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Request to Rezone Property at 1749 Churchill Drive Copyrighted September 18, 2023 City of Dubuque Public Hearings # 01. City Council Meeting ITEM TITLE: Requestto Rezone Propertyat 1749 Churchill Drive SUM MARY: Proof of Publication on notice of public hearing to consider Request to rezone property at 1749 Churchill Drive from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with submitted conditions and The Zoning Advisory Commission recommending approval. ORDINANCE Amending Title 16 of the City of Dubuque Code of Ordinances, Unified Development Code, by Reclassifying Hereinafter Described Property Located at 1749 Churchill Drive From R-1 Single- Family Residential District To R-3c Moderate Density Multiple-Family Residential District with Conditions as Established in the Attached Memorandum of Agreement SUGGESTED Suggested Disposition: Receive and File; Motion B; MotionA DISPOSITION: ATTACHMENTS: Description Type ZAC Letter to CC Staff Memo Ordinance Ordinance Application Supporting Documentation Vicinity Map Supporting Documentation St. Mary's Narrative Supporting Documentation St. Mary's Neighborhood Letter Supporting Documentation ZAC Staff Report Staff Memo R-1 Zoning District Supporting Documentation R-3 Zoning District Supporting Documentation Letter of Opposition Supporting Documentation Letter of Opposition Supporting Documentation Neighborhood Petition Supporting Documentation Public Input Map Supporting Documentation PowerPoint Presentation Supporting Documentation Public Input in Opposition Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Public Input in Support Supporting Documentation Planning Services Department Du6uque City Hall THE CITY OF � 50 West 13t"Street ��'�� DUB E �n,�.r,, ,� Dubuque,IA 52001-4864 1 I I I (563)589-4210 phone I � (563)589-4221 fax 563 690-6678 TDD za�7*zoiz�zol3 � � Masterpiece an tke Mississippi �al�*�oi� planning@cityof dubuque.org September 11, 2023 The Honorable Mayor and City Council Members City of Dubuque City Hall — 50 W. 13t" Street Dubuque IA 52001 Applicant: William R. Biver, President - Mary's Inn Maternity Home Location: 1749 Churchill Drive (PIN 1022379005) Description: To rezone property from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions. Dear Mayor and City Council Members: The City of Dubuque Zoning Advisory Commission has reviewed the above-cited request. The application, staff report, and related materials are attached for your review. Discussion John Freund, Freund Law Firm, P.C., 1005 Main Street, spoke on behalf of Mary's Inn. He noted the organization is a non-profit maternity home formed in 2014. He introduced the Chair of the Board of Directors for Mary's Inn, Bill Biver, and the Executive Director, Colleen Pasnik, both who were present. Mr. Freund described the process that Mary's Inn went through eight years ago to rezone a property on Balboa Drive for use as their maternity home and that there have been no complaints from neighbors about that property. Mary's Inn is now looking for a larger house for their organization to house four women and their babies. He described the maternity home operations and that they have an onsite staff member 24-hours a day. He stated there are specific rules for living at the house and that they should have little to no impact on the neighborhood and traffic, as most of the women don't have cars. He described how this location is a good fit for their goal to be in a residential neighborhood. They also like the carriage house on the property, where the staff could have their space and the director could have her office. Proximity to a bus line is a feature they are looking for. Mr. Freund spoke to some of the concerns that neighbors have expressed and referred to the letter Mary's Inn sent to neighbors in an effort to address their concerns. He spoke specifically about the maternity home would not affect the property values and stated that the home on Balboa has increased in property value and does not appear to have harmed property values in the area. He stated they are willing to only rezone the lot the house is on and leave the north lot as R-1. They are also willing to rezone the house property back to R-1 if they move in the future, and they do not want to sell it to a developer. He stated they are willing to accept conditions and want to be good neighbors. Service People Integrity Responsibility lnnovation Teamwark The Honorable Mayor and City Council Members Page 2 The Commission asked if they considered other properties and Mr. Freund stated they did, and this property was preferred in part because it has the carriage house where the director can have her office onsite. The Commission sought to understand how long women typically stay at the house. Colleen Pasnik, Director of Mary's Inn, 1535 Alta Vista, stated that the time is specific to the needs of the mother and the average stay is three to four months. Julie Fuller, 1780 Eden Lane, described her family's tenure in the neighborhood and reasons they like it so much including that it's a mix of all ages and families. She stated she supports the mission of the maternity home but has concerns about this neighborhood becoming R-3 zoning. She expressed concerns about lots considering the various permitted and conditional uses allowed in R-3 districts, the vacant lot being developed for multi-family housing, the difference between a group home and maternity home, and the previous rejection of a Conditional Use Permit for an accessory dwelling unit in 2010. She referenced a letter submitted by Steve Juergens and quoted the letter regarding the issuance of Conditional Use Permits. She concluded by stating she is opposed to the rezoning. Marlene Habel, 1285 Cortez Drive, stated that she lives close to Mary's Inn on Balboa Drive, and she feels they run the home extremely well, and she has observed no problems with it. Brian Kane, Kane Norby & Reddick P.C., 2100 Asbury, representing John and Ann Riley, 1733 Eden Lane, expressed that the mission of Mary's Inn is not what's being debated, but it's about what the zoning code says. He expressed that a maternity home is not a group home and that there is no definition of a maternity home in the unified development code, so it should not be permitted or a conditional permitted use in this case. Mr. Kane stated that rezoning the property could be spot zoning since it has been R-1 for over 60 years and has not changed. He noted the future land use map shows these parcels as residential and park. Mr. Kane also discussed the possibility of increased traffic to the property both vehicular and pedestrian and asked that the rezoning be considered as not a conditional permitted use, or that it is spot zoning, or that it is inconsistent with the Comprehensive Plan. Lance Andre, 1735 Eden Lane, described what he liked about his single-family neighborhood including the low volume of traffic along Eden Lane and that many kids play in the area, and expressed that this would be a change. He stated that he's concerned about what happens to the historic home and green space. Dr. Melissa Claussen, 2979 Pennsylvania Avenue, representing her parents, stated that the concern is not Mary's Inn, it's that they might leave, and the property would become multi-tenant. She stated that the bus stop at this location is across Pennsylvania Avenue and may be a safety concern. She shared an aerial view of the neighborhood for reference and discussed a previous request to rezone the subject property. She expressed concerns about the stress to rezone the neighborhood to R-3. She expressed concern about utilizing the carriage house as an office/business. She expressed concern about Service People Integrity Responsibility lnnovation Teamwork The Honorable Mayor and City Council Members Page 3 lead poisoning and other aspects of the home in question and worried that non-profits don't have oversight. Sharon Young, 1745 Eden Lane, stated that she's in favor of Mary's Inn but not at the expense of changing their neighborhood. She noted that she signed a petition of opposition and provided the petition to staff. Matt Selby, 1851 Eden Lane, stated that he and his family support Mary's Inn, along with their neighbors John & Sadie Robins, 1741 Eden Lane. He noted that they toured the Balboa house and found it to appear normal and be well-maintained, like a single-family home. He stated that they support the rezoning and feel it will enhance the neighborhood. He noted that he had the same concerns as others, but he's not worried about this situation as it will have limited vehicles, there are good people involved, and he doesn't believe it would change the neighborhood. Jenifer Luchene, 1736 Churchill Drive, expressed concern that Mary's Inn might build an addition to the house to expand their capacity beyond four women. William R. Biver, 1320 Oeth Court, stated that he is the original applicant. He noted that some of the general statements made by neighbors were addressed in the letter he submitted. He expressed that this request is not about transient women but is specifically about pregnant women and babies who deserve to be in a family neighborhood. He stated that they are willing to let go of rezoning the vacant lot and willing to rezone the south property back to R-1 if they move. He noted this is not the same as the accessory dwelling unit application and they have no intention of renting out any space on the property. He pointed out that maternity home falls under group home according to the previous commission who approved the rezoning on Balboa. Mr. Biver stated they are working to address all building code requirements with the city's housing department and are working through all local, state, and federal requirements for the maternity home. Mr. Freund concluded by reiterating Mr. Biver's statements. He expressed concern that this maternity home needs a place to go, and they feel they can fit the character of this neighborhood. He expressed that this rezoning request is very similar to the one that was approved in 2015. He noted that he had five teenagers at one time, and they generated more traffic than Mary's Inn will. He expressed that Mary's Inn is a sanctuary and will have the feel of a single-family residence. Staff detailed the staff report and highlighted two charts; 1) the first showing that the principal permitted uses would remain the same as R-1, so no multi-family uses would be allowed with the conditional rezoning, and 2) the second showing that the only added conditional use would be for group home. Staff explained that a maternity home is categorized as a group home, not a boarding or rooming house and noted that a Conditional Use Permit request would be reviewed by the Zoning Board of Adjustment, and they can place conditions such as the number of occupants. Staff expressed that a memorandum of agreement would be required as part of the approval and outlined a clause in the ordinance that would allow the city to rezone the property back to R-1 should the applicant not be in compliance with the conditions of the rezoning. Staff noted the Service People Integrity Responsibility lnnovation Teamwork The Honorable Mayor and City Council Members Page 4 2010 review was for an accessory dwelling unit, which have a very specific set of requirements, and that the request was not approved by the Zoning Board of Adjustment. Staff highlighted that the Comprehensive Plan encourages mixed development and separation of incompatible uses, and the Future Land Use Map shows the developed lot as residential and vacant lot as park and open space. Staff stated that as conditioned, the proposed rezoning and use is not anticipated to increase traffic in the neighborhood beyond a single-family use. Staff noted the Housing Department would work with the applicant on issues such as lead paint and egress and that the use of the carriage house as an office would be allowed as a no-impact home-based business. The Commission asked about the location of Mary's Inn on Balboa, and staff clarified it is in a single-family neighborhood at mid-block. The Commission asked about how to rezone just the south lot with the house, and staff stated they could rezone just one lot in the motion. The Commissioners further discussed the request highlighting their concerns and/or support of the proposed rezoning. The Commission discussed only rezoning the southern lot at 1749 Churchill Drive. Recommendation By a vote of 3 to 2, the Zoning Advisory Commission recommends that the City Council approve the rezoning of the south lot at 1749 Churchill Drive (PIN 1022379005) with the submitted conditions. Letters of opposition and a petition of opposition was submitted and signed by the owners of twenty percent (20%) or more of the property which is located within two hundred feet (200') of the exterior boundaries of the property being considered for rezoning. Therefore, a super majority vote is needed for the City Council to approve the request. Respectfully submitted, � � � ��. G�- Matthew Mulligan, Ch " erson Zoning Advisory Commission Attachments cc: Jeffrey & Patricia Szalkowski, 1749 Churchill Drive, Dubuque, IA 52001 Service People Integrity Responsibility lnnovation Teamwork 1111II III III I III 11111 III111111III Doc ID: 011148490005 Type GEN Kind: ORDINANCE Recorded: 09/27/2023 at 03:47:35 PM Fee Amt: $27.00 Page 1 of 5 Dubuque County Iowa Karol Kennedy Recorder File2023-00009261 Prepared by: Wally Wernimont, City Planner Address: City Hall, 50 W. 13t'' St Telephone: 589-4210 Return to: Adrienne Breitfelder, City Clerk Address: City Hall- 50 W. 13t'' St Telephone: 589-4121 ORDINANCE NO, 39 - 23 AN ORDINANCE AMENDING TITLE 16 OF THE CITY OF DUBUQUE CODE OF ORDINANCES, UNIFIED DEVELOPMENT CODE, BY RECLASSIFYING HEREINAFTER DESCRIBED PROPERTY LOCATED AT 1749 CHURCHILL DRIVE FROM R-1 SINGLE-FAMILY RESIDENTIAL DISTRICT TO R-3C MODERATE DENSITY MULTIPLE -FAMILY RESIDENTIAL DISTRICT WITH CONDITIONS AS ESTABLISHED IN THE ATTACHED MEMORANDUM OF AGREEMENT. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. That Title 16 of the City of Dubuque Code of Ordinances, the Unified Development Code, is hereby amended by reclassifying the hereinafter -described property from R-1 Single -Family Residential district to R-3c Moderate Density Multiple -Family Residential district with conditions, to wit: Lot 1 of Block 6 of Churchill Heights Subdivision, in the City of Dubuque, Iowa, according to the recorded plats thereof, subject to easements of record and to the centerline of the adjoining public right-of-way, all in the City of Dubuque, Iowa. Section 2. That the foregoing amendment has heretofore been reviewed by the Zoning Advisory Commission of the City of Dubuque, Iowa. Section 3. This Ordinance shall take effect immediately upon publication, as provided by law. Passed, approved, and adopted this day of 2023. Attest: Trish L. Gleason, Assistant City Clerk Bra:" . Cavana•: _ ►�'..yor .bBC.C,i-t-\j tc n ►-1 11 CERTIFICATE of the CITY CLERK STATE OF IOWA ) SS: COUNTY OF DUBUQUE ) I, Trish L. Gleason, do hereby certify that I am the duly appointed, qualified, Assistant City Clerk of the City of Dubuque, Iowa, in the County aforesaid, and as such Assistant City Clerk, I have in my possession or have access to the records of the proceedings of the City Council. I do further state that the hereto attached Ordinance No. 39-23 is a true and correct copy of the original. In Testimony Whereof, I hereunto set my hand and official seal of the City of Dubuque, Iowa. Dated at Dubuque, Iowa, on this 20th day of September, 2023. a.€1)301A, Trish L. Gleason, Assistant City Clerk Prepared by: Wally Wernimont, City Planner Address: City Hall, 50 W. 13th St Telephone: 589-4210 Return to: Adrienne Breitfelder, City Clerk Address:City Hall-50 W. 13th St Telephone: 589-4121 MEMORANDUM OF AGREEMENT Pursuant to the Iowa Code Section 414.5, and as an express condition of rezoning of the property located at 1749 Churchill Drive and legally described as: Lot 1 of Block 6 of Churchill Heights Subdivision, in the City of Dubuque, Iowa, according to the recorded plats thereof, subject to easements of record and to the centerline of the adjoining public right-of-way, all in the City of Dubuque, Iowa. Which is the subject of Ordinance No. 39-23, a copy of which is attached hereto and incorporated herein by reference, the undersigned property owner(s) agree(s) to the following conditions, all of which the property owner(s) further agree(s) are reasonable and are imposed to satisfy public needs which are caused directly by the rezoning: A) Conditions: 1) That the list of Permitted Uses shall be limited to: a. Single-family detached dwelling b. Cemetery, mausoleum, or columbarium c. Place of religious exercise or assembly d. Golf course e. Parks, public or private, and similar natural recreation areas f. Public, private or parochial school approved by the State of Iowa (K-12) g. Railroad or public or quasi-public utility, including substation h. Community gardens 2) That the list of Conditional Uses shall be limited to: a. Bed and breakfast home b. Licensed adult day services c. Licensed childcare center d. Mortuary, funeral home, or crematorium e. Off street parking f. Tour home g. Tourist home h. Wind energy conservation system I. Accessory dwelling unit j. Group home 3) Accessory Uses: Any use customarily incidental and subordinate to the principal use it serves. 4) Temporary uses shall be regulated in conformance with the provisions of section 16-3-19 of this title. 5) The Parking Requirements, Signs, and Bulk Regulations shall comply with the R-1 Single-Family Residential zoning regulations. B) Reclassification of the Subject Property. The City of Dubuque, Iowa may initiate zoning reclassification proceedings to the R-1 Single-Family Residential District if the property owner fails to complete any of the conditions or provisions of this Agreement. C) Modifications. Any modifications of this Agreement shall be considered a zoning reclassification and shall be subject to the provisions of the Title 16, Unified Development Code, governing zoning reclassifications. All such modifications must be approved by the City Council of Dubuque, Iowa. D) Recording. A copy of this Agreement shall be recorded with the Dubuque County Recorder as a permanent record of the conditions accepted as part of this rezoning approval within ten (10) days of the adoption of Ordinance No. 39-23. E) Construction. This Agreement shall be construed and interpreted as though it were part of Title 16 of the City of Dubuque Code of Ordinances, Unified Development Code. F) This Agreement shall be binding upon the undersigned and his/her heirs, successors, and assignees. ACCEPTANCE OF ORDINANCE NO. - 23 I, Jeffrey M. Szalkowski and Tricia M. Szalkowski, having read the terms and conditions of the foregoing Ordinance No. - 23 and being familiar with the conditions thereof, hereby accept this same and agree to the conditions required therein. Dated in Dubuque, Iowa this $04\ day of (a--1*,rA ,i , 2023. By: re M. Szalko ski, property owner ' Alliiiiille - ,_,T . M. Szalke ski, property owner On this \[A\f\ day ofc ,r} r 2023 before me, a Notary Public, in and for said state, personally appeared Jeffrey M. Szalkowski and Tricia M. Szalkowski, to me known to be the person(s) named in and who executed the foregoing instrument and acknowledged that they executed the same as their voluntary act and deed. \ \hpiO\ , ci,1 ,,.$0.4_, *, �v, THERES,A A. NEUHAUS Notary Public In the State Of Iowa J> ,u, Has,cr Number�,59995 My Commission expires: S \t1"11�1 TI I E C!"1 Y c�F � City of Dubuque Planning 5ervices Department D�� T Dubuque, IA 520f}1-4H45 _[.,, Phone: 563-589-4�10 F�x: 563-589-42Z1 NZII�tE'f�7r�'['t' i�1i fJPc' lti�lis�l�,i)��1��r elanninq{a�c�ofdubu uq e.or❑ . . , � f � Zoninq Advisory Zoning 6hard of be�elonment Serrrices Historic Preservation Cammission Cornmission Adiustment ❑ AnnexaYion ❑ Dernolition Review ❑ Amended PIJD �]x Conditional Use Permit ❑ Limited Setback Waiver ❑ Hiskoric {tevolving Loan x❑ Rezaning�PUD/ID ❑ Special Exception ❑ 5ite Plan Simple ❑ Certificate of Economic Non-Viabifity ❑Text Amendment ❑ Variance ❑ Site Plan Minor ❑ Design Revi�w Certificak� of ❑ Simple 5ubdivisian ❑ Appeal ❑ Site Plan Major Appropriateness ❑ Preliminary Plat ❑ 5imple Subdivision ❑ Advisory Design Review (Public ❑ Major Final Plat ❑ Temparary Use Permit Prnjects) ❑ Minor Final Plat ❑ Port of Dubuque/ ❑ Historic Designation ❑ Waiver from Site Chaplain Schmitt Island Design Standards Design Review - . , . , , . . . . - . , - . . -. . A. Property Information 5ite Location/Address: �749 Ghurchill Drive Legal Description/Parcel ID#/5ubdivision: ParCe� �� #��2237g�05 Existing Zoning: R� Proposed Zoning: R3 Site Area (square feet/acres): 17510 sq. ft.10.4 acr�s Historic �istrict: _andmark: ❑ Yes ❑ No �. Describe praposal and reasor�for application {attach a fetter af explanation, if necessary): House is for sale; new potentia! owner's want to re-�ocate Mary's Inn Matemity Home from its current oca ion a a oa r. a is prope y a urc i r. 3 "�a ��°� r e I y i� �' � � il� A.1 �P �,'.`" - � C. Appli�an� Age f� �1i�Pt�� "�a�sR� a51�ai�`d� Name: Mary's Inn Maternity HomelWilliam R. Biver- Presicfent phone: 563-5SO-6JSB Aadres5: �?50 Balboa Dr. �;�: Dubuque st�te: IA. �;p, 524�1 �,r,a;�: b.bi�er@dbqarch.org D. Praperty Owner(s) Infarmation n��met57: Jeffrey and Patricia Szalkowski pho�,�. 563-594-3642 �dd�ess: 'f 749 Chu�chill Dr. �;�,, Du�uque state: �A� zi�: �20d� ��,a;,: jmski1976@gmail.com E. CertiFication: I/we,the undersigned, do hereby certify/acknowledge that: 1. Payment dne5 not guarantee approva! and fees are nonrefundable; 2. All additional required wriften and graphic materials are attached; 3.It is the property owner's responsibility to locate property lines and ta review the abstract for easements and restrictive covenants; and 4.The infarmation submiCted herein is true and correct to the best of my/our knowledge and upon submit#al becornes public record. ,,,�,,,,, ,�, 08�07�2023 Applica�tlAgent: �f�a9.�,1�.�tr-y�€s,��.r1v��2�s�y ;,,:;- � _:�-��.� Date: ,-,,�,<:,,.�,>w��,.�.� .9��s.:.�,�: OSJ09�2023 Property Owner(s DaCe: _ ��:.Pr�� • • � � y � Fee $ ��1 Ck#� I � ❑CC ❑Cash Received by,/l<�� DateC� � �Y`�� i � i � �i� � � �� i � � � � � � � qE�3 � ' � � � � , �' � . � Vicinit Ma , � �.,, a� � Y p � � g � � � I � � � � F 2 Q7�3 9E'f� �� 9E7�7 � � N�'P��\P� T��m � o I ASe� RyRa �� !ro � � � � � � ENNSYLVANIA AVE DODGE ST � � � � � � �l � � sk, h ARTFRiq< � \ � � � � � � :�� / � � 9�p \ �0 qr�p °R-1 9R� :� � � � � � g 9r�t3 Applicant: William R. Biver, Mary's Inn Maternity � � � � 4�3 � Home � � Location: 1749 Churchill Driv I ! � � e (PIN 1022379005 � � � � and 1022379004) � � g� � � � � � Description: To rezone property from R-1 � Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions. � � � � �. . . . � � � � � � g ■ ■ Subject Property . . . � � � � �� QQ��,,�_ �� N � � � 9C�YJ � o �o �ao zao � 9C� q� � Feet �� D�ue County� � � � � � � 4°�JO � � 9C�h7 �:2,000 Travis Schrobilgen From: Biver, Deacon Bill <dbq061d@dbqarch.org> Sent: Friday, August 11, 2023 6:10 PM To: Travis Schrobilgen Cr. Colleen Pasnik Subject: Narrative for Re-zoning of 1749 Churchill Dr. Caution!This message was sent from outside your organization. Allow sender I Block sender Mary's Inn, having been located at 2750 Balboa Dr. since 2015, desires to re-locate its maternity home to a residence at 1749 Churchill Drive. Mary's Inn has made, and the owner's of the residence at 1749 Churchill have accepted an offer to purchase, contingent upon the sale of the Balboa property, financing, an inspection, and appropriate re-zoning of the Churchill residence from R-1 to R-3 and obtaining a Conditional Use Permit. An application to re-zone the Churchill property from R-1 to R-3 and to obtain a Conditional Use Permit was filed on August 7, 2023 by Mary's Inn Maternity Home by William R. Biver, President of its Board of Directors, and it was co-signed by the Churchill property owners Jeffrey and Patricia Szalkowski. Mary's Inn now requests to be present at public hearings of the Zoning Advisory Commission, City Council, and Zoning Board of Adjustment on September 6, 18, and 28 respectively, to speak in favor of the application being approved. We thank all parties in advance for the opportunity to present further details relating to this application for the re-zoning and the permit. Respectfully, Mary's Inn Maternity Home � William R. Biver - President Deacon Bill Biver St. Columbkille and St. Joseph the Worker Phone: 563-556-5314 (o) Phone: 563-580-6986 (C) 2 � � ' H ERE'S HOPE � - � , � : _, ,:_ ..,.. ... � � ., . ,. , � � _ _ - � � �> _ - • ' , " ��.- , . �, P.O. BOX3338 � DUSUQUE, IOWA 52004-3338 � (563) 552-6288 � wwwmarysimm�nte-rnztyhoJne.org � . August 15, 2023 RILEY, JpHI�t VV &ANN L TRUST 1733 EDEN LN DUBUQUE, IA 52001 E�ood afternoon, We are wrl�ing on behalf of the Board of Directors of M�1y's Inn iv[aternity Home. We wish to inform you of our hope of finalizing the purchase of th�residen.,e at 1749 Churchill Dr., the current residence of your neighbors Jeffrey and Trici"a Szalkowski.c�`� ��_>:_ - �-�._._�_--�.... _ m---�=.-v The sale of the house is contingent upon completion of pre-approved financing, inspection of the house, sale of our present property, and our obtaining re-zoning from the City of Dubuque of the Churchill property from Single Family to Multiple Family. To that end, we �ave f Ied an ap�lication for a Cor�ditional Use pei-ir�it and reclassification of zoning with th;, �';ty�f Dubuque. Pending thP satisfa�tion of the other contingencies and that �pproval, our plans ar�to rel�cate Mary's Inn from its current:ocaticn in D�zbuque to Churchill Drive. As you are more than likely aware, re-zoning requires tne approval of the City of Dubuque and that approval is, in some measure, �iependent upon input from neighbors, which is why we are contacting you. We are a maternity home. Our mission is to provide a familv living arrangement for women who are pregnant and/or are parenting an infant and need a safe place to stay and gro�v. We are fully aware that you may have concerns about a maternity home �n your neighborhood. W� �nticipate your concerns might include such things as our effect on y�ur property value as well as domestic,parking, traffic, and house maintenance issues. So, in u spirit of neighborly cooperation and full disclosure, we would like to tell you a little bit about our histor�,�and how we operate: • The home was founded upon and will be run by Christian principles. Our programrr,ing is based on Gospel vaiues and the teachings of the Catholic Church. + We have been in operation for eight years and have served 60 women and their babies. • In those eight years there has never been a complaint filed against us at our current location. • The maYimum num�er of women residents we can serve at ane time is 4. We typically have 2-3. • There are �stablisr�ed�ouse rules and guidelines tnat all residents are requir�d to fo11_ow to ma�ntain residence with us. • Boyfriends are not permitted on the pre�nises. � a.. � Th.�r� i� �.lvcrays adult s�.�e�'V151��.1�11-�ite 24/� 3�5 da • , ys/ye�.r to ��,nage and�ns�.r� an ord.erl h�use]holds � � �ur staff, b�w��°d a�d ��amp1�, �v�l�mod��wh�.t it m ' eans t� be g��d ne�ghbors. � Nlost of��.x resid�nts hav��.ot�r v�ill r��o�vr�a c�.�°o T • . h�y�� .�r�l�.�.te�r drlv��or th� ��t b�s f�r transpo�tat�a�. �' � �.her��ril1 be vis�ts from.val�.r�te�rs �.nd loc�.I a �n� ° ° � a . g Y pr�fess�on�.ls duar�r��wor�l�.��:ou��, b�.t th�s�vislts sh�uld b� s� inf�� ernt th�.t traf�ic ancl ° ° � � � q p�.rkl�g lssues w-��e��gllg�bl�. � Pr��acy a.md�onfzdentialxt�ar� ��entia� $'or a�.r r�sid ents. A11 correspond�n�e to ll�ary'� Inr�vvi�l be d�rec��d to a.p�st-�ff��b�x. 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If ya�u a��u�abl� ta att�nd, ar hav�qu.est�ons�n�.dvan�e, 1e�.se f�e� fr�e$c� � . i�.fo�m ' ° � C�11td.Ct e1��1e�'127.e C)�'�O��e]�4 P�,S111�. �ur �.t�on is b�lowa ��k g��u fo�°y��.r t�r�� and c��sid�rat�o�,o � �1nce�°el�y, ` b . (��,`�S�I .� l��a.c��. �11_�.��ver � . ��_l�er�P'�.s�.1k,I�IaEda ��.�°d�'r�s�d��t, l�lar�r's Irran IOiI�.��rr��t I�a�.e ' � ��r�ctor, IVI�xy's I�.I`I`✓Ila�e��ty��-Ior�e �.�. �� 333� ��C�. �� 333� I�ubuq�.e, I,��2004-3 3 3� I)�.buque, IA �2004�-�33$ 563-5��-69�� (p��sonal c�11) • , �6�-5 52-G2�8 (D1��ct�r s v�rork�el�� Em�.�l: b.1��A�d��.�•��..�� ° • -� • �rn.ai�e �.��°��:��c�,x�.�.� -��.��.�.��.�� .�.�r� REZONING STAFF REPORT Zoning Agenda: September 6, 2023 Property Address: 1749 Churchill Drive (PIN 1022379005 and 1022379004) Property Owner: Jeffrey and Patricia Szalkowski Applicant: William R. Biver— President, Mary's Inn Maternity Home Description: To rezone property from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions. Proposed Land Use: Residential Proposed Zoning: R-3c Existing Land Use: Residential Existing Zoning: R-1 Adjacent Land Use: Adjacent Zoning: North — Residential North — R-1 East — Residential East— R-1 South — Residential South — R-1 West — Residential West— R-1 Former Zoning: Prior to 1975 — Single-Family Residential 1975 — R-2 Residential 1985 — R-1 Residential Total Area: .7 acres / 30,758 sq. ft. Property History: The subject property is comprised of two lots which have historically been zoned for residential use. The lots are currently under common ownership and are currently listed for sale under one property listing. The southern lot, which is addressed as 1749 Churchill Drive, is improved with a two-story single-family residential dwelling with two attached garages and the lot to the north (PIN 1022379004) is currently vacant. Physical Characteristics: The subject property consists of two lots totaling .7-acres (30,758 sq. ft). The southern lot at 1749 Churchill Drive has street frontage along three property lines including Eden Lane to the west and south and Churchill Drive to the east. The northern lot (PIN 1022379004) has frontage along two streets, Eden Lane to the west and Churchill Drive to the east. The northern lot is currently vacant and has been utilized as a yard area for the 1749 Churchill single-family residence. The subject property is slightly sloped with an approximately 10' elevation change from the northernmost property boundary to the southernmost property boundary. Site image provided on the following page. Rezoning Staff Report— 1749 Churchill Drive, PIN 1022379005 & 1022379004 Page 2 �� M *�So� I ,:,�,f �F � � L'.'�� i-:•:a �F � i # . .' I + '-�r � h �� 1�a` I , • ' � lrr+4 � 1^�!L '�n 7�Q 1 ��1411�11� .� � ; � W � y � 7��4 � � I'.'