Summary: 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.
