates(HMA)toconductastudyofTexasboardinghousesandtodraftareportonasystematic approachforensuringthehealth,safetyandwellbeingofTexansresidinginboardinghouses.The contractforthisworkbeganinMay2008andalldatagatheringtosupportthefindingsinthisreport occurredduring2008.Researchanddatacollectionforthisreportinvolvedthefollowingcomponents: stakeholderassessments;developmentofadatabaseofknownboardinghouses;interviewswithboarding houseoperators;areviewofbestpracticesinregulationinotherstates;andareviewoflocalTexas ordinances. WhatisaBoardingHouse? Theterm“boardinghouse”isnotexplicitlydefinedinTexasstatuteortheTexas AdministrativeCode.However,HouseBill(HB)1168,80thLegislature(2007),whichrequired thestudythatistheimpetusforthisreport,definesaboardinghouseas— “anestablishmentthat:= (A) providesservices,includingcommunitymeals,lighthousework,meal preparation,transportation,groceryshopping,moneymanagement, orlaundryservicestothreeormoreelderlypersonsordisabled personsresidingintheboardinghousewhoareunrelatedtothe ownerorproprietoroftheestablishment; (B) isnot: (i) requiredtobelicensedunderChapter142[Homeand CommunitySupportServices],242[Convalescentand NursingHomesandRelatedInstitutions],246[Continuing CareFacilitieslicensedbytheTexasDepartmentof Insurance],247[AssistedLivingFacilities],or252 [IntermediateCareFacilitiesfortheMentallyRetarded], HealthandSafetyCode;or (ii) exemptfromlicensingunderSection142.003(a)(19)or 247.004(4),HealthandSafetyCode;and (C) isnota: (i) childcarefacilityasdefinedbySection42.002,Human ResourcesCode; (ii) familyviolencecenterasdefinedbySection51.002,Human ResourcesCode; (iii) hotelasdefinedbySection156.001,TaxCode; (iv) retirementcommunity; (v) monasteryorconvent;or (vi) sororityorfraternityhouseorotherdormitoryaffiliated withaninstitutionofhighereducation.” HealthManagementAssociates 2 December2008 = HMAsurveyedcurrentboardinghouseownersandoperatorsandfoundthat,ofthehouses surveyed,over75percentoftheboardinghouseswereownedversusrentedproperties.On average,theboardinghousessurveyedhadbeeninoperationapproximately11yearsand
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