�?• � �11�} � � ��f�� . � y� . �-- , � � � — � ��+�� -�� -- *17�� 17�� h�irchil I �rive & PIN 1{}�2�79[}�4 � ��j�t �t��p�rt�+ � F�-1 ��ni r�� Rezoning Staff Report— 1749 Churchill Drive, PIN 1022379005 & 1022379004 Page 3 Concurrence with Comprehensive Plan: The Comprehensive Plan encourages mixed- use development to create diverse and self-sufficient neighborhoods. It also recommends that incompatible uses be buffered and protected from each other. The Future Land Use Map identifies the southern lot at 1749 Churchill Drive as R-1 Residential and the northern lot (PIN 1022379004) as Park and Open Space. Impact of Request on: Utilities: Existing utilities are adequate to serve the site. Traffic Patterns/Counts: There are no current traffic counts available for Churchill Drive or Eden Lane. Staff anticipates that rezoning this property will generate little, if any, additional traffic above and beyond the existing single-family residential use. Public Services: Existing public services are adequate to serve the site regardless of how it may be utilized or redeveloped. Environment: The proposed rezoning is not anticipated to have any adverse impacts on the environment. The lot at 1749 Churchill is fully developed and the northern lot (PIN 1022379004) is currently vacant; however, any improvements to the property would be required to meet the standards for development including adequate green space, landscaping, setbacks, and stormwater management. If the requested rezoning is approved, any future development would be required to be in compliance with the approved rezoning ordinance and all applicable city codes. Adjacent Properties: The subject property is surrounded by single-family residences.The proposed conditional rezoning would not modify the zoning of adjacent properties. Rezoning the property to R-3 with conditions and establishing a group home may slightly increase the amount of activity and traffic beyond that of a typical single-family residence. CIP Investments: None proposed. Staff Analysis: St. Mary's Inn Maternity Home is currently operating as a Group Home' at 2750 Balboa Street. That property is located in an R-1 district and a rezoning to R-3c district was required in order to allow the Group Home. The applicant was also required to receive a Conditional Use Permit approval from the Zoning Board of Adjustment. To date, Planning Staff has not received any zoning enforcement complaints for their property on Balboa Street. St. Mary's is now seeking rezoning approval in order to allow a Group Home at the subject property. 1 GROUP HOME:Any group of persons not meeting the definition of"family"and occupying a single dwelling unit living together as a single housekeeping unit, but not including a boarding or rooming house. Rezoning Staff Report— 1749 Churchill Drive, PIN 1022379005 & 1022379004 Page 4 The applicant is proposing to rezone property from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions.The subject property consists of two lots with a combined area of .7 acres (30,758 sq. ft.). The southern lot located at 1749 Churchill Drive is improved with a two-story single-family residential dwelling with two attached garages. The northern lot is currently vacant and has been utilized as a yard area for the adjacent single-family residence. There are five parking spaces available on the lot (three spaces in the attached garages). The property is bordered on all sides by R-1 zoning and single-family residences. The applicant's intent is to operate a maternity home with staff support for pregnant women. The Unified Development Code classifies a maternity home as a Group Home which is not a permitted or conditionally permitted use in the R-1 district. Consequently, the applicant is requesting to conditionally rezone to the R-3 district in which a Group Home may be a permitted use through a Conditional Use Permit, which would require review and approval from the Zoning Board of Adjustment. The R-1 district allows for 8 principal permitted uses and the R-3 district allows for 11 principal permitted uses. As proposed and shown in the table below, the rezoning to R-3 with conditions would not permit multiple-family dwellings, townhouse, or two-family dwelling development on the subject property. The chart below outlines the permitted uses in the R-1 district, the permitted uses in the R-3 district, and the proposed permitted uses in the R-3c district. The uses hiqhliqhted in red are permitted in the R-3 but would not be permitted in the R-3c. . - . � � . . . - . � Cemetery, mausoleum, or Cemetery, mausoleum, or Cemetery, mausoleum, or columbarium columbarium columbarium Place of religious exercise or assembly Place of religious exercise or assembly Place of religious exercise or assembly Golf course Golf course Golf course Public, private, or parochial school Public, private, or parochial school Public, private, or parochial school Railroad, public or quasi-public utility Railroad, public or quasi-public utility Railroad, public or quasi-public utility Parks, public or private, and similar Parks, public or private, and similar Parks, public or private, and similar natural recreation areas natural recreation areas natural recreation areas Community gardens Community gardens Community gardens Single-family detached dwelling Single-family detached dwelling Single-family detached dwelling Multiple-family dwelling (max 6 units) Townhouse (max 6 units) Two-family dwelling (duplex) As previously stated, the applicant is seeking to allow a maternity home on the subject property, which is classified as a Group Home per the Unified Development Code.A Group Home is not permitted in the R-1 district but may be allowed as a conditional use in the R-3 district. If the rezoning is approved, the applicant would still require review and approval for a Conditional Use Permit by the Zoning Board of Adjustment. Rezoning Staff Report— 1749 Churchill Drive, PIN 1022379005 & 1022379004 Page 5 The R-1 district allows for 10 conditional uses and the R-3 district allows for 16 conditional uses. The proposed rezoning to R-3c district would allow for a total of 10 conditional uses, including a Group Home. The chart below outlines the conditional uses in the R-1 district, the conditional uses in the R-3 district, and the proposed conditional uses in the R-3c district. The uses highliqhted in red are conditionally permitted in the R-3 but would not be conditionally permitted in the proposed R-3c. The Group Home use is hiqhliqhted in yellow. . . . . . � . . � . . . - . . . Bed and breakfast home Bed and breakfast home Bed and breakfast home Licensed adult day services Licensed adult day services Licensed adult day services Licensed childcare center Licensed childcare center Licensed childcare center Mortuary,funeral home, or crematorium Mortuary,funeral home, or crematorium Mortuary,funeral home, or crematorium Off street parking Off street parking Off street parking Tour home Tour home Tour home Tourist home Tourist home Tourist home Wind energy conversion system Wind energy conversion system Wind energy conversion system Accessory dwelling unit Accessory dwelling unit Accessory dwelling unit Keeping of horses or ponies Group home Group home Hospice Housing for elderly or persons with disabilities Individual zero lot line detached dwelling Nursing or convalescent home Off premise residential garage Rooming or boarding house The Comprehensive Plan encourages mixed-use development to create diverse and self- sufficient neighborhoods. It also recommends that incompatible uses be buffered and protected from each other. The Future Land Use Map identifies the southern lot at 1749 Churchill Drive as Single-Family Residential and the northern lot(PIN 1022379004)as Park and Open Space. Planning staff recommends that the Zoning Advisory Commission review the information provided and make a recommendation on the requested rezoning to the City Council in accordance with Chapter 9 of the Unified Development Code and the criteria established for granting a zoning reclassification. � Prepared by: Date: 8/31/2023 8/30/23,8:19 AM https://export.amlegal.com/api/export-requests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 16-5-2: R-1 SINGLE-FAMILY RESIDENTIAL: The R-1 district is the most restrictive residential district and is intended to protect low density residential areas from the encroachment of incompatible uses.The principal use of land in this district is for low density single-family dwellings and related recreational,religious and educational facilities. (Ord. 52-09, 10-19-2009) 16-5-2-1: PRINCIPAL PERMITTED USES: The following uses are permitted in the R-1 district: Cemetery,mausoleum,or columbarium. Community gardens. Golf course. Parks,public or private,and similar natural recreation areas. Place of religious exercise or assembly. Public,private or parochial school approved by the state of lowa(K-12). Railroad or public or quasi-public utility,including substation. Single-family detached dwelling.(Ord.52-09, 10-19-2009;amd.Ord. 17-13,3-18-2013;Ord. 19-20,5-18-2020) 16-5-2-2: CONDITIONAL USES: The following conditional uses may be permitted in the R-1 district,subject to the provisions of section 16-8-5 of this title: Accessory dwelling unit. Bed and breakfast home. Keeping of horses or ponies. Licensed adult day services. Licensed childcare center. Mortuary,funeral home,or crematorium. Off street parking. Tour home. Tourist home. Wind energy conversion system.(Ord.52-09, 10-19-2009;amd.Ord.66-14, 11-17-2014) 16-5-2-3:ACCESSORY USES: The following uses are permitted as accessory uses as provided in section 16-3-7 of this title: Detached garage. Fence. Garage sale,provided that not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)consecutive days per sale. Home based business. Keeping of hens for egg production. Noncommercial garden,greenhouse or nursery. Off street parking and storage of vehicles. Satellite receiving dish. Solar collector(freestanding arrays are limited to not more than 100 aggregate square feet and 10 feet in height). Sport,recreation,or outdoor cooking equipment. Storage building. Tennis court,swimming pool or similar permanent facility. Wind turbine(building mounted).(Ord.52-09, 10-19-2009;amd.Ord.47-14,7-21-2014;Ord.54-15,8-17-2015) 16-5-2-4:TEMPORARY USES: Temporary uses shall be regulated in conformance with the provisions of section 16-3-19 of this title.(Ord.52-09, 10-19-2009) 16-5-2-5: PARKING: Minimum parking requirements shall be regulated in conformance with the provisions of chapter 14 of this title. (Ord.52-09, 10-19-2009) 16-5-2-6: SIGNS: Signs shall be regulated in conformance with the provisions of chapter 15 of this title.(Ord.52-09, 10-19-2009) 16-5-2-7: BULK REGULATIONS: Minimum Maximum Setbacks Minimum Lot Maximum R-1 Residential Lot Front Lot Area Coverage Minimum Minimum Height Fronta e Lot Area 2 Maximum g ( ) Minimum Side Rear https://export.amlegal.com/api/export-req uests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 1/2 8/30/23,8:19 AM https://export.amlegal.com/api/export-requests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ R-7 Residential Minimum Minimum Maximum Setbacks Maximum Lot Area Lot Lot Front Height Frontage Coverage Minimum Minimum (Lot Area) Minimum2 Maximum Side Rear ermi e uses: Place of religious exercise 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 75 n.� or assembly,school Single-family detached 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 6 ft. 20 ft. 30 ft. dwelling Conditional uses: Bed and breakfast home 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 6 ft. 20 ft. 30 ft. Licensed adult day services, 5,000 sq.ft. 50 ft. 40% 20 ft. - 6 ft. 20 ft. 30 ft. licensed childcare center Mortuary,funeral home or 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 30 ft. crematorium Notes: 1. May be erected to a height not exceeding 75 feet;provided,that such buildings shall provide at least 1 additional foot of yard space on all sides for each additional foot by which such building exceeds the maximum height limit of the district in which it is located. 2. See section 16-3-17 of this title for adjustment of minimum front yard setbacks. _._.�............................... . � ............................................w...._................. �.. .......... _ ..�.�.. . ................ .__ _.-----......�:. _�__„ , _______ � �~~~-~_~ �€ int u w �. '� �- - ��, - � rca �n� T n. ��u€red '::�� • F, ��:�; ' � i��a � _ � °:: : � � � `::�'r� ��JEI:��G�_u� � �� .. ; i .:�:. : . : ! i�;�;:. ,:�w�.�MM•.... . . . . . i. i ... _ � �.,., w. � '. i °':_: a. , i � � ::. -.. 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E,4... : �.:. .:::.. : ....... f. :::....; .. . . ....... � i ... ;. ... . . .........i_ �g F. .. .,...—:`..w"�` � �� •'�':� £T f ( ; f .s ; ( �#'r : :: � :. . � :....... � . .,..�,�.... . . '�� ..�::... � ..,:.:€ ..� � :. :�� :: %::�r.�.......; � .i .' :; i ..;� : :. . s ......._.... � 1 : �� : . � � ; , � §�`� .,." . . : �... : � � . e : � � .'�... ; � rM�. � x..... ... ....... «F�:. ,., .. � w x': ... . .,..; � . i . •..,•. . .. . a t••�..•s,•,^��,,,�-..... ..,:� ;;';:� ;: �� . : ,� � ...�:.< : ICC' d ` �3� ili-�� : :. . .. : : � - � � ' ' > p.� �ar rx- . ,i ef� ;:•r� �. Area � � _ -.. ,- i : : . : `+ F:'.,�,, ' ` � � st l�evef � � :�� __ __ M_ _...»._.��.�..��: , , �ac� :� � ..,.. ,. ____..._._......_. _ _ .._ ......., �... . u...�... x:� �#r ,-� �...�................. . �. _� _. ..... ;......... _ . �:� ntac�e ' ;.^�,, . µ,��;�.:��T �� ":::F��ir��: �.�..: ,�...�. _ . • . ..:. .. , ___. .... S�r�� . �...... _. . ., . � :<..::, : � =ra:::,�::.:: - 5 , . �. . ' _ , z.._ ::::.:::::: . ::::::- , ,.M �.. . � _:�:::::... ��:,�x::x; (Ord.52-09, 10-19-2009) https://export.amlegal.com/api/export-req uests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 2/2 8/30/23,8:20 AM https://export.amlegal.com/api/export-requests/b6f7027a-92ed-4ab0-88b4-c6cfa7bda29e/download/ 16-5-5: R-3 MODERATE DENSITY MULTI-FAMILY RESIDENTIAL: The R-3 district is intended to provide locations for a variety of dwelling types ranging from single-family to low rise multi-family dwellings.The R-3 district also serves as a transition between residential and nonresidential districts.(Ord.52-09, 10-19-2009) 16-5-5-1: PRINCIPAL PERMITTED USES: The following uses are permitted in the R-3 district: Cemetery,mausoleum,or columbarium. Community gardens. Golf course. Multi-family dwelling(maximum 6 dwelling units). Parks,public or private,and similar natural recreation areas. Place of religious exercise or assembly. Public,private,or parochial school approved by state of lowa(K-12). Railroad or public or quasi-public utility,including substation. Single-family detached dwelling. Townhouse(maximum 6 dwelling units). Two-family dwelling(duplex).(Ord.52-09,10-19-2009;amd.Ord.17-13,3-18-2013;Ord. 19-20,5-18-2020) 16-5-5-2:CONDITIONAL USES: The following conditional uses may be permitted in the R-3 district,subject to the provisions of section 16-8-5 of this title: Accessory dwelling unit. Bed and breakfast home. Group home. Hospice. Housing for the elderly or persons with disabilities. Individual zero lot line detached dwelling. Licensed adult day services. Licensed childcare center. Mortuary,funeral home,or crematorium. Nursing or convalescent home. Off premises residential garage. Off street parking. Rooming or boarding house. Tour home. Tourist home. Wind energy conversion system.(Ord.52-09, 10-19-2009;Ord.20-22,5-20-2022) 16-5-5-3:ACCESSORY USES: The following uses are permitted as accessory uses as provided in section 16-3-7 of this title: Detached garage. Fence. Garage sale,provided that not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)consecutive days per sale. Home based business. Keeping of hens for egg production. Noncommercial garden,greenhouse or nursery. Off street parking and storage of vehicles. Satellite receiving dish. Solar collector(freestanding arrays are limited to not more than 100 aggregate square feet and 10 feet in height). Sport,recreation,or outdoor cooking equipment. Storage building. Tennis court,swimming pool or similar permanent facility. Wind turbine(building mounted).(Ord.52-09, 10-19-2009;amd.Ord.47-14,7-21-2014;Ord.54-15,8-17-2015) 16-5-5-4:TEMPORARY USES: Temporary uses shall be regulated in conformance with the provisions of section 16-3-19 of this title.(Ord.52-09,10-19-2009) 16-5-5-5: PARKING: Minimum parking requirements shall be regulated in conformance with the provisions of chapter 14 of this title.(Ord.52-09,10-19-2009) 16-5-5-6:SIGNS: Signs shall be regulated in conformance with the provisions of chapter 15 of this title.(Ord.52-09,10-19-2009) https://export.amlegal.com/api/export-requests/b6f7027a-92ed-4ab0-88b4-c6cfa7bda29e/download/ 1/3 8/30/23,8:20 AM https://export.amlegal.com/api/export-requests/b6f7027a-92ed-4ab0-88b4-c6cfa7bda29e/download/ 16-5-5-7: BULK REGULATIONS: Minimum Maximum Setbacks Minimum Lot Maximum R-3 Residential Lot Front Minimum Minimum Lot Area Coverage Height Frontage �Lot Area) Minimum2 Maximum Side Rear Minimum Maximum Setbacks Minimum Lot Maximum R3 Residential Lot Front Minimum Minimum Lot Area Coverage Height Frontage �Lot Area) Minimum2 Maximum Side Rear Permitted uses: Multi-family dwelling(6 du 2,000 sq. 50 ft. 40% 20 ft. - 4 ft. 20 ft. 30 ft. maximum) ft./du Place of religious exercise 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 75 ft.� or assembly,school Single-family detached 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 4 ft. 20 ft. 30 ft. dwelling Townhouse(6 du maximum) 1,600 sq. �6 ft./du 40% 20 ft. - 4/0 ft. 20/0 ft. 30 ft. ft./du Two-family dwelling 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 4 ft. 20 ft. 30 ft. Conditional uses: Bed and breakfast home 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 4 ft. 20 ft. 30 ft. Group home 5,000 sq.ft. 50 ft. 40% 20 ft. - 4 ft. 20 ft. 30 ft. Hospice 5,000 sq.ft. 50 ft. 40% 20 ft. - 4 ft. 20 ft. 30 ft. Housing for the elderly or 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 30 ft. disabled Individual zero lot line 5,000 sq.ft. 50 ft. 40% 20 ft. 50 ft. 10/0 ft. 20 ft. 30 ft. dwelling Licensed adult day services, 5,000 sq.ft. 50 ft. 40% 20 ft. - 4 ft. 20 ft. 40 ft. licensed childcare center Mortuary,funeral home or 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 30 ft. crematorium Nursing or convalescent 20,000 sq.ft. 100 ft. 40% 20 ft. - 20 ft. 20 ft. 30 ft. home Off premises residential _ _ _ 20 ft. - 4 ft. 6 ft. 15 ft. garage Rooming or boarding house 5,000 sq.ft. 50 ft. 40% 20 ft. - 4 ft. 20 ft. 30 ft. Notes: 1. May be erected to a height not exceeding 75 feet;provided,that such buildings shall provide at least 1 additional foot of yard space on all sides for each additional foot by which such building exceeds the maximum height limit of the district in which it is located. 2. 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Applicant William R. Biver, Subject: Mary's Inn Maternity Home Notes: To: 15635894149 From: 15635833173 Date: 09/01/23 Time: 7:42 PM Page: 02/04 II Septcmber 1, 2023 Zoning Advisoiy Commrssion City of Dubuque j c/o Planning Services Deparhnent City Hall ' 50 West 13th Sh•eet Duhuque, Iowa 52001-4210 RE:Applicant: Williasn R. Biver, Mary's Inn Maternity Home I Dear Commissian Members: ' We reside at 1805 Eden Lane, Dubuque, Iowa 52001-4029 and are strongly opposed to j the above-referenced Application. Bc�th of us are oirt of the City on Septembe�•6 and are m�ahle i to attend the hea�7ng on that date in person. ,I I, We are opposed to the r�pplication for the following reasons: i (1) We concur with the arguments in oppoeition we knaw wil,l be delivered in person at the hearing by our neighbars. � (2)The Unified Development Code(hereafter the Code")provides that conditional uses 'I "may be"permitted. But they need not ba permitted. They are not mandatory.The permitting decfsion is w'rU�in Che sound discretic�n of tho Commission.A oonditional use permit is not � granted as a matter of right. ! (3)As a matter of sound public policy, conditional use permits should be rarely granted �li� because they are pennits far use inconsistent with the uses automatically permitted as a matter of right{i.e. favoreci}iu a given zoning district. Issu�tuce of such pei7nits by th�Cominission should he the exception,rather than the rule. Because conditiona2 uses are inconsistent with the permitted uses in the district, they are strictly defined and limited by the Code. (4)A"maCerniYy home"tise is not a Principal PermiYted iJse in our R-1 DisYrict under Section 5-2.1 of the code, nor is a"n�aternity home"use a permitted"conditional use"which may be permitted in our R-i District under Section 5-2.2. i f To: 15635894149 From: 15635833173 Date: 09/01/23 Time: 7:42 PM Page: 03/04 Section 8-5-1 of the Code states: � "1'he 'Loiung t3or�rd ofAdjustment may allow as conditional uses only those uses classified as conditional uses in this Code.No conditional use should be allowed in a particular district unless such use is specifically permitted as a conditional use in the ' regulations for that district..." Nor is a tnatei7iity hoine a principal pennitted use R-3 Moderate Density Multi-I�"amily District under section 5-5.1. Nor is a"maternity home" a permitted"conditional use"which may ', be permitted use under"R-3 Moderate Density Multi-Family District under Section 5-5.2. ' We submit that the absence of"matemity horae"in the Code provisions requires denial of the Application. "Mateniity home"is easily defined in some statues. For example, Section , 249.001§ of the Texas Statues contains the following definition of"maternity home": ', "Matemity home"means a place or establishment that receives, treats, or cares for ' overnight or longer, wathin a period a£12 months, four or more pregnant women.... �I We understand City Staff may contend the Applicant's "maternity home'is a"Group home" as defined in the Code.We respectfully disagree,because occupants of group homes are permanent occupiers, while unwed mothers in a maternity home are only temporary residents ' there. The population oF a m,aternity home is coiv�tantly changing. I (5�When each original property owner in Churchill Heights Subdivision purchased thair ' property, the property was impressed with a recorded Restrictive Covenant that their lot and each �� other lot in the subdivision "shall be used exclusively ets and£or residential property for the ' erection of a single-family dwelling, and far no ofher purposa. Tliis precludes any use other than single fainily. The eovenants also provided that "No structure shall be erected or permitted on 'i (sic}lot other than a single-family dwelling .... ". Based on that promise by the Daveloper, the , original owners bought their lots vid erected hmnes for single families throughout the i subdivision. The covenants prohibited in at lelst two (2.} sections the multi�family property use i Applicant seeks here. Whetl�er the original covenauts have expired or not, fhe Commission , should consider tha inequity of pennitting a single owner through Commission aetion to change the character of a single-family neighborhood every other owner has preserved for over 50 years and is committed to continue to preserve. , (6)A,n earlier application to change the use of the subject property from single-fainily to multi-family was rejected. On March 25, 2010, the City of Dubuque Zoning Board of ; Adjustment unnnimously(3-0}denied the application oftlndrea Beacham and Larry Loepke, � then owners of l 749 Churcl�ill Street,to covert the workshop on the property into an accessoiy I dwelling unit to be rented out to marelated third pa�•Cies. I We respectfully request that the Commission deny the Appiication in its entirety. , i I � I I I To: 15635894149 From: 15635833173 Date: 09/01/23 Time: 7:42 PM Page: 04/04 Thank you in advance for your consideration of our comments. Very truly yours, Steplien J. Juergens Suzamie M. Juergens i, i � i % �' � I Matt O'Brien From: Diana Robinson <32drobinson@gmail.com> Sent: Tuesday, September 5, 2023 11:44 AM To: Planning Subject: Rezoning-Mary's Maternity Home Caution!This message was sent from outside your organization. Allow sender I Block sender H i, I am against rezoning the property at 1749 Churchill Drive into a multi-family property/business. I believe that it should remain a family home. We live in an established neighborhood. We have lived here for 5 years now.The newest neighbors before us moving into this neighborhood had been 8 years. We are a family with 4 children. We were the only family that lived on our street.There were elderly people who lived by us, only until the last year or so have other families moved in with children. This is a very quiet neighborhood with very little traffic. Kids are riding bikes, walking, playing hide and seek, roller blading, ect. We homeschool, along with other families in our neighborhood. We know our neighbors. We feel safe. I am personally worried about the traffic, all the different people that will be coming and going into and out ofour neighborhood because of the multi-family/business that may go in,the noise from people coming and going and from construction that may need to happen in order for the current home to become a multi-family home,the value of our home, the taxes may change, and what if we would want to sell in the future it could affect the sale of our home. I believe that this is a kind of business and does not belong in a neighborhood. It is peaceful and quiet here, even though we are in the middle of Dubuque, it doesn't feel like it or sound like it. I believe that our neighborhood would not feel safe as it does now. Thank you for listening to me, I appreciate it Sincerely, Diana Robinson 1775 Eden Lane Dubuque, lowa 52001 � i I I I To our neighbors Re: The endin urchase of the ro ert located at 1749 Churchill Dubu ue IA 52001. p gp p p Y , q , II The purchase of a home is normally a relatively large investment for a family. Before - II making the purchase we typically look at a location, neighboring homes, as well as safe iand quiet streets. After making our investment, we fully expect the neighborhood to remain residential. The last thing we would want is a business of any kind. A place that needs to be rezoned does not belong in an area of homes that will significantly be affected in multiple ways. The property values in the surrounding area will be negatively impacted. In addition, our living environment will sufFer adversely should this business be permitted. This neighborhood is not conducive for ofFices volunteers, and city employed workers. The children that currently live in this neighborhood will succumb to an increase in traffic caused by the daily operations of a business. The potential hazard of domestic disturbance with the residents of proposed housing will increase the risk as well. If the property is rezoned, the owner may elect to use it for expansion. We may be opening a door for Mary's Inn that has not an out for us:This would never happen on � lower South Grandview, Plymouth Court, or Sunset Ridge, to name a few. It is my hope that the zoning commission realize that our homes mean just as much to us as those in more afFluent areas of the City of Dubuque. It is my intention to work with my neighbors to help sustain the integrity of what is now our peaceful and serene residential neighborhood. Respectfully, Barbara Motto Sharon Young Opposed to zone change at u ue Iowa � � 1749 Churchh�ll Drxve, Dub q , NAME ADDRESS � � -, o- l ��;}��5 c�� :�,��= ��U�� S� �� l�� 1 �� ,� �,� - '� , _�� L '� - ��, � �,�,�_ ,�, � .� _ - � �, / � �� z-�� . - I��L � � c��.� p ., , .yv C�_ � C�,� � - �� , ,� �� "' �� C ��-��-z� `� ] ��-�s� � �%�C��"�=�`�rJ � �,l�c;' 9 �� 4 U N h�5 ��rr G � Ir r �� • ` J L� �{ � � � / � � ' r� ti �'.�� rL � 'r`i � `�2�� .� S�� [ ��.�� . 1 �� 1� �� r—, . v � � �,_ � ,�__� � �,�� „'-�` "--"`"� - '---� � �� r �,# � ,��_— �'��.=� � .,, �� ] �� , � 3.� 1 � � � � ; � '��'-� � J 7� � � 'ct�� tt� ,�r, r , ,—�'� 4�� a �� ( C�.�.�� r��t�� .�. ``�s— ,r , , ' i; �'�i f� �, C�� C-=';�;,�� [��'��i n� � =-''i t � � • _ r�� / r � , � d `� ( , � � E�/�`��y �'a f�3 �'�, ' � � � I .� � .-� � �,�� ;��,/'��' � �,� ' , I� ,. �� v a. 1: ^ � � ✓� � --� J—�, �j�� [' 1 ! �� {..�� , � '�/�1 s� � 1 I �� ;. } r �� ;L � ,Y, �L;' I, � lu• f, `� Opposed to zone change at 1749 Churchhill Drive, Dubuque, Iowa NAME ADDRESS ,;-��1.--� ��5 � 2.:a—;.�.� -� �..7 �5.��v5 � �U � �.� ��c��'_-�,� �^/�`b�`i�� _ � � ,�� ,�e - � � � �,1�� _ � ��(� �5 � !/� . The undersigned are opposed to the rezoning of 1749 Churchill Dubuque, IA 52001 ' 1�Na Address � �� l�-� 2. � '�- _" " 3. 4. '� 5. 6. I' 7. 8. I' 9. 10. 11. 12. 13. 14. 15. 16. ' 17. 18. 19. Opposed to zone change at 1749 Churchhill Drive, Dubuque, Iowa ', NAME ADDRESS �`RYl t�_,-- �1A1.,U i.-E'�(l�-- �� t ��l,l�'L,VI~i �l �Y • �,cyl�:t.s�'U� ,�!�- � � ' � y �a-d� � � � �� 3b u-��a�cki�u_ nR I�vQ��. � .� ��a hu��rll ��?� owh�� .�� l�-� —e '7 3 5 C'�e�,.� � . �-- � � S h a►r� � Y� �� / 7 �� "��, �� ..�� - � �/ �� b�`�r��t- /`7' � 5' � � �.� 2..�,�, �-� � / e e• � e O e • • ° o � � � � �°°' � � � � � � moa •o. � � �o 1749 Churchill Drive�Public�'Input Subject Property � � � � � � � � � � O 200'Notification o 0 Boundary ; � /Q o o � U� m Parcel area within 200' � � � �'�° � = 237,583 sq.ft. 9� i ` � �� ' � � Petition Opposition � � � � q�q � Owner Opposition � � � 9:� within 200' = 105,453 ,� � .��p � � � � ,„�,_'j sq.ft. '1Y" :•0 Opposition outside ,� � � g � � � � � y� � 200' 0 0 Signature of address collected � �'' � o '��° � 9f3110 � :o• c�' outside this map boundary: � -3280 Pennsylvania Avenue � �� `;C� � 9� � � � � � � � � � � � � � � .�� . � � —� � � � � — :oo _ � �a Letter of Opposition q� �i .o � 9� •° . 9� .0 8 � 9� ... q� , 1— � � 9r�F3E3 � � 95ffi 9`rh�i � � � . Percent of owner area � opposed within notification � � � boundary: � � � � � � 105,453 sq.ft./237,583 sq. I � � � ft.=44.4% � � e o G��L�A o � � 90� �, � � � � o � � � � . . .•- 9C•� � •°o � � ° ° Q� ` °°° °�°� �. � � u.u � '�j � �C, o �� q(.� N �3 Feet �� ,�' 0 125 25� 5�0 ,�j � � . `L�''u9Juque County GIS,Source: Esri, Ma�x,�;,,rl�Ea�thsta�GeQ��aph�i�c and�rt:� GIS User�Coy_��/+`me�� yy� ,�, �}� "1� ' u r �yr '7� ,{0'�' s o� UiixJ '�5j'�f� `YT � U°Je.NJ � •�0 "V e�o � (7 "1!' •�� e . • � � . . - � .***. . � � - � i • 1749 C u rc i D rive ( PIN 1022379005 and 1022379004) Request to rezone from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions. Staff presentation to City Council September 18, 2023 Dubuquc � O�Tr,O � � f.-��,0 4�] � � �rr i�:�rrY c�F h� � � a��—� ,"''' .:, � '. � � F . ..s � DUB E l��I, !'r ,i 4� 03� � , � � ,,_,_:::.:��, �� ,�1,��f�•rlrie•c��rrPfrr:l�iti�i��rJ�J�1 zoii.