Seniors are being ‘trafficked’ into unlicensed assisted-living homes so operators can skim their benefits, lawyers say. How to protect your loved ones

These places are hiding in plain sight in houses, rowhomes, and small apartment buildings. But inside, it’s a different story: residents are packed into tiny rooms, left unwashed, unfed, and living in filth with no trained staff and zero legal oversight.

How did this happen?

A care crisis

Despite hundreds of complaints since 2023, the state’s Office of Health Care Quality (OHCQ) has forwarded just one referral for prosecution to shut down unlicensed assisted living facilities (ALFs).

The cost of legitimate long-term care has blown past what many Americans can afford.

In Maryland, licensed assisted living averages around $4,000 a month. Illegal operators charge $600 to $1,000, but the savings come with the risk of a brutal trade-off: safety, dignity, and older Americans’ lives (1).

Given what seniors on a fixed income earn, there’s a huge gap between the qualified, licensed services available and their ability to pay. Consider this:

• The average social security benefit: approximately $1,900/month (2)
• The median assisted-living cost nationwide is around $6,000/month (3)
• Medicare doesn’t cover assisted-living or long-term custodial care (4)
• Medicaid is only available when you have very few assets, likely because you have already spent down your savings on your care (5)

The care dilemma

That leaves millions of low-income, disabled, and elderly adults in a dangerous situation of being too poor for private care, not poor enough for Medicaid, and too vulnerable to live alone.

This has set up a situation where “They often have nowhere else to go,” Maryland Legal Aid, a nonprofit law firm serving low-income residents, told WJLA (1).

And it’s giving people running illegal care homes a ripe opportunity to take advantage.

The U.S. Department of Health and Human Services put together a report on unlicensed care homes and found that there’s “limited or no” oversight on these residences. The report included Maryland, Georgia, Indiana, North Carolina, Pennsylvania, and Texas in its findings. In some Maryland counties, researchers found hundreds of assisted-living beds in facilities operating outside the law (6).

WJLA tracked repeated 911 calls to the same Baltimore addresses where responders found seniors injured or neglected.

Lawyers have used the word “trafficking” to describe the scheme.

“It’s no secret that unlicensed ALFs engage in human and/or benefits trafficking, using coercion, deception, threats or other means to traffic a victim, moving them from one facility to another for the additional purpose of appropriating their benefits, such as Social Security Retirement, Food Stamps (SNAP), or other benefits,” Maryland Legal Aid said in a written testimony in 2023.

Nearly 70% of adults over 65 will need some level of long-term care,and according to AARP, many Americans simply underestimate the costs of care as they age (7).

Prepare yourself and your family

As loved ones age, families that are unprepared often react from a place of panic, and many take the first placement they’re offered. But with some careful preparation you can take steps to protect yourself and your elderly family members from falling into the trap of an illegal operation.

1. Check the license

Search your state’s online assisted-living database. Look out for red flags like not having an address listed, not having a license number, staff who won’t answer training or medical questions, and not being able to view the entire residence (8).

2. Look for Medicaid-friendly or nonprofit homes

These typically face higher scrutiny and have stronger patient protections. Ask specifically for placements that accept Medicaid HCBS waivers only in licensed facilities.

3. Do the research

Terms like personal care home, board and care, or supportive housing do not guarantee that a facility is licensed or regulated.