Summary: GAO investigated the abuse of boarding home residents and the lack of accountability by boarding home operators for the welfare of residents. Although the specific responsibilities of a boarding home operator will vary depending on licensing requirements, they generally are required to provide room and board, some type of personal care assistance as needed, help with medication, and overall surveillance, supervision, or direction of daily living activities. To complete its review, GAO subpoenaed various records from a select group of boarding homes. In most cases, the financial and operating information was not complete, and much of the supporting documentation that had been requested was either not maintained or was not furnished by the operators. Consequently, the review was based on information provided by the operators and GAO analysis of that data. In analyzing the residents' income, it was found that 96 percent of the income came from public funds. From the records available, it was determined that about 91 percent of a resident's income went to the operators for room and board, and the resident was able to retain the remaining 9 percent of his income for personal use. Generally, the amount of spending allowance provided to an individual resident was based on the amount of income received, and if the income was only sufficient to meet room and board charges, no spending allowance was provided. However, given the mental disability and questionable competency of most of the residents, GAO has reservations as to whether any recordkeeping system could accurately ensure that residents actually received the stipulated amount of spending money. In comparing income reported on tax returns with the room and board charges paid by the residents, GAO found that the operators had underreported their income and overstated their costs by varying amounts. Some residents received special energy assistance checks, which were turned over to the operators. GAO found that the total increased energy costs were substantially below the total amount of compensation received. It was also found that food stamps are not issued to boarding home residents. GAO attempted to determine the amount of Medicaid payments made on behalf of the residents, but less than half of the homes reviewed were in States which had an automated Medicaid information management system. It was found that two of the homes have either been or are being investigated for Medicaid fraud.