�os� � ;� o�, '� ,� � � � , ��, � Vicinity Map e— ) � '�[� I � 1f�.wJ � U'� �� -•a � � �� LrYI^j � �1 � ', 1F:JlIG � � � � _.� �.� � I � �� a� .r � � � � � �''` � � � * � . �1 � �� _ [('y;y� � � �� i . � RYRO �, i� yy{� [�'�`�'� � � }�.'J'.,J ' � �� ti%/.+Y 11U1'wJ p[ TWANNAYE ��EST I � � ' s � � �� _ � � ' � � � � � � � � � " ��ff 3� �� _ a� '• � mx:� ' � � � ,. � . t� -- � �� :�� _ �; � �,. � �} � � R'1 . ;� ' � _ , , i � :� ,",, ,� , ; � � _ � __ � � � Applicant: William R. Bi�er, Mary'SInn Maternity �3 Home Qr�3 ' �3' � ' � % � Location: 1749 Churchifl Drive(PIN 7.OZ237g005 � � - � q� and 1022379004) '� � � � � np `;. g� ' � � �� Description: To rezone property from R-1 '� � ' , 5ingle-Farnily Residential to R 3c Moderate Density ' � Multi-Family Residential with conditions. / G� — .. : � � � ' � '` � ' � � � � ' � �' Subject Property � 7 �3 � � �� --� � . . .■ �- � � �� ,_ � - �Q��''.:3 � �r. Q � 4'� �1 � _ � r - ,� � � �1 � o �o uo �eo � � � � � y:t7�l �" _r. _ . �� Fael . !� .� �,_..� � r:r�.i ! , � � /�j � / -"� . . � � �z.000 Proposed Request & Review Process ➢ Requesting a rezoning to R-3c in order to allow for a Group Home on the subject property. ➢ Review Process: 1. Rezoning request: • Requires review/recommendation by the Zoning Advisory Commission • City Council is the decision-making body 2. Conditional Use Permit • Group Homes require review and approval of a Conditional Use Permit by the Zoning Board of Adjustment � • • • ' • � • . � - - • - . ^ . � I � . I ' � • • - � ' I Cemetery, mausoleum, or Cemetery, mausoleum, or Cemetery, mausoleum, or columbarium columbarium columbarium Place of religious exercise or assembly Place of religious exercise or assembly Place of religious exercise or assemb�y Golf course Golf course Golf course Public, private, or �arochial school Public, private, or parochial school Public, private, or parochial school Railroad, public or quasi-public utility Railroad, public or quasi-public utility Railroad, public or quasi-public utility Parks, public or private, and similar Parks, public or private, and similar Parks, public or private, and similar natural recreation areas natural recreation areas natural recreation areas Community gardens Community gardens Community gardens Single-family detached dwefling Singfe-family detached dwelling Single-famiiy detached dwelling Multiple-family dwelling (max fi �nits} Townhouse (max 6 units} Two-family dweliing (duplex) . . - • ' . � ' ' • . • . . • • � • . • ' ' • � • • • • • ' • ' ' • � . . • • • . � - - • - . . . 1 ! 1 � 1 / 1 f • I ' • I / Bed and breakfast �ome Bed and breakfas# home Bed and break#ast home Licensed adult day services Licensed adult day services Licensed adult day services Licensed childcare center Licensed childcare center Licensed childcare center Mortuary, funeral home, or crematorium Mortuary, funeral home, or crematorium Mortuary, funeral home, or crematorium Off street parking Off street parking Off street parking Tour home Tour home Tour hom� Tourist home Tourist home Tourist home Wind energy conversion system Wind energy conversion system Wind energy conversion system Accessory dwelling unit Accessory dwelling unit Accessory dwelling unit Keeping of horses or ponies Group home Graup home Hospice Housing for elderly or persons wi#h disabilities Individuaf zero �ot line detached dwelling Nursing or convalescent home Off premise residentiaf garage Rooming or boarding house • • - • ' • • • • • • - • • • • - ' • • • • � - • • • _ • • • - • • • � • - • � • • u ic n ut ➢ Petition si ned b 38 nei h bori n g y � g residents ➢ �etterof o osition : pp ■ Stephen J . & Suzanne M . Juergens ■ Dia na Robi nson ➢ Speakers at ZAC meeting : ■ 6 in opposition ■ 3 in support � � � ��i � � ` � • '''�� !� . � �-'JII/' '� �� ,` �� ,r V ' " � J. �t:� �'•s,��i � �w� � � y � cv��..�y �r . ' 1'�Ctf) �W�� ' l � CS�.� ,1y749 Ch�urchill Drive �-yP�ublic�lnput• 4_ ' �� r�� _, _. �� ., _ : _ � _ :_ — r �r� . � _ . ._ ,� . sub�ecc Froperty �' -' ��' _ ' � j'�' F r�� - � _ � ` � �� • � �t� �� . 1 ' +'3 �� ..� Q 200'NOtitiCatiOn � � t,,'" i'� �i -� � �f � ` � �y . � � � _ �� I Boundary � ,, a � > ' " �. � . �, Parcel area witt�in 200' '�'-'� � , ,.� ' � � • � ,�� '_-_+�' � � � �'�^" � � ,�� , � �,, ^ =237,583 sq.ft. , �� .�' ��,ti '� �,� � �_� � � � � � I �� #•."�' s. Petition Opposition ' ^ �� I �� '.��' l� - � Y t ,-�,�-�� ;� � � .��..�� _ � ,:,.� , � ,� � �., Owner Oppositwn „�" F �� ._,� ��r , � l i�.�r� •� �� - �� . r within 200'= 105,453 \ + A .� �� I` � •:�� ,c� � � ��'� •��' : � _ � sq.R. — 1 .� '�. ' . (�'� :..� ��S�Gflfl OUtSlde � c ^�\ ~ '� � ' � �?'�'� f+y,� �.' �� < � ��l T� ♦ � 2U0� �' � ,°� �.�yf . �Tt,� � e � "� �i+ � I' 1� �� ,., �e, �•' i% �� ?y, � • �t � 'w 1 * , � �_�k�� T� =� �� k ' � r � Signature of address cdfected ,�� ''�•:.,? ' ,�'�� ,.- 1 ��.� � - out5ide this map boundary: �• _ � ' �> • �� ' � �,;, � � � ` •328Q Pennsylvania Avenue � �� i�.�, � � �'r`� � � � �`i ` ��'�� ,+ � �i� � _ � r + �iS' i _ , �`. '= �r � .f � � � � � � '� '� 1�- '� � , �, � �', �+17G�.3 � �--�-� t � ' �� '�� ,�'°� � � ' � �{�k, �J;'i �, , '�� , F! ,� � �, . �� a i ` �c 'K��` �' ''�' - . . a+ _ ��"1 �. � � � � _ ' ',�� ,"� -�s; ' .,. :.•'-i'! � ,»............ , �tr � � � � .� �. . t� �� . �� y�� i.j � � �� i l'�� i. �' � 4 , ' � . •�+"� - * , ��yt .._ Rr--- -� _ � � ' �+ '�i, � , .�� .� :11 �� --. � : � — �► �� j f�� ii . �. 1(!(�l� ,� Letter of Oppos�tion / �,� � � i` ` � �„�.�,� �'� �u.:J c�;) ,�r '�- �� '. �_S f��i7J " :� ` ' �, , rA� _� �'4. � � ,� �'�,��t � �� t�'w� * � 1 �, ,1 _..�� , �.Y�.�',d.' `1�.'� 1�' �t� . , . • � - � .. �� -- .. -� . .��, ��, .11 ` � � � ,� � �� -�1k�3 ;• � � . . � � 3' � �� •� �� 4� ' � �' i , �' M +'..`:, �� •i ]�\ ��„ [ � � ` � Percent of owner area '� • �� ` ' I •�� r-�� 1� opposed within notification ' _� '� � +►j._� i l � ? ; � ' � rbOundary: � '.'�r�r�' "'�',."' F �' t a. �!t -- � r 105,453 sq.h./237,583 sq. �` � � . . �.� I f�. � ,w�� ?� ., �c^,_ :��:�'.�_ S�iiX3 + . h.=aa.a% � .�. �� . ;� � �_ _ _ .:. i '�, _' '� . - - '�,,,�,�,' -�." �.,� � ' ' � �• ,, _ r..� ._" �• _,.+wy��- - :.. �-- �, .�.�-�i� ,r-=-• ?� a ' �» '� �+�" r ,�� . $ - �� r `� '.__ � ��. �;�..� �y �,:�. `� ��`-3 � � �-�:yy�f7 � f � � r � . r / . .' .._�--�.—I �r U�!� ,�' � � '�" � �,�, �� i- . �' I �` ��...� �� ,�� • ///�� 141 t � � •�JI I�l_ �1}._:.✓.�Y. . .�] _ w_ y f � ,''y/'/ � � �� t'1.i �. � � '�'� 1'E? H f� �„ � 1 �� y Ai r,.G�� ^ � f, . 4� � 1 � � /,u /�, � � F c e t � _ ;'"r'-� �� '� _ `'�15'!,�7� �' '� � 0 �25 250 500 p�. � � k5 . � �' � ° � �� .. �,� i�f;r:j , ..�y,` .� � `� •�L., �, . * -s+� � �35�„ � , �-. � ;._ ,��T�, � } 1 F` •� � y. City Council Vote Letters of opposition and a petition of opposition was submitted and signed by the owners of twenty percent (20%) or more of the property which is located within two hundred feet (200') of the exterior boundaries of the property being considered for rezoning. Therefore, a super ma�ority vote is needed for the City Council to approve the request. U ESTI O N S ? i .�C.' . ..v.I�y �i"7 KANE,NORBY& REDDICK, P.C. ATTORNEYS ;,; �.�„ , ,,, v-; Brian J.I{ane 2100 ASBURY ROAD,SUITE 2 -� � � � ��- �l i��i i�_• . Les V.Reddick DUBUQUE,IA 52001-3091 I Brad].Heying ToddL.Scevenson" - - � !��`- i Kevin T.Deen}�''* � ��.Retir�el; BradleyB.Kane GatyK.Norby Joseph P.Kane Nicholas J.Kane � . _ DavidJ.Kane.___. . _.. .__. ...._ _ _._. . _. . .- _. _. . __._— _ _. ._.._. _----- All admitted in Ioaa . Phone: (563)582-7980 "Also admiaed ialllinois Facsimile: (563)582-5312 '""Also admitted in Wisconsin E-mail:bkane�kanenorbylaw.com September 14, 2023 OBJECTION Honorable Mayor&City Council City Hall 50 West 131h Street Dubuque, IA 52001 Re: Rezoning—Traditional Applicant: William R.Biver,Mary's Inn Maternity Home Location: 1749 Churchill Drive (PIN 1022379005 and 1022379004) Description: To rezone property from R-1 Single-Family Residential to R-3c Moderate Density Multi-I+amily Residential with conditions Dear Mr. Mayor and Members of the Dubuque City Council: We are counsel for John and Ann Riley (hereafter the "Rileys"), who have resided at the address locally known as 1733 Eden Lane,Dubuque, IA 52001, since 1985. Their residence of 38 years places them directly across the street to the south of the parcels for which rezoning is sought by Mary's Inn Matemity Home. Last week, on September 6, 2023, the Zoning Advisory Commission (ZAC) held a public hearing on the above-referenced application to rezone 1749 Churchill Drive, as well as a neighboring parcel to the north of said residence, from R-1 Single- Family Residential District to an R-3 Moderate Density Multi-Family District. Despite objections from the Rileys and a number oftheir neighbors,which objections were wholly supported by Iowa law, the ZAC voted in favor of the application 3 to 2. We understand the application will now proceed to a public hearing before the City Council of the City of Dubuque, Iowa at its meeting scheduled for Monday, September 18, 2023. The undersigned requests that vou include this letter in vour record of the meeting scheduled for Monday, September 18, 2023. The Rileys' objections, as well as the obj ections of many of their neighbors, are supported by the applicable Iowa laws, including controlling Supreme Court of Iowa case law authorities, with respect to this type of rezoning application. Therefore, we respectfully request that the City Council of the City of Dubuque, Iowa deny Uus application for the following reasons: KANE,NORBY & REDDICK, P.C. September 14,2023 Page 2 I (1) As other objectors have noted, including Attorney Steve Juergens, who submitted an obj ection letter as part of the record of the September 6,2023 ZAC meeting,a"maternity home" is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District. In that regard, we would direct your attention to the applicable provisions of the City Code. We attach the applicable provisions of Chapter 5 of the - -------Unified-Developm�ntGod�r�garding-zoningdistrictsheretofor-yourr�ferenee.-"Maternityhoine" - - is not included in any of these provisions. (2) The applicant purports that Mary's Inn is a "group home" constituting a pennitted conditional use in an R-3 District; however, at this time we are not aware of any underlying Iowa authority which supports the notion that this type of business which provides temuorary support for these women and children actually qualifies as a group home as a matter of law. Group homes, in contrast to Mary's Inn, are permanent places of abode far their residents. Far example, Iowa Code §231B governs "elder group homes," Iowa Code § 135C.4 governs "residential care facilities," and Iowa Admin. Code 661-202.5 governs small group homes for specialized licensed facilities. In each case,residential services(sometimes in conjunction with healthcare services) are provided on a permanent basis—these are not transient guests like those staying at Mary's Inn, an important distinction. We note that the Rezoning StaffReport includes the City of Dubuque's definition of"group home" in footnote 1 on page 3 of said report. "Group hoine" is defined by the City of Dubuque, per Chapter 2 of the Unified Development Code, as "[a]ny group of persons not meeting the definition of "family" and occupying a single dwelling unit living together as a singie housekeeping unit, but not including a boarding or rooming house." It is a leap to suggest that Mary's Inn which, according to its executive director, has served approximately 60 mothers and their children over an eight-year period, with stays that have averaged three to four months (but that haue ranged anywhere from one month to eighteen months), constitutes a "group of persons..living together as a single housekeeping unit." On the contrary, Mary's Inn is arguably more akin to a boarding or rooming house, which is specifically excluded from the definition of "group home." Though presented with this distinction between "maternity home" and "group home" by miiltiple objecting parties, the ZAC apparently decided, as expressed by Chair Mulligan at the public hearing last week, that because Mary's Inn was treated as a "group home"by the ZAC at prior proceedings in 2015 that there is"precedent that the ZAC can rely upon"(to paraphrase Chair Mulligan). We would argue,however,that the ZAC's misinterpretation of the term"group home" in a public hearing that took place eight years ago is not a license to carty that misinterpretation forward to present and future public hearings before the ZAC and the City Council—especially when the distinction has been made clear by the objecting parties. (3) Nevertheless, even if the City Council concurs with the ZAC that there is no distinction between a maternity home and a gronp home for the purposes of these proceedings (a position with which we sUongly disagree), pursuant to a bevy of controlling Iowa case law authorities, the proposed rezoning of the property at issue would be prohibited"spot zoning"and, therefore, invalid. As a general ru1e, the Supreme Court of Iowa has held that the "[a]ction of imposing restrictions that do not bear alike on all persons living in the same territory under similar KANE,NORBY& REDDICK, P.C. September 14, 2023 Page 3 conditions and circumstances is discriminatory and will not be upheld...That a zoning statute must be impartially applied to all properties similarly situated is beyond dispute." See,ICeller v. City of Council Bluffs, Iowa, 246 Iowa 202,213 (Iowa 1954). The Keller Court finther opined that"spot zoning when construed to mean reclassification ---— of-on�or-more like-tr�cts or-similar traet�for a-use prohibited by the original-zoning-ordinance- - and out of harxnony therewith is illegal."Id. According to the Supreme Court of Iowa, "there must be substantial and reasonable grounds or basis for the discrimination, when one lot or tract is singled out in an amendatory ordinance removing therefrom restrictions imposed upon the remaining portions ofthe same zoning district."Id. at 214."When the tract is shown to be clearlv different in character or use from those around it. discrimination maV be leeallv iustified." Id. This exception clearly does not apply in the present case, where the property at issue is not clearly different in character or use from those around it—it has been a part of a single family, owner occupied residential neighborhood for many decades. Additionally, given the "horseshoe" shape of the neighborhood, this particular centrally located residence is inarguably the focal point of the entire neighborhood, with many residences facing these particular parcels. Other more recent cases also illustrate that spot zoning would not be appropriate under the circumstances. In ICane v. City Council of City of CednrRapids,537 N.W.2d 718,723 (Iowa 1995), the Supreme Court of Iowa reiterated the Keller standard while also opining: "Spot zoning results when a zoning ordinance creates a small island of property with restrictions on its use different from those imposed on the surrounding property." Spot zoning is not automatically invalid. If it is germane to an object within the police power and there is a reasonable basis to treat the spot-zoned property differently from the surrounding property, the spot zoning is valid. In determining whether there is a reasonable basis for spot zoning, we consider the size of the spot zoned,the uses of the surrounding property,the changing conditions of the area,the use to which the subject property has been put and its suitability and adaptability for various uses."(citingLittle v. Winborn. 518 N.W.2d 384,387(Iowa 1994). In Residential and Agricultural Advisory Committee, LLC v. Dyersville City Council, 888 N.W.2d 24,45-46(Iowa 2016),the Supreme Court of Iowa again discussed the issue of spot zoning and held: "Spot zoning is the creation of a small island of property with restrictions on its use different from those imposed on surrounding property."Perkins,636 N.W.2d at 67. Not all spot zoning is illegal,however, and we haue created a three-uron¢test for determining whether spot zoning is valid. Id. Under this test, we consider ,� whether the new zoninE is germane to an obiect witlun the uolice power; (2) whether there is a reasonable basis for makine a distinction between the spot zoned land and the surroundine property; and (3) whether the rezonin¢ is consistent with the comprehensive qlan. Id.; see also Little v. Winborn, 518 N.W.2d 384, 388 (Iowa 1994�. When there is snot zonine, °0there must be substantial and reasonable Erounds or basis for the discrimination when one KANE,NORBY&REDDICK, P.C. September 14, 2023 Page 4 lot or tract is sinaled out."Perlcins, 636 N.W.2d at 67 (quoting Fox v. Pollc Ctv. Bd. o�upervisors, 569 N.W.2d 503, 509 (Iowa 1997�, overruled in part on other grounds by Sutton 729 N.W.2d at 799)."(Emphasis added.) The proposed application to rezone fails the second a third tests, respectively. - - ---Representatives-for-Mary'sInn-have failed-to shaw (i) a reasonable basis-for rnaking-a distinction- - between the spot zoned land and the surrounding property; and (ii) that the rezoning is consistent with the comprehensive plan. They cannot do so because there is no reasonable basis for making a distinction between 1749 Churchill Drive and the rest of the surrounding neighborhood. This has been a fully established R-1 single family residential neighborhood for over sixty years, and arguably for even longer (the subject property itself was built in 1876). There is no reasonable basis for singling out this property. In fact, as others have noted, in March of 2010, the City of Dubuque Zoning Board of Adjushnent voted unanimously (3-0) to deny an application to convert a portion of the property(referred to as the"cottage house")into an accessory dwelling unit which would be rented out to unrelated third parties. That Board wisely voted to preserve the character of the neighborhood at that time, and the City Council should now do the same. Despite the fact that the undersigned emphasized the proposed rezoning would be invalid spot zoning at the ZAC meeting last week, it apparently was disregarded by the ZAC. Not one of the Commissioners, in particular those voting in favor of the application,made any mention of the spot zoning issue in their commentary prior to voting on a motion to approve the application. To disregard controlling Supreme Court of Iowa case law authority in arriving at their votes is, quite frankly, arbitrary and capricious and an abuse of discretion on the part of the ZAC. Much of the public hearing before the ZAC was misspent discussing the nature of Mary's Inn and their mission. As the undersigned related to the ZAC, Mary's Inn's mission is not debated—it is certainly a noble and admirable operation. The issue is where they want to operate and how they want to go about it. To disregard the legal issues at play in order to help this arganization just because one supparts the mission of Mary's Inn is plainly discrimination—it would be equally discriminatory voting practice to deny the application of a business whose mission the City Council does not support.Thus, it is imperative that the City Council focus solely on whether it is appropriate to rezone 1749 Churchill Drive from an R-1 Single-Family Residential classification to an R-3 Moderate Density Multi-Family classification. In light of the foregoing Iowa law, inchiding controlling Supreme Court of Iowa case law authorities, the answer is a resounding no—this is not an appropriate location for this maternity home and any rezoning of this property to accommodate Mary's Inn is discriminatory and not supported by Iowa law. (4) In addition to the foregoing legal argwnents, the Rileys wish to echo the concerns of many of their neighbors who are also objecting to this application, which concerns include but I are not limited to the following: I (a) Most residents in this neighborhood have concerns about the future use of these I I��, parcels if they are rezoned to an R-3 classification. Mary's Inn has operated out of its current �! ; Balboa Drive location for approximately 8 years and now seeks to move. What happens when, in ' ithe event Mary's Inn's application does succeed, Mary's Inn decides to move out of the 1749 ' Churchill Drive location at some uudetermined future date? The City would be opening the door II i KANE,NORBY& REDDICK, P.C. September 14, 2023 Page 5 I I for a variety of uses which do not belong in this neighborhood and would not be consistent with the comprehensive plan. In response to these concerns, the ZAC and the applicant apparently concurred that I approval of this rezoning could be conditional in that aspect and agreed that in the event Mary's I ----- --Inn-s�lls-1749-Churehill-Drive at a later date�that-the-property-would revert baek to-an R-1 -- - classification. This logic fails for two reasons: (i) even if the property does revert back to an R-1 classification, the neighborhood has no assurance that a future titleholder of the property would not succeed on its own application to rezone the property for whatever use it has in mind; and (ii) the apparent notion, according to the ZAC's comments, that the City would accommodate the rezoning only until Mary's Inn decides to sell the property is evidence of discrimination in and of itself. What legal justification is there for the City to rezone this property for Mary's Inn and to bar all other rezoning applicants thereafter with respect to this same property (applicants who, unlike Mary's Inn,might hypothetically seek to use the property for a principal permitted use or a permitted conditional use—a"maternity home,"on the other hand,is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District)? The answer is that there is no legal justification for any such discrimination in favor of Mary's Inn. (b) Other miscellaneous concerns of the neighborhood include concerns about the property values and marketability of the surrounding homes in the neighborhood; concerns about an increase in traffic(especially in a neighborhood with so many young children that play near the property at issue); concerns about the uncertainty ereated about the future use of the property(by Mary's Inn,who could reasonably be expected to expand their operations with a new,bigger space, but also by future property owners); general cosmetic concerns (what does this do to the"look"of the neighborhood when a business is essentially operating out of the focal point of the entire neighborhood?); the potential for other adjacent or nearby parcels to be rezoned to further deteriorate the character of the neighborhood(the City cannot realistically offer any assurances in this regard short of admitting illegal discrimination in favor of Mary's Inn); and general concerns that this rezoning will in any way interfere with the Rileys' and other neighborhood residents' vested property rights and the quiet use and enjoyment of their property as they have all long grown accustmned to. We respectfully request that the City take these concerns of the Rileys and their neighbors under careful consideration. We also note that, to the extent any Council Member is utunoved by these mare personal concerns,the City Council of the City of Dubuque,Iowa should still deny this application on the following legal basis: (1) A"maternity home"is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District. (2) The applicant purparts that Mary's Inn is a"group home" constituting a permitted conditional use in an R-3 District; however, the distinction between a "maternity home" and "group home"is clearly described above. KANE,NORBY & REDDICK, P.C. Septeinber 14, 2023 Page 6 (3) Even if the City Council concurs with tile ZAC that$lere is i10 distinction be#weei� a inateinity hot��e ai�d a group hoine far the purposes of these proceedings (a position with wlzich we stro�lgly disagree), the above-cited Iawa case law authorities make it abuzldantly clear that the proposed rezon�ng of the property at issue wauld be prol�ibited "spot zoning" and, #herefore, iilvalid. Therefore, as a mattea af law, th� City Council of tlie Gity of Dub«que, Iowa sho�ild deny this application. �'lease do not hesitate to contact us directiy should you have any questions. Thank you. Best regards, KANE,NORBY & REDDICK, P.C. � � � �� By�� . � ` B�ian .�. K Enclosi�res cc: Mr. ai�d Mrs. John W. Riley 8/30123,8:19AM https://export.amlegal.comlapi/export-requesls/tl2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 16-5-2:�R-1 SINGLE-FAMILYRESIDENTIALF The R-1 district is the most restrictive residential disirict and is intended to protect low densiry residential areas from the encroachment of incompatible � uses.The principal use of land in this district is for low density single-family dwellings and related recreational,rellgious and educational facilities.(Ord. �� 52-09, 10-19-2009) I . 16-5-2-1: PRINCIPAL PERMITTED USES: . The following uses are permitted in the R-1 tlistrict: ' Cemetery,mausoleum,or columbarlum. I Community gardens. � Galf course. Parks,public or private,and similar natural recreailon areas. . Place of religious exercise or assembly. � � Public,private or parochial school approvetl by the stale of lowa(K-12). � Railroad or public or quasi-public utility,Including substation. � Single-family detached dwelling.(Ord.52-09,10-19-2009;amd.Ord.17-13,3-18-2013;Ord.19-20,5-18-2020) � 16-5-2-2:CONDITIONAL USES: �� The following conditional uses may be permitted in the R-1 district,subject to the provisions of secfion 16-8-5 of this Utle: Accessory tlwelling unit. Bed and breakfast home. Keeping of horses or ponies. - Licensed adult day services. � Licensetl childcare center. Mortuary,funeral home,or crematodum. Off street parking. � Tour home. Tourist home. Wind energy conversion system.(Ord.52-09,10-19-2009;amd.Ord.66-14, 11-17-2014) 16-5-2-3;ACCESSORY USES: The following uses are permitted as accessory uses as provided in section 163-7 of this title: Detachetl garage. � Fence. Garage sale,provided thaf not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)conseculive days per sale. Home based business. Keeping of hens for egg produc�ion. ', Noncommercial garden,greenhouse or nursery. ��, � Off street parking and storage of vehicles. '�, - Satellite receiving dish. '�� Solar collector(freestanding arrays are limited to not more than 100 aggregate square feet and 10 feet in height). Sport,recreation,or ouldoor cooking equipment. Slorage building. �� Tennis court,swimming pool or similar permanent faclllry. Wnd turbine(building mounted).(Ord.52-09, 10-19-2009;amd.Ord.47-14,7-21-2014;Ord.54-15,8-17-2015) 76-6-2-4:TEMPORARY USES: Temporary uses shall be regulated in conformance with the provisions of sectlon 16-3-19 of this title.(Ord.52-09, 10-19-2009) 16-5-2-5:PARKING: �' Minimum parking requirements shall be regulated in conformance with the provisionsof chapter 14 of this title.(Ord.52-09,10-19-2009) 16�5-2-6:SIGNS: � Signs shall be regulated in conformance with the provisions of chapter 75 of this title.(Ord.52-09, 10-19-2009) 16-5-2-7:BULK REGULATIONS: Minimum Maximum Setbacks Minlmum Lot Maximum R-1 Residential Lot Front Minimum Minimum LotArea Coverage Height Fmntage �LotArea) Minimumz Maximum Side Rear hltps:l/export.amlegal.com/api/export-requestsld2476fSb-d4b2-47f1-a23f-3049741983b01download/ 1/2 8l30/23,820 AM https://export.amlegal.com/epilexport-requesls/b6t7027a-92ed-4ab0-88b4-c6cfa7bda29eldownload/ 16-5-5lR3�MODER4TE DENSITY MULTI-FAMILY RESIDENTIAL: The R-3 district is intended lo provide locations for a variety of dweiling types rangin8 from single-family to low rise multi-family dwellings.The R-3 district also serves as a fransilion behveen residential and nonresldential districts.(Ord.52-De, 10-19-2009) 16-5-5-1:PRINCIPAL PERMITTED USES: I The following uses are permifletl In the R-3 district ICemetery,mausoleum,or wlum6arium. Community gardens. � Golf course. MuW-family dwelling(mzcimum e tlwelling units). Pa�Cs,public or private,antl simllar natural recreation areas. Placa of religious exercise or assembly. � I _ .._ .._. _ ._. —_ . . .__ . _. ___._ ____._. . : ----- -Public,-private or parocRiel school approvedby statebf lowa(K=92}�- - -- Railroad or public or quasl-public utility,including substation. Single-family detachetl dwelling. Townhouse(maximum 6 dwelling units). Two-family dwelling(duplex).(Ord.52-09,10-19-2D09;amd.Ord.17-13,3-18-2013;Ord.19-20,5-18-2020) I 16-5-5-2:CONDITIONAL USES: The following conditional uses may be permilted in the R-3 district,subject to the provisions of sectlon 16-8-5 of this title: Accessory dwelling unit. Bed and breakfast home. . Group home. Hospice. Housing for the eldedy or persons with disabilities. Individual zero lot line detached dwelling. Llcensed adult tlay services. � Licensed childcare center. Mortuary,funeral home,or crematorium. Nursing or convalescenl home. ON premises residentlal garage. Off street parking. Rooming or boardin8 house. Tour home. Tourist home. Wind energy conversion system.(Ord.52-09,10-19-2009;Ord.20-22,5-20-2022) 16-5-5-3:ACCESSORY USES: - The following uses are permitted as accessory uses as provlded in section 16-3-7 of this title: Delached garage. Fence. Garage sale,provided ihal not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)consecutive days per sale. I Home 6ased business. �.. Keeping of hens for egg pradudion . '. � Noncommercial garden,greenhouse or nureery. �I, � Off sVeet parking antl slorage of vehicles. li � Satelllte receiving dish. '��. �. Solar collector(freestanding arrays are limited to not more than 100 aggregafe square feet and 10 feet in helght). '� Spod,recreation,or outtloor woking equipment. Storage building. Tennis court,swlmming pool or similar permanent facility. Wind Wrbine(building mountedj.(Ord.52-09,10d9-2�09;amd.Ord.47-14,7-21-2014;Ord.54-75,8-17-2015) � 1fi-5-6�4:TEMPOR.4RY USES: Temporary uses shall be regulatetl in conformance with the provisions of seclion 16-349 of ihis title.(Ord.52-09,10-19-2009) . 16-5-6-5:PARKING: � Minimum parking requirements shall be regulated in conformance with the provisions of chapter 14 of this title.(Ord.52-09,10-19-2009) � 16-5-b-6:SIGNS: � Signs shall be regulated in conformance with the provisions of chapter 15 of this tille.(Ord.52-09,10-19-2009) https:/lexport.amlegai.com/api/export-requests/b6f7027a-92ed-4ab0-8864-c6cfa7bda29eldownloatl/ 1/3 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Wednesday, September 13, 2023 7:59 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Martha Schmid Add ress: Ward: Phone:5635902476 Email: mdbluff@aol.com City Department:City Council Message: Dear City Council Members, I understand Mary's Inn is asking for rezoning of property they wish to buy on Churchill Dr. I understand there are concerned neighbors wishing to block the rezoning. In support of Mary's Inn, I would respectfully ask you to consider going forward with the rezoning. Over the eight years Mary's Inn has existed,their staff has helped 60 women in need and their babies.There has never been a complaint filed by neighbors,yet the lives of these women and children have been greatly impacted for the better. I see Dubuque as a town that is able and willing to help the most vulnerable in our community. Having such a well-run program here in Dubuque is a blessing,one we should all support. As you consider your decision next week,think about the lives you can impact with the mere raise of your hand.Whenever you see a child your heart can be full knowing you helped one who is in need. Respectfully submitted, Martha Schmid 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Tuesday, September 12, 2023 4:38 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Kristi Wieseler Address:2750 Balboa Drive Ward: Phone:563-580-2278 Email: Programsupervisormarysinn@gmail.com City Department:City Council Message: My name is Kristi, I am the Program Supervisor with Mary's Inn and have been with this ministry for 5 years. I recognize that there is quite a bit of opposition from the neighbors in the Churchill area where we are wishing to re-locate. I understand their concern and feel that it is fear driven as they truly do not know about our program. I want to take a few minutes of your time to talk about our program.When we receive a call from an 'at risk'woman we do a thorough evaluation of their needs. Each woman has an individualized care plan...we meet women where they are.A few of the main expectations of the program are sobriety/recovery, employment/school, brain health.We have firm guidelines that are in place,our goal is to always maintain a 'home'atmosphere at Mary's Inn.We have a 5:00(7:30 on weekends)curfew,we do random drug screen weekly, men are never allowed in the house unless it is for repairs.One of the arguments from the neighbors is that we are in a 4 bedroom house so why do we need to move to their neighborhood....the answer is that Churchill provides more square footage for our mom's that have a one or two year old. It will enable us to have a toy room for the little ones and a craft room for moms.Art therapy is great way for women to release stress &trauma. It also provides a bus line...not having access to a bus line is a major barrier for our population.This enables moms to have the dignity to learn to be self-sufficient in getting to/from work,appointments,groceries.All the things they need to know how to do to achieve independence. They deserve to live in a safe residential neighborhood just like anyone else in Dubuque.They are moms and babies and pose no threat to anyone in the neighborhood which you can see from our track record on Balboa drive. I am asking that you please support this rezoning for our moms/babies....they deserve it and they are worth it. Thank You, Kristi Wieseler 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Wednesday, September 13, 2023 9:03 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Chris Ehlers Address:510 STEVENS CT Ward:3 Phone:563-580-9269 Email: Dodger2x@msn.com City Department:City Council Message: I am writing to show my support for Mary's Inn to purchase property on Churchill Drive in Dubuque. It is vital that we support young women and their babies in Dubuque. Please vote yes and women everywhere that you care! 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Wednesday, September 13, 2023 8:44 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Brad Markham Address:2964 Brandywine Park Drive Ward: Phone:563-203-2583 Email: Bmarkham118@protonmail.com City Department:City Council Message: Please approve the zoning for Mary's Inn maternity home.The women of our community need it! 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Wednesday, September 13, 2023 7:13 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Caroline Mockler Address: 13738 BARRINGTON DR Ward: Phone:5635430565 Email:jvmcrm@mchsi.com City Department:City Council Message: I am writing to encourage you to vote yes for the re-zoning that will be addressed at your next meeting. It involves Mary's Inn with the Churchill property they would like to purchase. I volunteer currently& have been in their present neighborhood. It has always been very peaceful&quiet as I come&go. Mary's Inn provides a crucial service for women in need who are expecting.This re-zoning will allow Mary's Inn to continue to fill this need for women. Please allow them the new zoning for this house. I'm sure it will continue to serve others quietly, but effectively. Thank you. Sincerely, Caroline Mockler 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 9:03 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Susan&Jason Hughes, MD Address:2700 arbor hills drive Ward: Phone:815-520-0339 Email:Jshughes3@mchsi.com City Department:City Council Message: Dear Mayor Cavanagh&Council Members, I am writing in support of Mary's Inn maternity home's request to re-zone the home on Churchill Drive from R-1 to R-3C. Jason and I both volunteer at Mary's Inn and have done so for the past 2 years. He mows the lawn and I babysit, drive residents to school,and have spent the night when needed. We have witnessed first hand how the home is run,and how well it is maintained.With the guidance and rules,the residents are held to a high standard and the home is spotless. More importantly,we have been witnesses to the loving,transformative care that takes place.Young women who have nowhere else to go with negligible life and parenting skills have"graduated"from Mary's Inn armed with the skills and ability to hold down jobs, be responsible and independently raise their children.The leadership at Mary's Inn are wise,caring people.They welcome women at a critical time in their lives.The women are supervised and have rules they must adhere to in order to stay at Mary's Inn.There are early curfews, no guests,cleaning schedules,one on one coaching and expectations that they be either in school or working. Mary's Inn is the only maternity home in Eastern lowa and is a jewel of Dubuque. Please approve their re-zoning request so they can continue to help women in need. Respectfully, Susan&Jason Hughes, MD 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 10:42 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Augustine Payne Address: 1210 Loras Boulevard Ward: Phone:5632940496 Email:ajpayne8@gmail.com City Department:City Council Message: I support rezoning the Churchill property for Mary's Inn.They are a great organization that is providing a helping hand to pregnant mothers who don't have a suitable place to live. I believe their record of never having a complaint in the 8 previous years speaks to their commitment to building up the community and making it a better place to live.The City of Dubuque would do well to support their efforts. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 1:06 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Fr.Andy Upah Address: 1225 Alta Vista St Ward:4 Phone:5154188236 Email:dbqupah@dbqarch.org City Department:City Council Message: Greetings! I just want to take a moment to encourage you to vote for the proposed Mary's Inn Home to be re-zoned from R-1 (Single Family)to R-3.This is such a vital service for Eastern lowa,the only home like this in fact. I have visited the current location and I would have never guessed it was any different from any other family home on the block,well kept and quiet, but I could not believe how small it was for the level of service that they provide!Therefore it is no wonder they want to move.The people that are against it are most likely operating out of fear of the unknown, and fear is not from God, but if everyone in every neighborhood acted the same way,this valuable service could not be provided anywhere.Someone must step up to help these vulnerable young mothers,and I believe every fear could be alleviated by talking to some of the current neighbors,although they already have a pretty good track record.Thanks for considering and may God bless you. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 1:23 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Erik Anderson Address:2053 SCHILLER ST Ward:3 Phone:5635906079 Email:tubaerik@hotmail.com City Department:City Council Message: Hello, my name is Erik and I am writing in regards to a zoning change for 1749 Churchill Drive. Mary's Inn is hoping to relocate our maternity home to this address, however this will require the zoning to be changed to allow for a group home. Many of the neighbors have been opposed to this change in Zoning,citing many fears that range from property values,to'dangerous' people being in the neighborhood.All of the issues they raise are based on fear.We at Mary's have worked to provide answerers to questions and showed the fears they cite to be at best exaggerations and at worst thinly veiled elitism. Sadly logic will never defeat fears,explaining or challenging fears is always met with anger and resentment, leading to more fear and anger. I strongly encourage the city council to support the rezoning. Make a decision based on proving home and hope to those desperately in need, do not let fear guide your thinking as it will only lead to more fear and resentment in the end.Thank you for your time. Erik 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 3:09 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Mary Kluesner Add ress: Ward: Phone:5635432022 Email: mamekleez@aol.com City Department:City Council Message: I encourage each of you to vote for rezoning on Churchill,so Mary's Inn can relocate to a larger house.This maternity home provides a much-needed, safe space for many young women and their babies.Thank you. 1 Trish Gleason From: Shena Moon Sent: Wednesday, September 13, 2023 4:55 PM To: Trish Gleason Subject: Mary's Inn Rezoning Application Attachments: Final Summary Letter to Neighbors_09 02 2023.docx Caution!This message was sent from outside your organization. Allow sender I Block sender � .i:�Lit .i3 �Y��'L ��_ � � ` � / P.O. BOX 3338 � DUBUQUE, IOWA 52004-3338 � (563) 552-6288 � www.marysinnmaterr September 13, 2023 Honarable Mayor and Members of the City Council City of Dubuque, Iowa RE: MARY'S INN MATERNITY HOME REZONING APPLICATION: R-1 TO R-3c Dear Mr. Mayor and Honorable Members of the City Council: We are pleased to write to you in support and explanation of our application for rezoning that will be brought before you at the September 18, 2023 Dubuque City Council meeting. The undersigned is Executive Director of Mary's Inn Maternity Home and has served in that role since Mary's Inn's incorporation as an Iowa nonprofit organization in 2015. Far eight years, Mary's Inn has operated at 2750 Balboa Drive, Dubuque, IA 52001. By every measurable standard, Mary's Inn has been successful in fulfilling its mission to empower the physical, emotional, and spiritual well-being of pregnant mothers and their developing babies. i When Mary's Inn acquired its present home on Balboa Drive, we submitted a rezoning application which is identical to the application which will come before you now in 2023. The only difference is the address,which is 1749 Churchill Drive, Dubuque, IA 5200L The only reason for the present application is that Mary's Inn has outgrown Balboa Drive, and the property on Churchill Drive is ideal for the organization's operational and office needs. In 2015, Mary's Inn was granted its requested rezoning and conditional use permit, and in that time there have been no complaints or issues resulting from that rezoning. City Planning & Zoning staff have informed Mary's Inn of the proper rezoning and conditional use requests, and we have complied with the requirements. To summarize briefly, a "group home" as referred to in the City Code is the proper use relative to Mary's Inn operations and is a conditional use under the R-3 district. 1749 Churchill Drive is presently zoned R-1, so a rezoning change is necessary if Mary's Inn will acquire the property and use it. On September 6, 2023, the Zoning Advisory Commission voted to recommend the rezoning request. At that meeting, many people spoke both in favar of and against the rezoning application. We wish to reiterate a few points in support of the rezoning and to address some of the neighbor concerns which have been raised regarding the proposed rezoning. Su�orting Rationale • In eight years, Mary's Inn has served 60 pregnant women and their babies. This has satisfied a signi�cant need in the community while not placing a burden on neighborhood traffic or peace. Usually 6-7 women are assisted each year. • Mary's Inn has been a good neighbor at Balboa Drive. The organization keeps up the condition of the home and the yard. In addition, the atmosphere is peaceful, and visitor traffic is minimal (most likely lighter than many single-family homes in the community). • The application submitted by Mary's Inn originally referred to the two parcels being purchased: Parcel No. 102379004 is the northern parcel with no buildings on it, and Parcel No. 102379005 is the southern parcel and has the home and a carriage house located on it. Mary's Inn informed the Zoning Advisory Commission that it will be satisfied with rezoning only the southern parcel. Neighbors appeared to fear that an R-3 designation on both parcels would open up a possibility for construction of a large, out-of-character building. The intention of Mary's Inn is to use the existing structures as they are. The fact that the property contains a residential home rather than a multi-plex housing structure is an appealing factor, since Mary's Inn is trying to provide a home- like atmosphere for the women it serves. Thus,Marv's Inn is willin�to restrict its R-3 a�lication to the southern parcel only. • We also heard many neighbors suggest that if Mary's Inn were to sell the property that anyone could take advantage of the R-3 designation to change the property radically. To respond, Mary's Inn is willin�(at Mary's Inn's sole ex�ense)to commit itself,in the�ublic record and throu_gh an�process required bv the City of Dubuc�ue, 2 to a�lv for rezonin� back to R-1 should Mary's Inn ever sell the pro�erty. We understand the neighbors' concerns and wish to do everything possible to satisfy those concerns. • Mary's Inn already has plans for improving the yard and the structures on the site, and we are very sensitive to the "neighborhood feel" of the surrounding community. We want to uphold that feel and contribute to it. There will be no signage and no outward indication that a nonprofit organization is operating on the site. • The site has many other features ideal for our operations: o It is within two blocks of a bus stop; o The yard is ideal for providing young mothers and their children with a safe area to enjoy the outdoors; o The carriage house provides opportunity for an on-site office that is still removed from the residential area within the home; and o The size of the home is perfect for housing between 1 and 4 women and their children. Expressed Objections • As we indicate above, many neighbor objections have to do with other R-3 uses, and we re-state that we are willing to apply for rezoning back to R-1 if we ever sell the property, and we are willing to restrict the application to the southern parcel only. This approach makes it all but impossible for Mary's Inn to do anything other than operate exactly as it has for the last eight years. • Some neighbors have expressed concerns about traffic or parking. There is sufficient parking in the property's garage and driveway to minimize, if not eliminate, any street parking. • Some neighbors have expressed concern regarding the condition of the home, including pest control, ingress/egress, and lead-based paint. Mary's Inn is fully aware of these potential issues, and will address them as needed and will be subject to any required city inspections related to upkeep and safety. Furthermore, any such issues would have to be addressed by any purchaser, whether the zoning is R-3 or R-1. Mary's Inn is equipped to maintain the home in excellent condition suitable for raising infants. Rather than note each and every issue that has been raised, we believe that the attached letter from our board Chair, Bill Biver, addressed to all Churchill neighbors, is not only a reassurance of our intentions but also our good faith effort to be as good a neighbor as the Churchill neighbors are to each other. We want to be part of this neighborhood, and we want to maintain the family feel that all neighbors have described. We have met twice with the neighbors and have provided the attached response to their concerns, and we have publicly pledged all that we can to assure the neighbors and now the City Council that we will strive not to disturb the great community established in the Churchill Drive neighborhood. We encourage you to review the attached letter from Mr. Biver. Thank you for your time and consideration, and we respectfully request that you support our application with the conditions that we have voluntarily agreed to accept. Thank you. 3 Best Regards, l,f�.�/VI��Ga.�'Vl�Vl�' G�/��..�✓ Colleen Pasnik, Executive Director William Biver, Chair of the Board of Directors Mary's Inn Maternity Home Mary's Inn Maternity Home ec Planning & Zoning, City of Dubuque (wwernimo(a�cityofdubuque.org; smoon(a�cityofdubuque.org) Colleen Pasnik, M.Ed. Mary's Inn Maternity Home P.O. Box 3338 Dubuque, IA 52004-3338 (563) 552-6288 www.mar_ysinnmaternityhome.org Notice: This email(including attachments)is covered by the Electronic Communications Privacy Act, 18 U.S.C.2510-2521, is confidential.If you are not the intended recipient,you are hereby notified that any retention,dissemination,distribution,or copying of this communication is strictly prohibited.Please reply to the sender that you have received the message in error, and then delete it. Thank you. 4 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 5:01 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Mary Kluesner Add ress: Ward: Phone:5635432022 Email: mamekleez@aol.com City Department:City Council Message: I encourage each of you to vote for rezoning on Churchill,so Mary's Inn can relocate to a larger house.This maternity home provides a much-needed, safe space for many young women and their babies.Thank you. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 5:01 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Mary Kluesner Add ress: Ward: Phone:5635432022 Email: mamekleez@aol.com City Department:City Council Message: I encourage each of you to vote for rezoning on Churchill,so Mary's Inn can relocate to a larger house.This maternity home provides a much-needed, safe space for many young women and their babies.Thank you. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 8:04 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:WILLIAM C HOLLENSED Address: 1640 Born Ave Ward: 2 Phone:5635906967 Email:dabigdoc@gmail.com City Department:City Council Message: I am contacting you to request you approve the rezoning of 1749 Churchill Drive to allow Mary's Inn to purchase and occupy the home. Mary's Inn serves single mothers with a structured program to equip them to be productive members of the community.The mothers come from all levels of the community.The house would have only 4 mothers at a time and room for clerical functions. I live .3 of a mile away at 1640 Born.The home is close to the Jule route on Pennsylvania making it ideal.These young women are well supervised and the program has structure to help them gain employment. Random drug testing is part of the program insuring no issues. My wife and I are presently taking one of the residents of the current home to church on Sunday.She is so thankful for the help she is getting to care for her new baby and become independent. I cannot imagine better home owners. Mary's Inn is a well established ministry that is well supported and recieved in the community. Please give them the opportunity to expand and help more of the mothers become productive. Please call me if you have questions. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 6:21 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Mark M.and Mary K. Nauman Add ress: Ward: Phone: 15635997709 Email: mmnauman@aol.com City Department:City Council Message:We are asking for your support for the rezoning request for Mary's Inn to relocate to Churchill Drive.The home, location and neighborhood are perfect for this program. It is our understanding that there is nothing on record of disturbances or complaints that would justify not approving this request. Dubuque is a city known for its support,caring and helping those in need;this is an opportunity to enhance that positive aspect of our community.Thank you for considering this and for all you do. Mark and Mary Nauman 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 6:44 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Hanna Kasal Address:740 Duggan Drive,#2 Ward: Phone:5635817773 Email: ic.punchticket@gmail.com City Department:City Council Message: Please vote YES to rezoning the new property on Churchill Drive on Monday,September 18th for Mary's Inn. It's a great opportunity for them to better serve mothers and their babies.The new property will provide more privacy,confidentiality,and allow staff to be in an adjoining structure without being in the middle of the home and disrupting the families.Your support is much appreciated! 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 6:56 PM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Mark Lansing Address:5192 Grand Meadow Drive Ward: Phone:563 451 3346 Email: mmslansing@mchsi.com City Department:City Council Message: My wife Suzanne and I urge the Council to support Mary's Inn in its mission to serve pregnant girls by purchasing the house on 1749 Churchill.This house would provide the additional space Mary's Inn needs to serve the girls we help. Mary's Inn has been an excellent neighbor at its current location and has made significant improvements to the house. Mary's Inn will be an excellent neighbor for its new neighbors as well. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Friday, September 15, 2023 4:51 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Janet Wegner Address:2721 ANDREW CT Ward:3 Phone:515-341-3123 Email:Janet.wegner@proton.me City Department:City Council Message: Please vote yes for rezoning for Mary's Inn.Thank you. 1 JOHN B MYERS -65 N. Booth Street -Received Via Web QA I urge the City Council to GRANT a zoning change which will allow Mary's Inn to relocate to Churchill Street in the City of Dubuque. Unlike Planned Parenthood,this organization saves the BABY from abortion, and gives the mother the means to have the child with plenty of support during her pregnancy. Dubuque County Right to Life has been instrumental in the fight against abortion, and given the need for Mary's Inn's need for more space, our City Council would be making the right decision to approve the rezoning request. Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Thursday, September 14, 2023 10:31 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Ellen Markham Address: 1724 Geraldine Drive Ward: Phone:5635578117 Email:elmarkham@mchsi.com City Department:City Council Message: Please support the zoning for Mary's Inn maternity home.They provide a much needed service, have been successful with their interventions for the mothers,and have a proven record of being a good neighbor. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Friday, September 15, 2023 9:35 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Ken Blackburn Address:961 June Dr. Ward: Phone:563-580-4859 Email: Kenpblackburn@aol.com City Department:City Council Message: Please vote to rezone to allow MARY'S INN new location 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Friday, September 15, 2023 8:44 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Ken Blackburn Address:961 June Dr. Ward: Phone:563-580-4859 Email: Kenpblackburn@aol.com City Department:City Council Message: Please vote to rezone to allow MARY'S INN new location 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Friday, September 15, 2023 10:18 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name: Rev. Dennis Quint Address:231 BLUFF ST Ward:4 Phone:563.582.7646 Email:d.quint@dbqarch.org City Department:City Council Message: I encourage you to vote for the proposed Mary's Inn Home to be re-zoned from R-1 (Single Family)to R-3.The Inn provides a vital and unique service for Dubuque and Eastern lowa.The current home is maintained well, but simply too small. I know the leaders of this charity well and they are responsible,trustworthy,and upstanding.Thanks for considering and may God bless you. 1 Trish Gleason From: Citizen Support Center <dubuqueia@mycusthelp.net> Sent: Friday, September 15, 2023 9:47 AM To: Trish Gleason Subject: "Contact Us" inquiry from City of Dubuque website � I � This sender is trusted. � Contact Us Name:Tom Oglesby Address:2266 Martin Dr Ward: 2 Phone:5632311210 Email:tjoglesby@mchsi.com City Department:City Council Message: Please support the zoning request for Mary's Inn Maternity Home. Thankyou 1 STATE OF IOWA SS: DUBUQUE COUNTY CERTIFICATE OF PUBLICATION I, Kathy Goetzinger, a Billing Clerk for Woodward Communications, Inc., an Iowa corporation, publisher of the Telegraph Herald, a newspaper of general circulation published in the City of Dubuque, County of Dubuque and State of Iowa; hereby certify that the attached notice was published in said newspaper on the following dates: 09/08/2023 and for which the charge is 47.47 Subscribed to efore me, a Notary Pub is in and for Dubuque County, Iowa, this 8th day of September, 2023 Notary P v in and for Dubuque County, Iowa. JANET K. PAPE y Commission Number 199659 My Commission Expires 12111 /2025 Ad text : CITY OF DUBUQUE, IOWA OFFICIAL NOTICE PUBLIC NOTICE is hereby given that the Dubuque City Council will conduct public hearings on the 18th day of September, 2023, at 6:30 p.m., in the Historic Federal Building, 350 W. 6th Street, 2nd floor, Dubuque, Iowa, on the following: REZONINOS 1, Request from William R. Biver, Marys Inn Maternity Home to rezone property located at 1749 Churchill Drive from R-1 Single -Family Residential to R-3c Moderate Density Multi -Family Residential with conditions, 2, Request from Cory Ranson to rezone property located at 25 Bissell Lane from OR Office Residential to C-3 General Commercial. 3. Request from Richard Sova; Landover Corporation to rezone property located at Radford Road from Planned Unit Development with PC - Planned Commercial designation to OC Office Commercial, 4, Request from Kim Adams, DuTrac Community Credit Union to rezone property located at 3465 Asbury Road from Planned Unit Development with PC - Planned Commercial designation to C-3 General Commercial 5. Request from Capra Bank to amend the Unified Development Code to allow Drive -Up Automatic Bank Teller as a Permitted Use in the C-3 General Commercial zoning district, as a Conditional Use in the C-4 Downtown Commercial zoning district, and to establish signage regulations for a Drive -Up Automatic Bank Teller use. At the meeting, the City Council will receive oral and written comments from any resident or property owner of said City on the above action. The official agenda will be posted the Friday before the meeting and will contain public input options. The City Council agenda can be accessed at https://cityoRlubuque.novusagenda.com/AgendaPublic/ Written comments regarding the above public hearings may be submitted to the City Clerk's Office via email at ctyclerk©cityofdubuque.org or by mail to City Clerk's Office, City Hall, 50 W, 13th St., Dubuque, IA 52001, or by contacting the City Clerk's Office at 563-589-4100 before said time of public hearing. At the said time and place of public hearings the City Council will receive any written comments, Copies of supporting documents for the public hearings are on file in the City Clerk's Office and may be viewed Monday through Friday between 8:00 a.m, and 5:00 p.m. Individuals with limited English proficiency, vision, hearing, or speech impairments requiring special assistance should contact the City Clerk's Office at (563) 589-4100, ctyclerk©cityofdubuque.org as soon as feasible, Deaf or hard -of -hearing individuals can use Relay Iowa by dialing 711 or (800) 735-2942. Trish L. Gleason, Assistant City Clerk It 9/8 f; 1 For Sale > 0 {mot_ 51 5,000 4 bd 3 ba 3,848 soft `, ,,,,,,-.44 1749 Churchill Dr, Dubuque, IA 52001 i Est.: $3,508/mo / 'Get. pre-qualified w _: Request a tour as early as roday ar 2:OC) m Overview Pacts and features Home value Price and tax history Monthly cost Down p Bedrooms and bathYooms Bedroorn4 L ivingR om 9 Bedrooms: 4 e Level: Second p Level: First O Bathrooms: 3 e Area: 171 .58 0 Area: 475 s ei, Full bathrooms: 3 g Dimensions: 14.5 x 9 Dimensions: 30 x 15.f 0 Main level bathrooms: 11 .83 Basement 1 DiningRoorn 0 Basement: Full Bedroorni e Level: First Keating Level: Second o Area: 189.58 0 Heating features: o Area: 210.22 0 Dimensions: 14.58 x 13 Radiant, Hot Water Dimensions: 14.33 x FailyRoom Cooling 14.67 0 Level: First o cooling features: '' Bedroom G Area: 996.17 Central Air a Level: Second e Dimensions: 43 x 23.17 Appliances • Area: 189.29 Kitchen 9 Appliances included: o Dimensions: 14.75 x Level: First Refrigerator, 12.83 Range/Oven, Area: 373.63 Dishwasher, f edr'tor3 0 Dimensions: 25.92 x Microwave, Disposal, Level: Second 14.42 Area: 164,08 Washer, Dryer tl Laundry features: o Dimensions: 14.92 x 1 1 Lower Level • Total spaces: 2 a Levels: One rnarrnetiin rtirr=n-11-t irnc. a Cl-nrinc-• 1 b Parcel ntrnnher: ,i4 9OO 4 bd I 3,128 sgft 2750 Balboa Dr, Dubuque, IA 52001 Est.: $2,145/mo Get pre-qualified Overview Facts and features Home value Price and tax history Monthly cost Down p, Bedrooms and bathrooms Bedroorn4 LivingRoom • Bedrooms: 4 Level: Lower * Level: First • Bathrooms: 3 Area: 126 9 Area: 275.5 * F u€i bathrooms: 3 Dimensions: 9 x 14 Dimensions: 14.5 x 1 Main level bathrooms: DiningRoom Basement o Level: First * Basement: Full • Main level bedrooms: ?.. Area: 114 Heating L'Idroorni Dimensions: 9.5 x 12 * Heating features: e Level: First Forced Air Fa iiyRoorn O Area: 126 o Level: Lower Cooling * Dimensions: 10,5 x 12 ▪ Area: 350 * Cooling features: ede oo 2 o Dimensions: 17.5 x 20 Central Air o Level: First Appliances Kitchenpp o Area: 99.75 Level: First e Appliances included: o Dimensions: 9.5 x 10.5 Area: 115.5 Refrigerator, Bedr r Range/Oven, Dimensions: 10.5 x '11 Dishwasher, O Level: Lower Microwave, Disposal, • Area: 119 Washer, Dryer @ Dimensions: 8.5 x 14 Laundry features: Ma Level Property detas Parking Property Other property 4 ?1 ' CD ap a a m ? _d a ? C cn O ,Pl '0. m Zit VI C pj v1i R O O O ❑_ a ry y3�7 rD rD S 7 C C iy V C� rQ�rQ �, n S rD fD a In �n a :U ^{ pCPm' 0 N . ❑ m p :�+. r p r° fp �^. 7 _o n b n .l V 1 _ ky`-' ; o N ri.. n p �y TTIrn N S C n ''* n �. m CO) 2 VJ p B 7 7 3 O Vi I. • ro vn d N cc' Qa Q Q D e M. b CED a a n coro , • O p @ Q rt fD d .-r p a u, 5' � v S Q f Ln ' - Ojn y w Q 0_ a Cu a a l - I jiUfl d n V � S d 0 rD 'C Li rt� C r* d y [D S._ O n a C o - -5' •Z N ' z li v il'- o f10 S -" C 6 ~ v@i 3 j .. 40 `-* Ll 111 juilfl c as in M /t co to S O tD a [n vi m -0 in- a CD O N O O c IP rh',1 0 TJ a 9a a C CI) 3 p i • 0 .c m 0 a' a ru o 3 a m m c c a < m rD ` CD rD 7 C. C _En c o 3 - n c = -,. m m „.T...,,}.-' rp 5- .... co buy! a nl rD ,3 7 d Di IAA tn a '� i. rD 0 4;4& E 0 . i yptf C !.- q, ❑ rD m ❑ o> >-ci _ r , . ne ip D fl v n NI _ o ri• - m 2 n n y N © J rr Z a v rpPO 1 . a) m rD liZC ❑ .r°• -aErl 1 - 4C Z Ia O DJ n ''.-. rD N m ILA. 00 m. 4i'L - n D d C y m i . . 1 .., A r i+i American Academy of Pediatrics \ `` : DEDICATED TO THE HEALTH 0I Al I. 0I0l Detection of Lead Poisoning How is Lead Poisoning Detected? Lead poisoning usually is detected by measuring the level in blood. Many screening procedures use capillary blood as point-of-care testing. While finger-prick samples are appropriate for screening tests, all elevated capillary levels should have confirmation with a venous blood draw since capillary tests can yield frequent false positives. An elevated capillary lead level indicates that lead is in the child's environment even if the venous level is low, however, so primary prevention and education should be initiated. The current Bright Futures/AAP Periodicity Schedule recommends a risk assessment at the following well-child visits: 6 months, 9 months,iz. months, 18 months, 24 months, and at3, 4, 5 and 6 years of age. The recommendation is to do a risk assessment, and do a blood lead level test only if the risk assessment comes back positive. Accordingto the AAP and CDC, universal screens or blood lead level tests are not recommended anymore except for high prevalence areas with increased risk factors as described in a 2012 CDCreport, such as older ho, sThg. Most initial blood lead level tests are now performed as a result ofa positive risk assessment or parental concern rather than because children have symptoms that suggest lead poisoning. However, children of all ages who are recent immigrants, refugees, or adoptees are more likely to have elevated blood lead levels and should be screened at the earliest opportunity. Additionally, children who live in lower socioeconomic areas may be at higher risk. Medicaid-eligible patients also tend to be at higher risk for lead exposure because many live in these lower socioeconomic areas. Many state Medicaid/Early and Periodic Screening, Diagnostic, and Treatment programs require a universal blood lead level test at the 1z-month and 24.-month visits, no matter the prevalence of elevated levels based on factors such as where the patient lives. While these programs have been directed to transition their requirements to be more in line with prevalence data (targeted screening), most states have not completed these efforts. For more information, see the CMCHS Information Bulletin, Target Lead ScreeningPlans or the CDC Guide For Stqtes Interested in Transitioning to Targeted Blood Lead Screening for Medicaict-Eligible Chadrea. Pediatricians should ask their state Medicaid office to determine which requirements they should follow when it comes Medicaid-eligible patients. This information is available for most states on the CDC Web site. However, pediatricians may err on the side of caution arid obtain a lead level in Medicaid patients and those who they feel are at high risk. Because of lead's effects on the developing fetus,some states have developed lead screening guidelines for pregnant women. The CDC recently published guidelines on the screening of pregnant women for lead, medical and environmental management, and follow-up of mothers and infants when maternal lead levels are at least 5 micrograms per deciliter. Care of the infant includes measuring cord or neonatal blood lead to establish a baseline. Once the child is born, the guideline calls for an interruption of breastfeeding only if the maternal blood lead level is 4o micrograms per deciliter or more. Above this level, women should pump and discard their milk until after their blood lead level decreases below that benchmark. For families using tap water to reconstitute infant formula or juice, or where.there has been local concern, tap water testing may be recommended. To help determine whether a home's water might contain lead, parents can call the EPA Safe Drinking Water Hotline at (Soo) 426- 4791 or their local health department to find out about water testing. Well water should be tested for lead when the well is new and tested again when a pregnant woman, infant or child less than 18 years of age moves into the home. For a discussion about using well water to feed infants, see the AAP policy statement on drinking water from private wells. Most water filters remove lead. When is Diagnostic Testing Warranted? Some experienced clinicians measure the blood lead level in children with growth retardation, speech or language dysfunction, anemia, and attentional or behavioral disorders, especially if the parents have a specific concern about lead or about health effects from environmental chemicals. However, elevated blood lead levels that continue into school age are unusual, even if peak blood lead level at 2 years of age was high and the child's home exposures have not been addressed. Therefore, a relatively low blood lead level in a school-aged child does not rule out earlier lead poisoning. If the question of current lead poisoning arises, however,the only reliable way to make a diagnosis is with blood lead measurement. Hair or urine lead levels give no useful information and should not be performed. Additional Resources • CDC's Childhood Lead Poisoning Prevention Program • CDC Low Level Exposure Harms Children:A Renewed Call for Primary Prevention • Pediatric Environmental Health Specialty Unit • CMCS Targeted Lead Screening Plans • CMS Guide for States Interested in Transitioning to Targeted Blood Lead Screening for Medicaid-Eligible Children • Bloo4_Lead Levels in Children:What Parents Need to KnowWhere We Stand:Lead Screening Last Updated 06/29/2023 Source American Academy of Pediatrics ©Copyright 2023 American Academy of Pediatrics. All rights reserved. I To whom it may concern, Lead-based paint was banned from was banned on residential structures in 1978 by the consumers products safety commission. The likelihood of finding lead-based paint increases with age of the home. Two out of three homes built between 1940 and 1960 have lead-based paint. Nine out of ten homes built before 1940 have lead-based paint. Exposure to lead during pregnancy has known adverse effects on maternal health and infant outcomes. Elevated lead levels in pregnancy have been associated with gestational hypertension,spontaneous abortion or miscarriage, low birth weight,and impaired neurodevelopment. Lead exposure prenataly and postnatally has also been associated with developmental and behavioral problems in children. Protecting pregnant women and children from lead exposure is very important to assure healthy development.CDC recommends removing lead hazards from the environment is primary prevention. No blood lead levels are safe,so avoiding all exposure is advised. Sincerely, Velaterina Bakhta, MD FACOG it Re: Understanding Unlicensed Care Homes: Final Report I ASPE From: melissa claussen (mclaussen556@gmail.com) To: rtfmat@aol.com Date: Monday, September 18, 2023 at 09:09 AM CDT On Sep 15, 2023, at 2:08 PM, melissa claussen <mclaussen556@gmail.com>wrote: https://aspe.hhs.gov/reports/understanding-unlicensed-care-homes-final-report-0 Understanding Unlicensed Care Homes: Final Report Breadcrumb Angela M. Greene, Michael Lepore, Linda Lux, Kristie Porter, and Emily Vreeland RTI International Printer Friendly Version in PDF Format (81 PDF pages) ABSTRACT Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state. These homes often serve very vulnerable individuals such as individuals with serious mental illness or other disabilities, or older adults with functional limitations and limited financial resources. Some of these homes are legally unlicensed while others operate illegally. The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option, the types of individuals who reside in them,their characteristics including quality and safety and the policies that influence the supply of and demand for these homes. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes. DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services,the contractor or any other funding organization. TABLE OF CONTENTS 1. INTRODUCTION 2. METHODS • 2.1. Literature Review • 2.2. Subject Matter Expert Interviews • 2.3. Site Selection and Site Visits 3. FINDINGS • 3.1. Summary of Literature • 3.2. Populations Served and Conditions in Unlicensed Care Homes • 3.3.Abuse,Neglect, and Financial Exploitation • 3.4. Strategies for Identifying Legally and Illegally Unlicensed Care Homes • 3.5. Strategies for Addressing Issues in Legally and Illegally Unlicensed Care Homes • 3.6. Potential Data Sources or Listings of Unlicensed Care Homes 4. POLICY AND PRACTICE IMPLICATIONS • 4.1. Licensed Care Home Admission and Discharge Policies • 4.2. Modest Public Benefits • 4.3. Closing Institutions • 4.4. Hospital Discharge 5. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS • 5.1. Study Limitations • 5.2. Conditions in Unlicensed Care Homes • 5.3. Strategies for Identifying Unlicensed Care Homes • 5.4. Strategies for Addressing Conditions in Unlicensed Care IIomes • 5.5. Implications for Policy • 6. RECOMMENDATIONS FOR FUTURE RESEARCH • 6.1. Legally Unlicensed Residential Care Homes • 6.2. Illegally Unlicensed Residential Care Homes • 6.3. Financial Exploitation,Abuse of Residents'Rights, and Program Fraud in Unlicensed Residential Care Homes • 6.4. Other Research Ideas Suggested by Subject Matter Experts or Individuals Interviewed in State Site Visits APPENDICES • APPENDIX A: State Summaries • APPENDIX B: Findings from the Environmental Scan ACRONYMS The following acronyms are mentioned in this report and/or appendices. I AAA Area Agency on Aging i ACL HHS Administration for Community Living ADA Americans with Disabilities Act ADL Activity of Daily Living AG Attorney General APS Adult Protective Services ! ASPE HHS Office of the Assistant Secretary for Planning and Evaluation BHSL Pennsylvania Bureau of Human Services and Licensure CMS HHS Centers for Medicare and Medicaid Services DADS Texas Department of Aging and Disability Services Dom Care Domiciliary Care EMS Emergency Medical Services HCBS Home and Community-Based Services HFR Healthcare Facility Regulation HHS U.S.Department of Health and Human Services i IADL Instrumental Activity of Daily Living LME Local Management Entity LTSS Long-Term Services and Supports MCO Managed Care Organization NANII National Alliance for Mental Illness NDRN National Disability Rights Network P&A Protection and Advocacy Agency PCRR Personal Care Risk Reduction RCF Residential Care Facility SME Subject Matter Expert SSA U.S. Social Security Administration SSI Supplemental Security Income SSP State Supplementary Payment EXECUTIVE SUMMARY ES.1. Introduction There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited fmancial resources. Unlicensed care homes--which provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state- fill some of the gaps in the availability of housing and services for these populations. Some of these places are legally unlicensed, while others operate without a license illegally. Although little is known about unlicensed care homes, a variety of signals, including media reports, highlight potential safety and quality concerns. The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option; the types of individuals who reside in them; their characteristics, including their quality and safety; and policies that influence the supply of and demand for these homes. Through a targeted series of interviews and a scan of the literature, we sought to contribute foundational information about unlicensed care homes. Although the scope of our research was limited--involving a small number of interviews with subject matter experts (SMEs) and interviews with informants in three communities in three states--the findings have relevance for national, state, and local policies and practices and for future research. ES.2. Methods We conducted an environmental scan primarily focused on information spanning a five year period from 2009 through 2014. The scan included published peer-reviewed and grey literature, including abuse blogs and media reports about legally and illegally unlicensed residential care homes. Few peer-reviewed articles have been published on unlicensed care homes, but numerous media reports were examined. Following the environmental scan, we conducted interviews with SMEs on the topic of unlicensed care homes. The environmental scan and SME interviews informed state selection for site visits.After recommending six states for site visits, the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation and the research team selected three communities in three states for on-site visits: Atlanta, Georgia; Raleigh/Durham,North Carolina; and Allegheny County, Pennsylvania. The team conducted interviews with key informants in each of these communities. ES.3. Findings Based on the findings from this exploratory study, unlicensed care homes appear to be widespread in some areas within some states. They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches. Findings from the environmental scan highlighted issues of safety, abuse, and exploitation in unlicensed care homes; however, the source material, including media reports, tend to highlight negative and sometimes sensational stories, which may or may not represent the norm in unlicensed care homes. Though outside the scope of our focus, some of the searches also produced media reports and grey literature about concerns in licensed care homes; however, reports about unlicensed care homes and the quality of care described therein was sometimes worse than those for licensed care homes. Site visit findings were largely consistent with those of the environmental scan, and despite increased attention to unlicensed care homes in some states, key informants highlighted issues of safety, abuse, and exploitation. However, our key informants (including representatives of adult protective services, ombudsmen programs, and police and fire departments) were informed about unlicensed care homes only in response to complaints or emergencies, which may have biased their views of these homes. Although some SMEs and key informants provided a few examples of unlicensed care homes where residents receive what they categorized as good care, it appears that abuse, neglect, and financial exploitation of these vulnerable residents is commonplace. ES.4. Populations Served and Conditions in Unlicensed Care Homes Based on our findings, the residents of these homes are extremely vulnerable. While some unlicensed homes reportedly serve elderly and physically disabled residents, key informants noted that many also serve persons who were formerly homeless, persons who may have substance use disorders, persons with severe and persistent mental illness, and parolees. Some of these homes also serve mixed populations (e.g., elderly residents as well as individuals with severe and persistent mental illness). 11 Interview findings indicate that many residents of unlicensed care home are Supplemental Security Income(SSI)beneficiaries. Several informants explained that some unlicensed care home operators require residents to make the care home operator or the operator's designee their representative payee for SSI benefits, and that some operators also collect food stamps, medications, or other resources from residents, which the operators can then sell for profit. Key informants also commonly described the conditions in unlicensed care homes as abusive, financially exploitative, and neglectful of residents' basic needs, and depicted situations that involved false imprisonment of the residents and repeatedly moving the residents from one facility to another,both within and across states, to evade law enforcement. One SME pointed out that many unlicensed care home cases are analogous to human trafficking, such as when residents are held against their will and then moved from one location to another to avoid detection; however, the current federal definition of human trafficking specifies that the trafficking is done for the purpose of labor or sex, and not for the collection of public benefits (U.S. Department of State, 2015). Informants expressed other specific concerns about unlicensed care homes, including improper management of residents'medications; unsafe, unsanitary, and uncomfortable living environments; theft of utilities from neighbors; and fraudulent collection of government payments (e.g., not reporting residents' deaths and continuing to collect their SSI payments). ES.5. Strategies for Identifying and Addressing Quality in Unlicensed Care Homes Strategies for identifying and addressing quality in legally and illegally unlicensed care homes appear to differ across states. Interview discussions often touched on the question of how best to identify illegally unlicensed care homes, and key informants noted this as a major challenge. In the states we visited, a common theme across interviews was that addressing quality in illegally unlicensed care homes tends to focus on shutting down the operations. In contrast, identifying and addressing quality in legally unlicensed care homes was only minimally discussed; however, in at least one of our site visit states, interviewees felt that it was feasible to identify these homes, given the existence of listings of these homes. The most prevalent strategy used by state and local officials to identify illegally unlicensed care homes is responding to complaints. Licensure offices and other agencies or organizations respond to complaints made by concerned citizens, including family members and friends of residents, neighbors of unlicensed care home operators, health care providers serving unlicensed care home residents, firemen, ambulance services, police, and licensed care home operators. Notably, the strategy of responding to complaints limits the amount of information available about unlicensed care homes about which complaints are not made (i.e., possibly better quality homes). Key informants recommended more proactive strategies for identifying unlicensed care homes, such as tracking individuals' benefits (e.g., SSI) to unlicensed care homes, obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them, and utilizing owners of licensed or legally unlicensed facilities as a source of information about illegally unlicensed care homes. Key informants recommended several tactics to address poor quality in unlicensed care homes, but the overall strategy consistently discussed was to shut down these homes. Informants noted that interagency, multidisciplinary teams at state and local levels are imperative to the success of shutting down unlicensed care homes, and to address the various issues involved in such closures, such as meeting the housing and services needs of residents, addressing any criminal behaviors of the care home operators, and ensuring the safety of the house or facility and neighboring properties. The informants recommended the formation of teams including a range of stakeholders, including state licensure officials,Adult Protective Services (APS), ombudsmen, police, firefighters, emergency medical services, code enforcement, and local advocacy organization workers.1 To address unlicensed care homes, states commonly use a strategy that includes penalty systems that fine operators as a way to try and close illegally unlicensed care homes. However, according to interview participants, fines have had little impact on closing the homes, as they were often unenforceable and rarely paid. Additionally, states may implement public awareness campaigns to support identification of unlicensed care homes. Two of our three site visit states aimed to enhance awareness of poor and inadequate unlicensed care homes by increasing education for the public and key stakeholders: Pennsylvania held a statewide education and marketing campaign to inform the public about unlicensed care homes, and Georgia conducted training sessions to educate law enforcement and first responders about these homes. E.6. Policy and Practice Implications Based on our exploratory research,we found that a number of factors may have an effect on the demand for unlicensed care homes. According to SMEs and key informants, the following factors are likely drivers of the demand for unlicensed care homes in their communities or states: • The policies that licensed care homes have against admitting residents who exhibit behavior problems and those who have substance use disorders, or to discharge residents who develop these problems. • The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. • The closure of large mental health institutions and concomitant transition of previously- institutionalized individuals with severe and persistent mental issues to community-based care settings, such as legally unlicensed care homes. • The financial pressure hospitals feel to free up hospital beds sometimes results in discharges to unlicensed care homes, both unintentionally and for expediency. ES.7. Conclusions and Caveats While this was a limited exploratory study, our findings point toward serious issues with unlicensed care homes, as well as gaps in our knowledge, and they have important implications for future research on unlicensed care homes. We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limited the scope of our findings.Also, the information collected from newspapers, ombudsmen,APS staff, or other agency reports (by their very nature) skew towards negative events. Thus, although our findings consistently highlighted concerns about safety and quality, we cannot assess the generalizability of these findings and concerns.Additionally, some of what we heard about policies that affect demand for and supply of unlicensed care homes was based on the opinions of the individuals interviewed and may not be representative of others' views, and we do not have data to support these viewpoints. While experts may speculate on changing market dynamics, we do not have a reliable estimate of the unlicensed care home market prior to these policies taking effect, so we do not lcnow what the market would have been without such policies. However, even with those limitations, we know that in the communities we visited, there were significant health and safety concerns for residents, as well as concerns about financial exploitation and government fraud. Finally, as noted later in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or being unnecessarily institutionalized. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety, or appropriateness of those other environments.Additional research on unlicensed care homes will be valuable to build our understanding of the role--intended or unintended--of these places in our long-term services and supports systems, and the policies affecting it. 1. INTRODUCTION There is a critical challenge of providing housing and supportive services for particularly vulnerable groups, including individuals: who have severe and persistent mental illness or other disabilities, were formerly homeless, or older adults who have limited fmancial resources. Providers of housing and care services that are licensed by the state, such as nursing homes and residential care facilities (RCFs), serve some of these individuals. However, unlicensed care homes, which provide room and board and some level of personal care services, but are notlicensed by the state, fill some of the gaps in the availability of housing and services for these populations. These unlicensed care homes are referred to by several different names in different states, such as "board and care homes," "boarding homes," and "adult care homes." Regardless of what they are called, this study focuses on places that provide room and board and sometimes provide personal care to two or more unrelated individuals,but whose operators are not licensed or certified by the state.All states license residential care such as assisted living, and most states license small adult care homes, often referred to as adult foster care (Carder, O'Keeffe, & O'Keeffe, 2015). But there are homes providing room, board, and personal care that either fall outside the bounds of the state licensure requirements or are deliberately avoiding state licensure requirements. Some states permit unlicensed care homes to operate legally under the guidance of state regulation; others do not. In either case, while states regulate and provide some level of monitoring and oversight of licensed care homes, state and local oversight of unlicensed care homes can be minimal or non-existent, and these facilities provide questionable care and services. And regardless of whether states have regulations concerning unlicensed homes, many operators choose to operate illegally unlicensed homes. Media and state reports have highlighted homes operating deliberately illegally--that is, they are avoiding required licensure or certification (Tobia, 2014; Georgia Association of Chiefs of Police Ad Hoc Committee on At-Risk Adult Abuse,Neglect& Exploitation, 2013). Further, evidence exists from several states that there are still unlicensed residential care homes and that, in some states at least, the number of unlicensed facilities is increasing. - More information exists about licensed RCFs than unlicensed care homes, thus knowledge of the unlicensed care homes is limited. This lack of knowledge contributes to the need for the government and policy makers to have a better understanding of unlicensed care homes. Therefore, the purpose of this project was to conduct exploratory research on unlicensed care homes to understand more about their prevalence, factors contributing to their prevalence, their characteristics(including their overall quality and safety), and the types of residents they serve. In this study we sought to identify: • Characteristics of unlicensed care homes and the residents they serve. • Conditions (including quality and safety) of unlicensed care homes. • Strategies for identifying illegally unlicensed care homes. • Strategies used to address health, quality and safety issues in unlicensed care homes. • Policies affecting the supply of and demand for unlicensed care homes. • Areas for future research and potential data sources related to unlicensed care homes. This report describes the methods used to conduct the study, summarizes the information learned from an environmental scan and the results from interviews with subject matter experts (SMEs) and site visits, discusses implications of the findings and, based on the study findings, offers recommendations for future research on unlicensed care homes. 2. METHODS The goal of this study was to provide foundational information intended to answer or provide insight into the study research questions.To accomplish this we conducted an enviromnental scan, including a review of the peer-reviewed and grey literature and interviews with SMEs. We also conducted site visits to a total of three communities in three states, including interviews with local and state-level key informants.Although limited in scope, the study provides foundational information about unlicensed care homes based on a narrow review of the literature and the reports of select SMEs and key informants in three states. 2.1. Literature Review The objective of the literature review was to identify current information(2009-2014) on both legally and illegally unlicensed RCFs and to inform the conduct of SME interviews and site visits to communities in three states. The literature review was not an exhaustive effort,but rather a targeted scan of information on unlicensed care homes in the peer-reviewed and grey literature, abuse blogs, and media reports. PubMed and other database searches yielded very little literature related to unlicensed RCFs. General searchtenns included unlicensed, not licensed, unregulated, adult, elderly, residential care, and assisted living. Targeted search terms incorporated specific licensure category names for each specific state. Most of the literature we found referenced problems in and the prevalence of unlicensed residential care homes prior to 2009, or addressed abuse an.d exploitation of adults living in licensed facilities. Many publications also focused on quality of care or other issues related to unlicensed care staff. On the other hand, grey literature--that is, reporting databases, blogs, and media reports--produced more results about unlicensed care homes. Study staff screened each of the collected articles,blogs, and reports to identify relevant material for review. 2.2. Subject Matter Expert Interviews We utilized the information obtained in the literature review, in addition to our own expertise, that of our consultant, as well as that of U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation(ASPE) and the HHS Administration for Community Living(ACL) staff familiar with unlicensed care homes, to develop an initial listing of SMEs to interview. Potential SMEs were included in the initial listing based on their familiarity with residential care regulations, experience in and research about residential care, experience working with the potential target populations of unlicensed care homes, and knowledge of Medicare and Medicaid payment policies and home and community-based services (HCBS) waiver programs. Following the development of the initial list of SMEs, we divided the list into two categories: (1) a subset of individuals identified as "key experts" who would be prioritized for interviewing because we determined they had relevant information related to unlicensed care homes; and (2) individuals identified as "potential experts" who would first be vetted to determine their level of knowledge about unlicensed care homes. The team conducted brief vetting calls with the second subset of SMEs to determine their appropriateness for an interview; if they were not deemed appropriate, they were asked whether they knew of any other potential interviewees.After completing the vetting calls, we emailed an introductory letter explaining the purpose and goals of the research to the potential interviewees. In several cases, the potential interviewees did not have direct knowledge on the topic of unlicensed care homes, and were not interviewed,but referred us to interviewees with more knowledge on the topic. We completed 17 interviews with SMEs. Two interviews were completed with representatives from the Federal Government, seven with representatives from state agencies, three with representatives from policy organizations, one with a representative from a national advocacy group, and four interviewees were researchers knowledgeable about unlicensed care homes. Interview questions were based on respondent expertise, and were tailored for each respondent. Thus, no more than nine individuals were ever asked the same question. SME interviews primarily focused on federal and state policies that may impact the prevalence of unlicensed care homes. Each interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. We then asked questions specific to the type of SME, including: • What gaps unlicensed care homes may fill in the spectrum of long-term services and supports (LTSS)? • Which states have had an increase or decrease in the number of unlicensed care homes and why? • What is the scope of concerns in unlicensed care homes, including quality of care, safety, sexual or physical abuse, and financial exploitation concerns? • How do states address unlicensed care homes, and if states or other organizations maintain lists of unlicensed care homes (legal or illegal)? • What federal and state policies affect the supply and demand of unlicensed care homes? 2.3. Site Selection and Site Visits Site visit locations were based on the information gathered in the environmental scan, SME interviews, and a review of residential care regulations.For example, as part of interviews with SMEs, we asked them to recommend potential key informants to meet with during site visits. Based on the information gathered, we determined key criteria for site visit location selection, including having good leads/contacts for identifying key informants in the state, and having geographic variation across states. We targeted site visits in communities that varied according to whether the state: (1) has legally unlicensed care homes; (2)has a list of unlicensed care homes; and(3) ranks among the highest or lowest in HCBS waiver expenditures. 2.3.1. Site Selection Based on the criteria noted above, we recommended six states to ASPE as possible site visit locations: Georgia, Indiana, Maryland, North Carolina, Pennsylvania, and Texas.After discussions with ASPE, we identified three states and communities within each state as site visit locations: Atlanta, Georgia;Raleigh/Durham,North Carolina; and Allegheny County, Pennsylvania. These locations were selected based on their differences across the selection criteria domains described above, as well as our understanding of the environments surrounding unlicensed care homes in each of the locations, and our ability to identify potential informants in each of the selected locations. 2.3.2. Site Visits During each site visit we interviewed state licensure agency staff to obtain a broad perspective on the regulations surrounding residential care in each of the states.Additional key informants for the site visit interviews were selected based on information provided by the SMEs or what we learned from the environmental scan.For example, in Georgia it recently became a misdemeanor to operate an unlicensed care home,therefore we aimed to speak with law enforcement officials who had been involved in the process of investigating unlicensed care homes. In Pennsylvania counties, a multidisciplinary team called the Personal Care Risk Reduction(PCRR) team helps to address illegally unlicensed care homes; thus we attempted to interview key informants involved in this process. Key informants for each site visit location included representatives of local public safety organizations such as law enforcement or firefighters,Adult Protective Services (APS) staff:, and ombudsmen.Additional key informants participating in interviews during site visits included local hospital discharge planners (North Carolina), representatives of organizations providing services to residents of unlicensed care homes (Georgia), and local advocacy organizations including National Alliance on Mental Illness (NAMI),Disability Rights North Carolina and Disability Rights Network of Pennsylvania.Although we attempted to conduct interviews with operators of unlicensed care homes on our site visit states, we could not identify or gain access to any. Key informant interviews focused on local context, state and local policies that may impact or affect the demand for unlicensed care homes, and informants' direct experiences with unlicensed care homes. Like the SME interviews, each key informant interview began with a general question to ascertain what the interviewee knew about unlicensed care homes. We focused on a range of questions, including: • How do agencies handle specific complaints about unlicensed care homes? • Which agencies get involved when addressing unlicensed care homes? • What concerns are there about the quality of care and safety in unlicensed care homes? • What populations do unlicensed care homes serve? • What types of reports of mistreatment do the agencies receive? • What are the interviewees' thoughts on the best strategies to identify unlicensed care homes? Results of key informant interviews from site visits, as well as the SME interviews and the literature review, are presented in the Findings section that follows. 3. FINDINGS Findings from our limited number of interviews with site visit key informants and SMEs are consistent with the information found during the environmental scan. Both the information we collected about unlicensed homes in the literature review and that which we collected through interviews mostly paint a negative view of these settings. Newspaper and media reports generally focus on what they view as the dramatic; the positive aspects of unlicensed care homes are often omitted from these reports. Similarly, by nature of their jobs, many of our interview participants, including APS staff, ombudsmen, police, and fire department personnel, typically hear about care homes when there are complaints or emergencies. Consequently, although we attempted to elicit information about the positive aspects of unlicensed care homes, key informants largely provided us with a less favorable view of unlicensed care homes. Furthermore, illegally unlicensed care homes continue to exist because they try to avoid detection; therefore, favorable reports of unlicensed care homes are minimal. Study findings should be viewed in light of these limitations. Although limited in scope, the findings of this exploratory study provide important foundational information about current conditions in some unlicensed care homes, factors that may influence demand for these homes, and strategies to identify them and address their quality. In this section, we summarize results of the literature review and interviews with SMEs and key informants. Key informant interviews were conducted in three communities across three states: Allegheny County, Pennsylvania;Atlanta, Georgia; and Raleigh/Durham,North Carolina. Site visit summaries, which provide more state-specific information, and information on other states considered for site visits, are included in Appendix A. 3.1. Summary of Literature We found little published information about unlicensed residential care homes; in fact, the scan revealed that most of the literature about conditions in RCFs covered licensed residential care or were about unlicensed care staff. What information exists reflects a concern about the conditions under which residents in these places live. Most of the literature and media reports reviewed focused on the pitfalls of unlicensed care homes and the poor quality and safety provided in these settings. No positive literature was found, which, as noted earlier,may be reflective of the fact that nothing is published about these places unless they are discovered because they are being investigated for poor care or resident exploitation or abuse. In regard to the prevalence of unlicensed care homes, state-level estimates were only reported for Georgia, Maryland, and Florida. Further details on findings from the environmental scan can be found in Appendix B. Our examination of the Medicaid Fraud Control Unit reports (2009-2013) showed that only a couple cases were reported to the media; the rest had not made the news. We found three cases in Florida of charges against unlicensed RCFs involving allegations of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility; and three cases in Nevada of neglect and/or criminal offenses while operating without a license (one where the accused also operated a licensed facility).A separate search of a few state Attorney General (AG) reports of unlicensed RCFs identified six cases of successful prosecutions in New York,Nevada, Florida, and California for operating an RCF without a license--and, in several cases, for gross neglect. The information focused on specific cases, but not on how many of these places exist in these states. Using information from a HHS Administration on Aging report,provided by the National Ombudsman Reporting System(2009-2013), we identified reports regarding unlicensed facilities in five states: Maryland, Michigan, Nevada, Florida, and Georgia, as well as the District of Columbia. Ombudsmen reported increasing numbers of RCFs operating without a license in both Maryland and Nevada. None of the reports provided evidence on the prevalence of unlicensed care homes in these states or the magnitude of the issue statewide. We hypothesized that states that do not have well-funded HCBS programs may have a higher incidence of illegally unlicensed homes than states with more robust HCBS programs. If states have reduced funding for HCBS needed by low-income elderly and disabled individuals, thenlicensed care homes,which may have higher rates and fees than unlicensed homes, may no longer be an option for these individuals, or they may be faced with a potentially longer waiting list for licensed care homes.As a result, we also examined HCBS expenditures in a select number of states:Using the 2012 annual Medicaid LTSS expenditures report produced by Truven, we identified the ten states that spent the highest percentage of their LTSS expenditures on HCBS and the ten that spent the least. We then examined if those percentages might be related to the number of unlicensed care facilities in those states. Targeted searches of media reports in states with the lowest percentages of their LTSS expenditures on HCBS (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield more reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona,Vermont,Alaska, Minnesota, and Oregon). With one exception--Georgia--the same held true for the ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island,Alabama,Tennessee, Georgia, New Hampshire,Massachusetts, and Delaware. From our review of states' regulatory information on licensed residential care categories during the development of the sampling frame for the 2014 National Study of Long-Term Care Providers, and our review of ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy (2015), we found that 30 states require residential care homes to be licensed if they have at least one bed. Massachusetts exempts small private-pay homes from licensure.According to the regulations, some states also allow residential care homes to be legally unlicensed if they have 1-2 beds.Ten states (Delaware, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. Six states (Colorado, Iowa, Illinois, Maine, Missouri, and Vermont)license starting at three beds; Vermont exempts small private-pay homes. In one state, Pennsylvania, three bed residential care homes are legally unlicensed. Pennsylvania begins licensure with four beds, but the state has locally certified domiciliary care (Dom Care) homes that serve 1-3 residents. Lack of clarity in licensure regulations regarding minimum bed size required by licensure also exists in a few states. Maryland, Mississippi, and the District of Columbia have no minimum bed size for licensure, implying that some residential care homes can be legally unlicensed. New Jersey and Tennessee have a licensure category that specifies the maximum number of beds required for licensure, but not a minimum, which also implies that in these states some residential care homes may be legally unlicensed. Several states (California, Pennsylvania, Maryland, and Mississippi)publish notices of how and where to report unlicensed care facilities, which implies that these states may be experiencing problems with unlicensed homes. However, our literature search did not reveal any estimates of the prevalence of unlicensed residential care homes in most of these states. Media reports were usually about an action by a licensing agency, Medicaid Fraud Unit,APS, or the police arresting an operator; these reports do not provide much information about the extent to which unlicensed homes exist in the state. Three reports are worth noting separately. The first, a six-state study on elder abuse in RCFs conducted by Hawes & Kimbell(2010) for the U.S. Department of Justice found that unlicensed homes remain a serious,largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Estimates of the number of unlicensed RCFs, as detailed in this report, were in the hundreds in two states: one state estimated more than 200 unlicensed homes in contrast to their 400 licensed facilities; and the other state estimated more than several hundred unlicensed homes but noted there was no reliable count. In the latter state, it was said that unlicensed homes "flourished in the larger cities, particularly those that had significant populations of poor elders and persons with mental illness who had been released from state mental hospitals" (Hawes & Kimbell, 2010). A paper by Tobia(2014) describes the state of unlicensed residential care in one county in Maryland, where as many as 78 unlicensed care homes may be serving as many as 400 individuals. According to the report, these warehoused residents are vulnerable older adults with "hard to place" mental health needs and paroled individuals. Other estimates of the number of unlicensed care homes in the state range from 500 to 1,500 within one metropolitan area. Because of the potential for a large loss of life from fires in these places, comprehensive emergency management planning and practices are reported to be needed to proactively protect those at risk (Tobia, 2014). Finally, a peer-reviewed publication by Perkins, Ball, Whittington, &Combs (2004)provides insights into why an operator continues to operate an unlicensed care home. Though it is outside the time period of our environmental scan, the case study describes how regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential care homes. Operators of small care homes lack knowledge of licensure regulations and how to navigate the different government agencies, and there is a perceived lack of respect from government staff regarding the quality of care that non-professional staff can provide in these small residential care homes. As described in Section 2, to inform the selection of states for site visits, we looked closely at the information available for six states where the environmental scan or SMEs indicated unlicensed care homes likely exist. Based on this information, we chose three states, and subsequently identified three communities within those states, to visit and conduct case studies? Following is a summary of the literature, media coverage, and regulations for those three states (Georgia, Pennsylvania, and North Carolina). Georgia Reporters from the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local officials, social service providers, and advocates, and then published a series of articles on the status of affairs in unlicensed residential care homes (Schneider & Simmons, 2012a; Schneider& Simmons, 2012b; Schneider& Simmons, 2012c). The reporters described cases of abuse in which residents were being beaten and burned, locked in basements or other rooms, given buckets for toilets, and had their benefit checks taken from them. Licensure staff admitted they only learn about the unlicensed facilities when someone reports them. State inspection staff, already overwhelmed with large caseloads, were required to obtain search warrants to execute searches, a time-consuming process,when trying to follow up on reports of unlicensed homes. In 2011, only two such warrants were obtained. Advocates reported a growing number of unlicensed facilities and difficulties distinguishing them from boarding homes or other types of RCFs. Unlicensed homes were described as less expensive than licensed facilities but as shabbier and offering fewer services. Residential care homes that are legal often serve as covers for or conduits to illegal homes. Oversight was spread across several agencies and depicted as convoluted and overstretched. Local efforts were noted to be inconsistent and uncoordinated because authorities were unfamiliar with the laws. As a result of the newspaper exposé, Georgia enacted new stronger laws. It is now a misdemeanor to operate an unlicensed RCF. Efforts are now under way to provide workshops that clarify the new laws about unlicensed care facilities and how law enforcement and other agencies can work together to identify and investigate crimes against at-risk adults and prepare the necessary components for successful prosecutions. Concerns remain that agencies do not have the resources to monitor and follow through with the appropriate actions (e.g., finding emergency placements for residents,prosecuting violators, ensuring that the facility remains closed and has not reopened in another location) for the unlicensed facilities. Pennsylvania Residential care homes that serve three or fewer residents are legally unlicensed in this state. Per one report, the Department of Public Welfare lacks the legal authority to inspect, require plans of correction, or fine these facilities; however,APS can act on referrals of abuse (Pennsylvania Health Law Project &North Penn Legal Services, 2007). The Depai anent of Public Welfare also can take action against boarding homes and similar facilities that house four or more people if they are providing personal care services because they are considered illegally unlicensed.A 2010 annual report from the Department noted that the number of illegal residential care homes had increased from four homes in 2009 to 27 in 2010, most of them located in the Philadelphia area (Pennsylvania Department of Public Welfare, 2011). In 2012, the Secretary of the Department of Public Welfare noted that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly" (Pennsylvania Department of Public Welfare, 2012). In one court case, the judge deemed a "boarding house" as an unlicensed residential care home because only three of the six people renting rooms received personal care from the owner's licensed home care agency, even though four actually needed those services. The fact that four people should have been receiving personal care services made the home eligible for licensure as a residential care home--not the fact that three people were receiving the services (which would make it under the legal limit). North Carolina The environmental scan did not yield peer-reviewed publications or reports about unlicensed residential care in North Carolina. New stringent eligibility criteria for state plans to cover services in group homes serving persons with mental illness have reportedly made it financially difficult for the adult care homes and group homes to continue operating, and some have reportedly been forced to close. From our review of the regulations, we identified that North Carolina likely has legally unlicensed care homes (e.g.,boarding homes serving 4-5 residents ' who do not require 24 hour supervision), and we suspect that illegally unlicensed care homes also exist. The recent changes to state regulations for community living arrangements are also reportedly becoming more favorable toward independent living, which may lead to an increase in the number of unlicensed facilities. The remainder of this section summarizes findings from interviews with SMEs and site visit key informants, and also includes additional information from the environmental scan. 3.2. Populations Served and Conditions in Unlicensed Care Homes SMEs and site visit key informants noted that individuals being served in unlicensed care homes are very vulnerable adults. They noted that some unlicensed care homes provide good care; however, SMEs and other informants consistently reported substantial concerns about neglect, unmet health needs, unsafe and unsanitary conditions, abuse, financial exploitation, false imprisonment, and moving residents to different care homes across communities and states to evade detection. In fact, these concerns extended across illegally and legally unlicensed homes, and some stakeholders reported these concerns also exist about care being provided in some licensed residential care homes. 3.2.1. Populations in Unlicensed Care Homes Residents of unlicensed care homes are vulnerable adults. The majority of key informants reported that unlicensed care homes primarily, though not exclusively, serve individuals with severe and persistent mental illness. There were reports that while unlicensed homes in some states (such as Maryland) serve elderly and physically disabled residents, many also serve a clientele who once were homeless, persons who may have substance use disorders, and 1 individuals who were formerly incarcerated. Key informants also noted that unlicensed care homes may serve mixed populations within the same home(e.g., elderly residents as well as individuals with severe and persistent mental illness). Interviews with key informants also indicate that many residents are poor and receive Supplemental Security Income (SSI) benefits from the U.S. Social Security Administration (SSA); the SSI program pays benefits to disabled adults and children who have limited income and resources. Several SMEs and key informants noted that individuals who had only SSI to pay for care have few options for housing and care, and often end up in unlicensed care homes. Additionally key informants indicated that many unlicensed care home residents who receive SSI payments participate in Social Security's Representative Payment Program, whereby payments are managed by an individual or organization that is representing the beneficiary because the • beneficiary is unable to manage the payments independently. Several informants reported that it is common for the operator of an unlicensed care home, or representatives designated by the care home operator,to serve as the representative payee for the residents. 3.2.2. Service Provision The vast majority of key informant reports emphasize often alarming conditions in unlicensed care homes. However, several SMEs and key informants noted that some unlicensed care homes are good and provide a clean, safe environment for individuals who might otherwise be homeless. The primary concern expressed about the unlicensed homes that were otherwise safewas that they might not be able to provide the level of care and services needed by the residents (e.g., medication supervision for residents with severe and persistent mental illness). Another concern expressed by some of the individuals interviewed was that even those unlicensed homes that were clean or free of neglect and abuse, commonly have safety hazards and do not meet the fire safety codes required of licensed facilities. Consistent with information from the environmental scan, key informant interviews indicate that some unlicensed homes use basements to house residents, including residents who do not have the capacity to exit safely in the event of a fire or similar emergency, such as those who are unable to climb the stairs and those receiving hospice care. 3.1.3. Health,Safety, and Sanitary Conditions The nature of health and safety concerns described by key informants were wide-ranging and often included neglect and the risk of death to residents. Consistent with findings from the environmental scan, stakeholders (including SMEs and site visit key informants in the three communities we visited)repeatedly raised a variety of concerns about neglect of residents' health care needs and unsafe and unsanitary conditions in unlicensed care homes. Specific concerns included: • Managing resident medications improperly. • Providing unsafe housing conditions, including overcrowding of resident rooms, housing many more residents in bedrooms than is allowed by state licensure regulations, housing residents in storage sheds,basements, and attics that were unsafe, unsanitary, and made egress difficult for frail or disabled residents. • Having buildings that were infested with bedbugs, other insects, and rodents. • Failing to consistently provide running water and electricity, or having unsafe or illegal electrical wiring. • Failing to have safety equipment available, such as smoke detectors and fire extinguishers. • Locking residents in rooms or chaining the doors at night to prevent residents from leaving the facility, which imprisoned residents and placed them at risk in case of fire. • Preventing residents from using the bathrooms after a certain time at night and providing buckets for residents to use rather than toilets. • Locking refrigerators or pantries to limit resident access to food between meals, with some residents being malnourished and dehydrated and one resident breaking into a neighbor's home for food. • Failing to promptly report resident deaths, including more than one instance of leaving a dead body in the facility or back yard. 3.3. Abuse, Neglect, and Financial Exploitation As with health and safety concerns, the environmental scan and interviews conducted with SMEs and key informants revealed myriad concerns about abuse,neglect and financial exploitation. Specific concerns raised by SMEs and site visit informants are highlighted in this section. 3.3.1.Abuse and Neglect Concerns about abuse and neglect were a major topic of discussion during interviews, and they extended across illegally and legally unlicensed homes. Information from interviews with key informants also revealed incidents of emotional and physical abuse, including intimidation, and threats. Cases of physical abuse, such as residents being beaten and burned as described in the environmental scan, were also reported during interviews. Several key informants expressed concern about neglect of the health needs of residents because of too few or inadequately trained staff, particularly in regard to the care of residents who have severe and persistent mental illness and need monitoring of their conditions and reactions to medications. Furthermore, some key informants noted that some unlicensed homes fail to provide or arrange treatment for residents' conditions in order to avoid bringing the attention of authorities. 3.3.2. Financial Exploitation Similar to the information summarized in the environmental scan, interviews with key informants revealed that unlicensed care homes make money off of residents in sophisticated and profitable ways. The following are some examples of financial exploitation depicted during interviews; these examples are discussed at greater detail below: • • Operators of unlicensed care homes collecting the residents' medications and selling the medications on the street for cash. • Operators seizing the residents' food stamps and selling them for cash. • Operators forcing the resident to name the operator as the representative payee for government payments, such as SSI, and controlling the use of that money. Treatment of residents as a commodity was a common theme across interviews. Key informants described instances of operators making money off of vulnerable residents in a variety of ways that involved theft from residents and theft from government programs. For example, SMEs indicated that law enforcement investigators have discovered operators of unlicensed homes with scores of electronic cards for food stamp benefits that belonged to current and former residents. One SME explained that the operators sell the food stamps for cash. In this kind of scam, food stamp benefits are reportedly stolen from residents, who are then provided with little or outdated food, and may subsequently go hungry or beg or steal food from neighbors. Key informants noted that the possibility for theft from residents and from government programs also exits with the practice of operators taking control of residents' monthly income from SSA. According to reports and state-level investigators, many of the residents in unlicensed homes are living on SSI or Social Security Disability Income. Most key informants stated that many unlicensed care home operators receive the income from the SSA directly, either in the name of the resident or by requiring the resident to name the operator or someone else as a representative payee. One SME also noted that some unlicensed care home operators take residents' veteran's benefits. By taking control of the resident's benefits, the operator controls the resident's funds, and should be using those funds for room and board and other beneficiary expenses. However, key informants emphasized that in some cases,the residents become tethered to the operators through financial exploitation and emotional manipulation, and as a result are unable to leave these abusive and exploitative situations. They also noted that, despite receiving payment for room, board, and services, some unlicensed care home operators provide subpar or poor quality accommodations and services to residents. The frequently reported act whereby the operator of an unlicensed home makes money from their control of vulnerable residents and moves these residents from one unlicensed care home to another to avoid detection, led one SME to refer to it as "human trafficking." Currently human trafficking is defined as "the act of recruiting,harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts" (U.S. Department of State, 2015),however, one SME recommended expanding this definition to include the situation in which an administrator for the unlicensed care homes seize and maintain control of vulnerable individuals in order to maximize revenue by taking the public benefits that the individual may be receiving. This key informant also emphasized that unlicensed care home operators tend to work with a network of collaborators who support moving residents between homes to avoid detection by legal authorities, and also help with re-recruiting residents and reopening a care home after an unlicensed care home is closed down. The key informant likened these networked operations to organized crime: "The other thing we are seeing too is that people[operators] are well networked, and within a day or two people are identified and going back, herding them up again...they are well networked so we look at them as organized crime organizations." We heard stories from SMEs and site visit informants of operators recruiting vulnerable individuals from psychiatric wards of hospitals, from acute care hospitals through the hospital discharge planners, from homeless shelters, and directly from the street, similar to those we found in media reports(see Appendix B for details). With regard to recruiting residents from hospitals, we also heard of unlicensed care home operators receiving payments of up to a month's fees from hospitals anxious to discharge the residents to free up hospital beds. One key informant shared a specific example of an operator targeting individuals in hospitals: "Hospitals are putting them on the street. One woman was marketing heavy to the hospitals, and taking them to the licensed facilities, and then moving them to the unlicensed facilities, in result to those types offacilities. That's what they're doing, targeting individuals with cognitive impairment." Further, key informants reported that many operators require residents to surrender all forms of identification "for safe keeping"by the operator. This makes it difficult, if not impossible, for residents to leave the facility, a difficulty sometimes exacerbated by limiting residents' access to their funds, to the facility phone, and, as noted above, by locking residents in their rooms or the facility. We also heard from nearly all state-level informants that some operators routinely shifted residents from one address to another if an APS worker, other advocate, or potential regulator showed up at the facility asking questions. In essence, unlicensed care home operators have several opportunities for gaining almost absolute control over these residents who are physically, cognitively, and financially vulnerable. Moreover, unlicensed care home operators have an opportunity to operate virtually unchecked in terms of seizing control of the residents' government benefits. During interviews, informants talked about situations in which the operators of unlicensed care homes continue to be the representative payee and continue collecting the SSE checks of residents even after the resident moved out of home. We also heard of operators not reporting the death of a resident to SSA so the operator could continue collecting the resident's checks from the government. One key informant described the selling of residents from an unlicensed care facility located in a house. The operator of the facility had recently received and accepted an offer to sell the house, and so was closing down the facility. In preparation for closing, the operator "turned over the residents to other operators for a fee of$100 per resident." 3.4. Strategies for Identifying Legally and Illegally Unlicensed Care Homes One of the points made by key informants is that states have very few, if any, strategies to easily identify unlicensed care homes. Most state licensure offices, county offices, or advocacy agencies use a complaint system to identify unlicensed care homes. This reactive strategy underscores the difficulty states and local agencies have in identifying unlicensed care homes. Almost all SMEs and key informants recommended more proactive strategies to identify unlicensed care homes. These included: (1) tracking individuals'public benefits; (2) obtaining lists of unlicensed care homes from health care and advocacy organizations that refer individuals to them; (3) accessing information from emergency response personnel; and (4) utilizing owners of licensed facilities as a source to identify illegally unlicensed care homes. It is important to note that legally unlicensed care homes are not typically tracked by local community agencies, organizations or states. Most state informants said legally unlicensed care homes did not fall under state regulatory purview, and thus were not monitored (or investigated unless there is a complaint). 3.4.1. Complaint Systems As described by all informants, complaint systems are the most common strategy used for a state or locality to become aware of unlicensed care homes. State licensure offices primarily depend on complaints via phone calls3 that come first to a local county APS or regional licensure or monitoring office. These local and regional offices--as well as ombudsmen and other national, state, and local advocacy groups--receive complaint calls from a variety of sources including residents' family members;members of the general community such as neighbors or other providers; and medical and service providers(e.g., hospital or clinic doctors, nurses, social workers) who interact with residents inside and outside of unlicensed homes. Although these complaint systems are not specifically designed to identify and track unlicensed care homes, some states use the complaint systems in this way. Multiple SMEs stated that licensure offices and agencies like APS are not equipped to track unlicensed care homes. For example, one SME from a state licensure office reported that their database does not include information on whether the call pertains to a licensed or unlicensed care home. One SME from an advocacy organization in Pennsylvania shared that they use an Excel spreadsheet to track illegally unlicensed care homes identified as a result of a complaint. They capture key variables such as the name and any aliases of the illegally unlicensed care home; the owner's name and whether they own more than one unlicensed care home; the licensure status (formerly licensed, never licensed,operating illegally); and any relevant information about the complaint(e.g., investigation dates, or dates any residents were moved/relocated). Other states also track complaint calls as a means for identifying unlicensed care homes. For example, Georgia reported an increase in complaint calls about unlicensed residential care homes from 2013 to 2014. Pennsylvania lists the number of enforcement actions taken against illegally unlicensed residential care homes in their annual report on personal care homes, but this information may not be representative of how many complaints about unlicensed care homes are made(see the state summaries in Appendix A for more details). Notably, reliance on complaints to identify unlicensed care homes limits identification of these homes to those that raise concerns about safety or quality. As noted by one SME, unlicensed care homes that provide good care and a safe environment may intentionally not be brought to the attention of state agencies nor be reported by these agencies when they learn of these homes: "We do receive reports, about 6 months ago someone wrote to me about their mother who was getting care in an unlicensed home...she was getting wonderful care, she wasn't going to report it. I'm not going to report it. She was getting good care and it was something the mother could afford." 3.4.2. Tracking Public Benefits and Representative Payees Many residents in unlicensed care homes receive SSI, and some residents may qualify for waivers to provide long-term care services in HCBS. Multiple SMEs and key informants suggested following or tracking these benefits as a way to identify individuals in unlicensed care homes.Additionally, agencies such as The National Disability Rights Network's Protection and Advocacy Agency(NDRN P&A) could potentially use representative payee data to identify unlicensed care homes. The NDRN P&A reportedly has suggested that SSA require representative payees to self-identify if they own a residential care home (licensed or unlicensed). If the SSA implements this requirement, it could become a potential source for identifying unlicensed care homes. One SME, who works on the Representative Payee Project,4 mentioned that this project only investigates a sample of individuals who are representative payees for 15 or more individuals. The SME noted that this approach misses individuals who are representative payees for fewer than 15 individuals and as such may miss operators of small unlicensed residential care homes. 3.4.3. Referral and Placement Agencies and Discharge Planners Many key informants and SMEs discussed how homeless shelters, advocacy organizations, and churches or other faith-based organizations often serve as a resource to link vulnerable individuals who cannot afford the expense of a licensed care home to unlicensed care homes instead. As such, key informants speculated that these types of organizations may maintain lists of residential care homes. Some SMEs and key informants noted that if lists could be obtained from these organizations, they could then be compared to state licensure lists to determine whether the residential care homes are unlicensed. In addition, hospital discharge planners reportedly work with placement agencies to find housing for patients who cannot return home alone. One key informant in Allegheny County shared a list of seven current placement agencies that likely have registers of illegally unlicensed care homes. Key informants from Georgia and Pennsylvania reported that hospitals and hospital discharge planners (or their contractors) often place patients in unlicensed care homes (described in more detail in Section 4).As such, they could be a key source for learning about currently unlicensed care homes. 3.4.4. First Responders:EMS, Firefighters, and Police Most key informants and SMEs suggested that first responders such as EMS, firefighters,and police are potential sources for identifying unlicensed care homes because they respond to emergency calls received from or about them. Some key informants noted that EMS personnel are a better source than firefighters to learn about unlicensed care homes in a community because EMS personnel respond to all emergency calls while firefighters do not. One SME,who was a firefighter and paramedic who has responded to calls from several unlicensed care homes, stated that he often had more comprehensive listings of unlicensed care homes than the local ombudsman. Interview results indicate that police may also be helpful in identifying unlicensed care homes, but the extent of that help may vary from state to state and across communities within states. For example, key informants in Allegheny County, Pennsylvania, stated that police in rural areas of the county are more responsive to reports of unlicensed care homes than are the city police. Although this might not be the case in other states, in this community it appears that rural police may be more helpful than those in urban areas in identifying unlicensed care homes. 3.4.5. Legally Unlicensed and Licensed Care Home Operators Licensed care home operators were also identified as potential sources for identifying unlicensed care homes. During site visits, key informants reported that owners of licensed care homes often report operators of unlicensed care homes to authorities. SMEs indicated that such reports can be used to identify unlicensed care home operators. Key informants in Pennsylvania speculated that owners of legally unlicensed care homes may have direct experience operating an illegally unlicensed home or know someone operating one, and therefore may be able to help identify unlicensed homes or their operators. 3.5. Strategies for Addressing Issues in Legally and Illegally Unlicensed Care Homes Almost all SMEs and key informants we interviewed offered strategies to identify, monitor, or close unlicensed care homes. Very little discussion centered on improving the quality of unlicensed care homes. Discussions with SMEs and key informants explicitly differentiated between legally and illegally unlicensed care homes only minimally,but the opinion of SMEs and key informants we interviewed seemed to be that state efforts to address legally unlicensed care homes should focus on monitoring and improving quality, whereas state efforts to address illegally unlicensed care homes should be on identifying these homes and shutting them down. One strategy recommended by key informants to address unlicensed care homes is to change the regulations to reduce the number of unlicensed care homes that operate legally.Another strategy is the creation and involvement of interagency and multidisciplinary teams at the state and local levels, which based on our key informant interviewsappears to be a successful strategy. Regulatory changes and the role of multidisciplinary task forces (which are relevant to both legally and illegally unlicensed care homes) are described next, followed by a summary of the strategies discussed during interviews to identify and shut down illegally unlicensed care homes and to monitor and improve quality in legally unlicensed care homes. 3.5.1. Regulatory Licensure Changes Making changes to licensed care home regulations is one example of how states may address unlicensed care homes. Not all states license all residential settings with as few as one resident, as Georgia does; therefore many states, such as Pennsylvania, legally allow some unlicensed care homes to operate. Before 2005, Pennsylvania allowed residential care homes with 1-8 individuals to be legally unlicensed. However, there were many reports of poor conditions in legally unlicensed care homes. In 2005, Pennsylvania changed the regulations so all residential care homes with four or more individuals had to be licensed by the state, but 1-3 bed residential care homes still could be legally unlicensed.Although this regulation reduced the number of legally unlicensed care homes and reduced their capacity to three or fewer residents, many key informants in Pennsylvania noted that this had the unintended consequence of spurring many more illegally unlicensed care homes to open. As a result, Pennsylvania enacted a strategy to address the illegally unlicensed care homes, which included providing the Pennsylvania Bureau of Human Services and Licensure (BHSL) the ability to serve warrants and creating the PCRR team mentioned earlier and discussed in the next section. 3.5.2. Interagency and Multidisciplinary Teams A coordinated, interagency,multidisciplinary effort across state and local agency and organizational levels is an important component to addressing unlicensed care homes. This became evident during discussions with informants in Pennsylvania and Georgia; it has also been reported in the literature, as we found in the environmental scan. In Georgia, informants talked about the Abuse, Neglect and Exploitation Workgroup, which is led by the Georgia Bureau of Investigation and is comprised of individuals from several state, local and federal agencies. The PCRR teams in Pennsylvania are similar, and are based at the local level working in coordination with state licensure offices. Key informants described the way the teams function.A local ombudsman and APS supervisor lead the PCRR team and maintain lists of both known illegally operating homes and those that are potentially illegal operations. Complaint calls are received by each participating agency,therefore the team meets monthly to share complaints about potentially illegal unlicensed care homes. Once an unlicensed care home is identified, the PCRR team works closely with the both the state and regional licensure offices to take the necessary steps to deal with the home. These steps include site visits to suspected illegally unlicensed care homes, during which an ombudsman may inform residents of their rights,APS may conduct abuse or neglect investigations, licensure staff may assess whether the residents should be in a licensed care home based on the level of service needs, and code enforcement staff may determine if the home meets regulatory code requirements. The team works together to track homes they identify as unlicensed and then monitors them until the home is closed. Although a coordinated, multidisciplinary effort appears necessary to comprehensively address unlicensed care homes, several key informants discussed the lack of ombudsman jurisdiction to access residents in unlicensed care homes. State regulations appear to vary widely in regards to ombudsman jurisdiction. In Pennsylvania and Georgia, key informants indicated ombudsmen are permitted to make site visits to unlicensed care homes if complaints are received, although access can be denied by the operator. In contrast, in North Carolina (and other states not included in our site visits) ombudsmen have no authority in or responsibility for residents in unlicensed care homes according to state regulations. One key informant explained how North Carolina regulations restrict ombudsman activity in unlicensed care homes, stating "our structure is pretty clear as far as the accountability," implying that the regulations make ombudsmen unaccountable for residents in unlicensed care homes. Key agencies and team members involved in local or state teams to address unlicensed care homes include APS, ombudsmen, building code enforcement, social workers and first responders such as EMS, police, or firefighters, and other representatives from local advocacy groups such as Disability Rights. Each of these agencies is able to address different elements of the complex situations that exist within unlicensed care homes, including the needs of residents, as well as issues with the building and any criminal acts of the operators. 3.5.3. Education:Statewide or Interagency Key informants from Georgia and Pennsylvania shared examples of efforts to increase awareness of unlicensed care homes through education or marketing for the general public or the agencies they involve in addressing unlicensed care homes. Key informants in Georgia described training sessions to educate law enforcement and first responders about unlicensed care homes. In Pennsylvania informants described a public education campaign including advertisements warning people about placing their loved ones in unlicensed care homes. In addition, the APS staff in Pennsylvania had recent communications with local hospital discharge coordinators informing them about known illegally unlicensed care homes and asking them not to discharge patients to these settings; however, key informants noted that hospital discharge planners continue discharge individuals to known unlicensed care homes. 3.5.4. State Law, Jurisdiction, and Penalties for Illegally Unlicensed Care Homes The enactment of state laws or penalties and fines related to the operation of illegally unlicensed care homes is a strategy that states can use to address illegal unlicensed care homes. Key informants in all three site visit states provided examples of how this might happen. Georgia law changed in 2015, making it a misdemeanor to operate an unlicensed residential care home if abuse, neglect, or exploitation were found to have occurred there. Compared to our other site visit states, Georgia has the harshest law against operators of unlicensed care homes. Pennsylvania's BHSL and the North Carolina Adult Care Licensure Office and Mental Health Licensure Office will offer to work with unlicensed residential care homes to help facilitate licensure. In Pennsylvania, one key informant noted that this assistance is given only to those operators who have opened their first illegally unlicensed care home without realizing they needed to be licensed; assistance is not provided for those who are repeat offenders. Pennsylvania and North Carolina have some similarities in how they address unlicensed care homes. Both states use a penalty system to fine operators for illegal operations. These fines ($50 for a first offense in North Carolina and $500 for a first offense in Pennsylvania)become more severe if criminal activity or a resident's death is involved. One key informant in North Carolina indicated that fines for the operation of unlicensed care homes have little impact on closing the homes, are rarely collected, and are not enforceable by their agency because the operation of an unlicensed care home is considered a criminal offense, and thus under the purview of law enforcement. Informants said that many local sheriffs and District Attorneys are not supportive of following through to enforce penalties, nor do they press charges against the operators. In addition, one key informant stated that penalties for operating unlicensed care homes are similar to only a Class C offense, which is "equivalent to fishing without a license." In contrast, in Pennsylvania, the BHSL has the authority to execute a warrant to investigate a suspected illegally unlicensed care home. While North Carolina's licensure offices do not have this same authority, key informants in North Carolina did note that most unlicensed care home operators allow them entry even without legal authority. Pennsylvania's BHSL is currently working on an amendment to create a graduated fine system for those operators who continue their illegally unlicensed care homes after they have been ordered to cease operations.According to key informants, this graduated fine system is intended to be a "bigger hammer" to stop "belligerent repeat illegal operators." 3.5.5. Monitoring and Improving Quality in Legally Unlicensed Care Homes Some key informants described frustration with the lack of monitoring and lack of jurisdiction by the licensing offices to access or track legally unlicensed care homes. As discussed earlier, Pennsylvania is a state that legally allows unlicensed residential care homes, if they serve three or fewer individuals. Two key informants spoke about the lack of oversight of these homes and the concern for the well-being and safety of their residents. Because these homes are legally unlicensed, the state licensure office has no jurisdiction to monitor them, but APS may receive complaints about them. One key informant from Pennsylvania spoke about the difficulty in handling reports of neglect or abuse in legally unlicensed care homes: "...we will have repeated incidences, or alleged incidences[at legally unlicensed residential care homes] and we don't report to anyone[any agency or the state] either. That makes it difficult for the licensing agencies to understand what's going on because they don't have the information and aren't privy to it." One key informant also emphasized that the limited monitoring of legally unlicensed care homes limits the state's ability to identify and subsequently address any issues of quality or safety in these settings. 3.6. Potential Data Sources or Listings of Unlicensed Care Homes As part of this study,we sought to identify potential data sources or listings of unlicensed care homes that may be useful in efforts to understand how widespread unlicensed care homes might be, and whether these settings can be identified for future research purposes,both in the states we visited and in other states. While no comprehensive nationwide list of unlicensed care homes exists, the environmental scan identified one state (Florida) and one city (Houston, Texas) that maintain listings of unlicensed care homes.Also, Indiana state law requires legally unlicensed assisted living facilities to submit disclosure forms to the Family and Social Services Administration within the Division of Aging; thus, the state may be able to compile a listing of legally unlicensed facilities. However, site visit key informants and SMEs we interviewed were unaware of any such lists of unlicensed homes and could not identify existing methods for tracking them. Although they did not know about exiting listings, several informants suggested potential ways to develop a list of unlicensed care homes. These include tapping into fire/EMS databases to identify addresses of care homes that could be unlicensed, and tracking multiple SSI payments that go to a single representative payee at the same address. Several key informants mentioned that hospital discharge planners sometimes discharge patients to unlicensed care homes (described in more detail in Section 4), and as such they might be a potential source for compiling a list of these homes. As noted in Section 3.4.1, one SME from an advocacy organization in Pennsylvania noted that they log specific information concerning names and dates into an Excel spreadsheet once a complaint has been lodged against an illegally unlicensed care home.The advocacy agency also collects information about whether the operators own more than one unlicensed care home. While this may be a promising source of unlicensed homes only in Allegheny County, Pennsylvania, similar tracking mechanisms may be used or developed for use in other communities as well. 4. POLICY AND PRACTICE IMPLICATIONS SMEs and keyinformants discussed a number of factors that mayhave an effect on the supply of PP Y and demand for unlicensed care homes. They noted that the following may have heightened the demand for unlicensed care homes: • The admission and discharge policies of licensed care homes. • The modest payments made by SSI or State Supplemental Payments to residential care homes, which may be inadequate to cover expenses in licensed facilities. • The closure of large mental health institutions and concomitant transition of previously- institutionalized individuals with severe and persistent mental illness to community-based care settings, such as legally unlicensed care homes. • The financial pressure hospitals feel to free up hospital beds quickly, which sometimes results in discharges to unlicensed care homes,both intentionally and unintentionally. Each of these factors is discussed in more detail in the sections that follow. 4.1. Licensed Care Home Admission and Discharge Policies Some SMEs noted that many licensed facilities are unwilling to admit or retain individuals with severe and persistent mental illness, intellectual disabilities, or challenging behaviors. Indeed, results from the National Survey of Residential Care Facilities indicate that only 40% of licensed RCFs admit individuals with behavior problems, and just 55% admit individuals with moderate to severe cognitive impairment(Greene et al., 2013). For many such individuals, their only options may be unlicensed facilities or homelessness. SMEs also discussed the fact that some residents are involuntarily discharged from licensed care homes when they exhaust their funds. If ombudsmen become aware of such discharges,they will likely attempt to assist individuals or their families to find licensed options, but they can only provide aid if they are notified.Absent assistance from the ombudsman or other support in • finding affordable licensed care options, unlicensed care homes may be the only option these individuals have. 4.2. Modest Public Benefits • SMEs and key informants consistently noted that many low-income individuals cannot afford licensed facilities, which makes the less expensive unlicensed care home an attractive option, and thus contributes to the existence of unlicensed care homes.As noted in earlier sections, many unlicensed care home residents receive federal SSI benefits, and many unlicensed care homes receive these benefits directly through the SSI representative payee program. However, SSI payments are low, and most states supplement these payments with a State Supplementary Payment(SSP). Currently, 46 states provide some type of SSP (SSA, 2015). However, a few states (such as Georgia and Texas) provide those supplements only to residents in residential care homes certified to offer services covered by Medicaid. The payments also vary considerably from state to state, and are quite modest in some states (e.g., from $46 to$100 per month). Incentives this modest provide little encouragement for residential care homes to incur the cost of licensure if their primary clientele has only SSI to pay for care. SMEs mentioned the lack of SSPs to residential care home residents who receive SSI as a factor that encourages the existence of unlicensed care homes. 4.3. Closing Institutions Multiple key informants discussed the impact that policy changes regarding community-based care have had on unlicensed care homes in their communities, including state efforts to comply with the Americans with Disabilities Act(ADA) requirements. For example, in Allegheny County, Pennsylvania, informants noted that the closure of Mayview Psychiatric Hospital in 2008 resulted in the displacement of persons with mental illness. One key informant estimated this hospital served 3,700 patients at its peak.Although the residents who were moved out of this hospital may have been relocated to licensed facilities when the hospital closed, the fact that such institutional settings are no longer an available option may have encouraged unlicensed care homes to open. Indeed, several key informants in Allegheny County reported that the closure of Mayview Psychiatric Hospital led to an increase in the prevalence of illegally unlicensed care homes in the county. Several SMEs also noted inadequate funding and housing options for persons with severe and persistent mental illness or intellectual disabilities who have been moved out of state facilities may contribute to demand for unlicensed care homes, because these individuals may not be able to afford the cost of a licensed care home. 4.4. Hospital Discharge Several key informants discussed the role hospitals and hospital discharge planners potentially play in referring patients to unlicensed care homes. Hospitals and hospital discharge planners are responsible-for the safe discharge of individuals into the community, but some hospitals may have policies that incentivize the discharge of individuals to unlicensed care homes. Many key informants and SMEs suggested that discharge planners face difficulty placing residents in licensed care homes because these homes often do not accept patients who only have SSI (or otherwise have little money), and they often will not accept individuals with a history of mental illness, substance abuse, or those who are homeless. Unlicensed care homes commonly will accept these individuals and many market themselves to discharge planners. Key informants in two states confirmed that some hospitals there contract with placement agencies that, in turn, place individuals in unlicensed care homes,particularly individuals with limited resources and mental health issues.As described earlier, some of our key informants noted that hospital discharge planners knowingly discharge these individuals to unlicensed care homes to alleviate the immense pressure they are under to facilitate quick patient turnover, and some hospitals reportedly will pay unlicensed care homes to admit these individuals. In Allegheny County, key informants said that some hospitals use placement agencies to assist with difficult discharges (e.g., persons with severe or persistent mental illness, the homeless, or persons with little money). In Georgia, key informants also noted that hospitals directly discharge individuals to unlicensed care homes and some pay the first month of the resident's fees.As one informant in Georgia reported, "the hospital will say 'this is an expensive bed, you need to get [the patient] out.'The latest thing with hospitals, not only discharging to substandard places, the hospital is paying for the first month because it's cheaper than an expensive hospital bed." 5. LIMITATIONS, CONCLUSIONS AND POLICY IMPLICATIONS Based on the findings from this exploratory study, illegally unlicensed care homes appear to be a problem for at least some states; the residents of these homes are extremely vulnerable, and while some are elderly and physically disabled, many have severe and persistent mental illness.Abuse, neglect, and financial exploitation of these vulnerable residents appear common. While we visited only three communities, the concerns articulated by the case study respondents were echoed by SMEs from other areas of the country and are consistent with the literature and media reports in the environmental scan. These preliminary findings are worth considering as policy makers implement federal, state, and local policies and practices that may relate to unlicensed care homes. Although exploratory in nature, these findings point toward concerning issues with unlicensed care homes as well as gaps in our knowledge, and have important implications for future research on unlicensed care homes. 5.1. Study Limitations We relied on a targeted literature review, interviews with a small number of SMEs, and site visits to just three communities, all of which limit the scope of our findings.Also, the information gathered during informant interviews about unlicensed homes primarily painted a negative picture of these places. Newspaper and media reports generally focus on what they view as the dramatic; the positive aspects of unlicensed care homes are often omitted from these reports. Similarly,APS and ombudsmen staff receive complaints about quality, violations of resident rights, and allegations of abuse. Indeed, many key informants emphasized that they only knew about unlicensed care homes because of complaints being made about them. Thus, although our findings consistently highlight concerns about safety and quality, we cannot assess the generalizability of these findings and concerns, and our findings only minimally address unlicensed care homes that are safe and provide quality care.Additionally, what we heard about the policies that affect demand for and supply of unlicensed homes, and how unlicensed homes can be identified or detected, may not be representative of the situation in other states. Findings from this study are necessarily limited by the number of experts we identified and states we visited.Also, new HHS Centers for Medicare and Medicaid Services (CMS) policies on waivers and where waiver services may be provided may alter the prevalence of legally and illegally unlicensed care homes across the nation. Finally, as noted in the report, many individuals seek care in unlicensed care homes because they are in other undesirable situations, such as experiencing chronic homelessness or unnecessarily institutionalized. It was outside the scope of this project to examine the alternatives to unlicensed care homes or the health, safety or appropriateness of those environments. 5.2. Conditions in Unlicensed Care Homes Much of the information we gathered from the environmental scan, from SME interviews, and from site visit informants raises concerns about the conditions experienced by residents in unlicensed residential care homes. Although there were some reports of clean and safe unlicensed homes, the negative findings about conditions were predominant.Additionally, several SMEs and key informants noted that in many cases unlicensed homes are the only option, other than homeless shelters or living on the streets, for some of these residents. Findings also indicate that conditions in some unlicensed care homes are unsafe, abusive, financially exploitative, and neglectful of residents'basic needs. Further, in site visits and the literature, we found reports of situations that were repeatedly depicted as involving activity that was similar to "human trafficking" and "false imprisonment" of vulnerable individuals. In addition, the reports of financial abuse also may represent considerable financial fraud of federal programs including SSI, food stamps, and the programs paying for resident medications (i.e., Medicare and Medicaid). These findings highlight a set of potentially serious problems and issues. First, there is a lack of information about the effect of various state and national policies on the vulnerable individuals the policies were designed to protect and whose well-being they were intended to enhance. Second, the findings highlight the need for federal and state agencies to determine the nature and scope of financial fraud being committed by operators of unlicensed residential care homes. Third, the findings suggest it is important to determine the nature and scope of abuse neglect and unsafe conditions experienced by people who have low incomes and physical and intellectual or cognitive disabilities. Fourth, study findings also suggest that efforts are needed to understand the differences in conditions between legally and illegally unlicensed care homes, as well as how illegally unlicensed care homes successfully evade licensure. A wide range of specific concerns about unlicensed care homes were identified in this study, including improper management of residents'medications; unsafe, unsanitary, and inadequate living environments; failure to adequately feed residents; and monetary theft of benefits. Given these diverse concerns, SMEs and site visits interviewees suggested that coordinated efforts across a range of stakeholders, including state licensure agencies, ombudsmen,APS,law enforcement, and others may be necessary to address unlicensed care homes.At least two states have demonstrated that coordinated efforts can effect changes to laws and policies and create at least initial disincentives or barriers to the operation of illegally unlicensed care homes. 5.3. Strategies for Identifying Unlicensed Care Homes Although a substantial amount of information and suggestions about methods of identifying unlicensed care homes came from site visits to communities in three states (Pennsylvania,North Carolina, and Georgia), whether any of these strategies will apply to other states or other communities is unclear. Further, receipt of a complaint was the most commonly cited method to spur identification of an unlicensed care home. However,this likely is not a viable method for detecting the population of illegally unlicensed residential care homes. Thus, one implication of the study is that it may be worthwhile in one or more states or communities to test and evaluate other methods of detecting illegally unlicensed care homes. Finally, in some states, SMEs and the environmental scan identified legally and illegally unlicensed residential care homes that were referred to as boarding homes or board and care homes. Some of these housed mainly older residents. One issue that remains to be determined is the conditions or criteria by which such places constitute "unlicensed residential care homes." For example, is it defined by the services the home offers, the services needed by residents, or the services provided to the residents in the unlicensed care setting. Clarifying this definition will be critical to understand the prevalence of unlicensed residential care homes, as well as the characteristics of residents in these homes. 5.4. Strategies for Addressing Conditions in Unlicensed Care Homes As noted, we found the prevalence of legally and illegally unlicensed residential care homes varies by state. One of the SMEs shared comments from ombudsmen that the numbers of unlicensed homes in some states are increasing, while in other states, they reported that they had not heard about unlicensed care homes. Further, some of the ombudsmen reported that if an unlicensed home was providing good care, they did not report it to the licensure agency. Thus, we lack information about unlicensed care homes in moststates, and even in our study states there were no reliable counts of illegal unlicensed care homes. Despite this lack of information about prevalence, we heard about many strategies for addressing the existence of unlicensed care homes and the conditions in them. States have a variety of options for reducing the prevalence of both legally and illegally unlicensed residential care homes, such as changing regulations and coordinating across agencies to address these homes. We also heard suggestions from some SMEs and state stakeholders for improving safety and quality. However, the effectiveness of these strategies in monitoring or otherwise addressing the prevalence of unlicensed care homes is unknown. SMEs and key informants also noted that states varied in their licensure laws and their ability to enter and investigate unlicensed care homes without a warrant issued by a judge. One of our study states made it a crime to operate an illegally unlicensed residential care home, and some states have the capacity to penalize unlicensed care homes with monetary fines. None of these approaches or strategies completely addresses the concern about providing a safe environment and quality services to the vulnerable individuals being served in unlicensed care homes. Demographic trends are placing an increasing number of older persons at-risk for needing • residential long-term care, but many of these same individuals have out-lived their savings or had low incomes to start. Further, implementation of the Olmstead decision has increased the demand for residential long-term care settings and services. While it is outside the scope of this project to investigate alternatives to unlicensed care homes, we speculate that increasing the supply of alternatives for affordable housing with services would reduce the market for unlicensed homes. 5.5. Implications for Policy Findings indicate that a variety of policies may have an impact on the supply of and demand for unlicensed care homes. For example, some states have adopted policies including licensure regulations that allow legally unlicensed care homes to operate. In some instances, these places may be certified or otherwise listed at a local level, but they may not be monitored by the state for quality and safety issues.As such, limited information is available about the quality of care and services provided in legally unlicensed care homes. States with concerns about the prevalence of unlicensed care homes may wish to examine their licensure regulations, as these may influence the supply of and demand for unlicensed care homes, either because the complexity of some regulations makes them hard for operators to understand, or because they might contain loopholes that operators can easily exploit. States with concerns about quality and safety in unlicensed care homes may also wish to examine their requirements for monitoring legally unlicensed care homes and the information available about safety and quality in these places. Many low-income individuals cannot afford the cost of licensed residential care homes, and some residents exhaust their private funds in licensed facilities and are discharged with no options other than lower cost care homes,some of which may be unlicensed. Furthermore, many licensed facilities are unwilling to admit or retain individuals with challenging behaviors. For many of these individuals, their only option may be unlicensed facilities. States with concerns about vulnerable adults' access to housing with services may wish to examine their admission and discharge requirements for licensed care homes. These findings suggest that as states continue to move toward serving more of their Medicaid beneficiaries in the community rather than in institutions, consideration should be given to ensure appropriate safeguards are in place for these beneficiaries.As states are working to meet their ADA obligations as reaffirmed in Olmstead vs. L.C., they may need to pay particular attention to ensuring the availability of sufficient and affordable licensed care homes or other supportive housing options that offer person-centered care in a safe and appropriate environment. 6. RECOMMENDATIONS FOR FUTURE RESEARCH The information collected as part of this exploratory study was intended to provide a foundation for a more complete understanding about unlicensed care homes and the gaps these homes might fill as housing options for persons with low incomes. While the information herein is not generalizable--it is based on a targeted scan and a limited number of interviews--it does highlight the fact that unlicensed care homes appear to be a problem in at least some states. However, gaps in our knowledge about unlicensed homes remain, and several issues raisedduring interviews with key informants warrant further investigation. The following section presents individual research topics and identifies the related questions that might guide future research on unlicensed residential care homes. 6.1. Legally Unlicensed Residential Care Homes As noted in Section 4.1, states use a variety of definitions or criteria that allow some homes to operate legally without a license. In addition, SMEs noted variability across states in the availability of resident advocacy and protection through such agencies as the ombudsman program. However, while SMEs reported variability in licensure requirements and the authority, responsibility and funding of ombudsmen agencies with respect to unlicensed homes, there is very little information available about legally unlicensed homes, including the characteristics of residents, their care and service needs, and their preferences. There is no systematic information about the actual nature or range of conditions in legally unlicensed homes (e.g., safety, quality of care, issues of abuse and neglect), or provision of services and care through Medicare or Medicaid home health, private attendants, or HCBS waivers. These are important issues since they affect many vulnerable adults who have physical, intellectual, or cognitive disabilities. Moreover, the 1976 Keys Amendment to the Social Security Act requires states to assure that SSI recipients do not reside in substandard facilities, and states must annually certify that this is true. Research about legally unlicensed care homes might focus on collecting information about characteristics of legally unlicensed care homes, the services they offer and the residents they serve, such as through a larger number of site visits and interviews with ombudsmen and state regulatory agencies or through a survey of the operators of legally unlicensed homes in states or areas that maintain lists of these homes, such as Florida, Georgia and Texas. This research might also address whether the Keys Amendment is achieving its goal of protecting the well-being of SSI recipients. 6.2. Illegally Unlicensed Residential Care Homes Although we heard about a range of conditions in illegally unlicensed homes, including neglect, abuse, and financial exploitation, it is unclear whether this is the norm or whether the findings are skewed because of the types of key informants we interviewed. Informants did note that while some places are bad, some unlicensed care homes may be fairly decent. Given the types of key informants interviewed for this study, and the limited viewpoints captured, more information is needed to understand the characteristics of unlicensed care homes and the residents they serve. One way to collect this information to develop a frame of unlicensed care homes and conduct a small scale study of unlicensed care home operators. It is worth noting that this research activity would require developing an operational definition of"unlicensed residential care home," since definitions vary considerably across and sometimes within states, as some focus on services offered, some on size, and some on the characteristics of the residents. 6.3. Financial Exploitation, Abuse of Residents' Rights, and Program Fraud in Unlicensed Residential Care Homes It is important to note that we do not know whether the types of financial exploitation and abuse described by the SMEs and key informants occur in both legally and illegally unlicensed care homes, or how commonplace they are. However, these are issues that warrant additional research. The issue of financial exploitation is described in detail in Section 3.3.2. Operators often gain control of residents' funds by becoming the representative payee for residents receiving SSI, a common payer source in unlicensed residential care homes. Even with relatively low payment rates, operators can make profits by cutting corners in housing and services and trafficking in the federal benefits they seize from residents. Some trawl for residents, picking residents up off the street, from homeless shelters, and from hospitals, and routinely shift residents from one facility to another in order to keep their occupancy rates high. In addition, investigations by Georgia law enforcement officials indicated that there is considerable fraud with respect to SSI, Social Security, residents' personal needs allowances, Medicare and Medicaid, and the food stamp program. Such practices violate residents' rights, and the profit-enhancing practices of the operators, such. as limiting the availability of food, water, and other basic needs, endanger residents' lives and well-being. It is important to learn if such abuses and frauds are limited to a small number of communities or if they are more widespread. 6.4. Other Research Ideas Suggested by Subject Matter Experts or Individuals Interviewed in State Site Visits Additional potential research questions or issues were raised by one or more SMEs or arose from our state site visits or the environmental scan. Some of these ideas may be relevant for agencies other than or in addition to ASPE, such as the National Institute of Justice, CMS, or ACL. • Resident Case Mix. Many SMEs reported that persons with severe and persistent mental illness are the majority of residents in unlicensed residential care homes. However, some SMEs and key informants also noted that many of these individuals with psychiatric conditions are older,having aged in state institutions, and that persons 65 years of age and older who receive SSI payments also often live in unlicensed care homes. Some SMEs suggested that state policies affect the mix of residents in unlicensed care homes. Other SMEs reported that efforts to discharge or divert residents from nursing facilities to community-based settings led to greater use of licensed RCFs and noted instances in which residents who exhausted their private funds might have no options other than unlicensed residential care homes. Thus, future research might be warranted to determine the characteristics of residents in unlicensed care homes and whether they differ across legally and illegally unlicensed homes. Research could also examine whether and how federal or state policies might affect the resident mix in unlicensed care homes. • Ombudsmen.As noted, the responsibility and authority of ombudsmen in unlicensed care homes--even in terms of receiving and acting on complaints--varies from state to state. In addition, states differ in whether they provide additional funds to the ombudsman program, over and above the federal funds from the Older Americans Act. Future research could be conducted to describe the nature of ombudsman involvement in unlicensed care homes and how it differs across states. It might also determine which states provide additional state funding to the ombudsman program, and whether the level of available resources is a limitation on ombudsman involvement in unlicensed care homes. • Abuse and Neglect. Instances or allegations of physical and psychological abuse and neglect of residents were reported by SMEs and key informants and highlighted in the environmental scan.Although such issues are not restricted to unlicensed care homes, as they are known to occur in licensed care facilities as well, future research might examine and describe the mechanisms states use to detect, investigate, and resolve allegations of abuse or neglect in unlicensed residential care homes and how they compare to the mechanisms used to identify and resolve instances of abuse and neglect in licensed care homes. REFERENCES Assisted Living Facilities in Indianapolis, Indiana. (n.d.).Retrieved from http://www.agiingavenues.com/topics/ass isted-living-facil ities-in-indianapol.is-indiana. Barry, R., Sallah, M., & Miller, C. (2011). Neglected to death, part 1: Once pride of Florida; now scenes of neglect.Miami Herald. Retrieved from http://www.miamiherald.com. Carder, P., O'Keeffe, J., &O'Keeffe, C. (2015). Compendium of residential care and assisted living regulations and policy, 2015 edition.Prepared for U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.Available at hops://aspe.hhs gov/basic-report/compendium-residential-care-and-assisted-livuig-regulations- and-policy-2015-editunn. Centers for Medicare and Medicaid Services. (n.d.).Regulatory requirements for home and community-based settings. Retrieved August 6, 2015 from http://www.medicaid gov/m,edicaid- chip=program-information/by-topics/long-term-services-and-supports/home-and-community_ based-services/downloads/requirements-for-home-and-community-settings.p . Figueroa,L. (2011). Neglected to death, part 3: Inspectors find violations at Lauderhill ALFs. Miami Herald. Retrieved from http://www.miamiherald.com. Georgia Association of Chiefs of Police Ad I-Ioc Committee on At-Risk Adult Abuse, Neglect and Exploitation. (2013).At risk adult abuse, neglect and exploitation in Georgia: Review and recommendations. Retrieved from http://www.gachi.efs.com/pdfs/White%20Papers_Committee%20Reports/AtRiskAdultAbuse Whit ePaper.pdf. Greene,A.M., Wiener, J.M., Khatutsky, G., Johnson, R., & O'Keeffe, J. (2013).Medicaid in residential care. Retrieved from httgs;[/ pe.hhs,gov/report/medicaid-residential-care. Hancock, L. (2007).Troubled residents languish in flophouses.Dallas Morning News. Retrieved from http://www.dallasmorningnews.com. Hawes, C. &Kimbell,A.M. (2010).Detecting, investigating and addressing elder abuse in residential long-term care facilities. Monograph for the National Institute of Justice, U.S. Department of Justice.Available at http://www,ncj ,g pdffiles1/nij/grants/229299.pdf. Health Management Associates. (2009).Report on Texas boarding houses. Submitted to the Governor and the Texas Legislature and the Texas Health and Human Services Commission. Austin, Texas. Pennsylvania Department of Public Welfare. (2011).Adult residential licensing, 2010 annual report:A report on licensed personal care homes. Retrieved from rttp://www.dhs.state,pa.us/cs/groups/webcontent/documents/report/p_01101.5.pdf. Pennsylvania Department of Public Welfare. (2012).Pennsylvania DPW highlights safety and care regulations at personal care homes. Press Release.Retrieved from hgp://www.bizjournals.com/prnewswire/press_releases/2012/04/17/DC88926. Pennsylvania Health Law Project and North Penn Legal Services. (2007).Personal care homes in Pennsylvania:A guide for advocates. Retrieved from http://www.phlp.org/wp. content/uploads/2011/03/PCII_manual-for-advocates-Feb-20071.pdf. Perkins, M., Ball, M., Whittington,F., & Combs, B. (2004). Managing the care needs of low- income board-and-care home residents:A process of negotiating risks. Qualitative Health Research, 14(4), 478-495. Sallah, M., Miller. C., &Bany, R. (2011).Neglected to death,part 2:Assisted-living facility caretakers unpunished: 'There's a lack of justice.'Miami Herald. Retrieved from http://www.miamiherald.com. Savchuk,K. (2013). Troubled Group Homes Escape State Scrutiny.Miami Herald. Retrieved from http://www.miamiherald.com. Schneider, C., & Simmons,A. (2012a). Lax enforcement in personal care homes.Atlanta Journal-Constitution. Retrieved from bttp;//www,ajc.com. Schneider, C., & Simmons,A. (2012b). Perils in personal care homes.Atlanta Journal- Constitution. Retrieved from h�tp://www.ajc.com. Schneider, C., & Simmons,A. (2012c). Unlicensed homes to face more state scrutiny.Atlanta Journal-Constitution. Retrieved from http://www.ajc.com. Social Security Administration. (n.d.). Understanding Supplemental Security Income SSI benefits, 2015 edition. Retrieved from htlps://www.secialsecurity,gov/ssi/text-benefits-ussi,htm. Spencer, D., &Mimica,L. (2014). "Caretaker"Accused of Abusing and Neglecting Mentally Challenged Victims.NBC News 4,Washington D.C. Retrieved from http://www.nbcwashington.com/news/local/Caretaker-Accused-ofAbusing-and-Neglecting- Kamara-Zanaib-268343912,html. Texas Department of Aging and Disability Services. (2015).Assisted living provider resources: Unlicensed facilities. Retrieved from http://www.dads.state.tx.us/providers/alf/howto.html. Texas Legislative Budget Board. (2009). Fiscal note, 81st legislative regular session. Estimate of 2-year cost of implementing HB216. Tobia, M. (2014).Personal board and care homes:A hidden population in Anne Arundel County. Anne Arundel County Fire Department,Millersville,Maryland U.S. Department of State, Office of the Under Secretary for Civilian Security, Democracy and Human Rights. (2015). Trafficking in persons report. Retrieved from blip://www.state.gov/documents/organization/245365.pdf. APPENDIX A. STATE SUMMARIES A.1. Georgia Site Selection Georgia was selected as a state for our site visit because of the state's actions surrounding unlicensed care homes described during interviews with SMEs, and the numerous news reports about unlicensed care homes in the state. In the past l5 years,the issues surrounding unlicensed personal care homes in the state have become more prominent, and coordinated action across several agencies has been taken to address them. The state has started training sessions to educate law enforcement and first responders about unlicensed care homes, and these education efforts may contribute to the state's ability to identify unlicensed personal care homes. Key Informants The research team interviewed 12 key informants in Georgia. Key informants included representatives from several agencies, including the state Healthcare Facility Regulation (HFR) and APS offices, local fire departments, local and state law enforcement and ombudsmen, and a church-affiliated provider of day services used by individuals who live in unlicensed care homes. State Regulations Facilities providing or arranging for housing, food service, and one or more personal services for two or more unrelated adults must be licensed by the state as a personal care home. Licensed personal care homes are required to assist with personal services, supervise self-administration of medication, and provide social activities, as needed.A facility that advertises or represents via verbal communication that it provides personal assistance is required to make personal services available to its residents. In other types of residential care, if the care is arranged or managed by the owner, manager, or staff of the building, home, or community, then the facility must be licensed. Provision of housing plus one or more personal services requires a personal care home (or other licensed facility) permit.At least one administrator, on-site manager, or responsible person must be on duty 24 hours per day, seven days a week, and all staff must be trained as personal care workers within 60 days of hire. In addition to serving the elderly, personal care homes can exclusively serve persons with serious mental illness and/or intellectual and developmental disabilities, on condition that the home is appropriately staffed and is capable of providing the needed care within the scope of its license. With the passage of a new law in July 2012, it is a misdemeanor to operate an unlicensed personal care home, and if an unlicensed care home is linked to abuse, neglect, or exploitation, the violation is considered a misdemeanor. Along with funding to cover relocation of residents, this legislation empowers state and local multidisciplinary teams to collaboratively plan and coordinate efforts to identify, investigate, and pursue any necessary regulatory enforcement or legal action against unlicensed facilities. Local Context In Georgia, all unlicensed personal care homes are illegal, and thus to remain in operation they try to avoid being identified. Discussions with key informants in the state suggest Georgia has a high prevalence of these homes. This is evidenced by the number of reports and complaints received about unlicensed personal care homes, the number of hours spent by law enforcement officials on investigating unlicensed personal care homes, and the estimates given of the numbers of unlicensed care homes that are operating in the state (reported by one informant as one unlicensed care home for every licensed home). Based on the collective feedback of a diverse group of key informants, unlicensed personal care homes appear to be prevalent and problematic in the state. Of the approximately 1,400 complaints received by APS each year, an estimated 20% pertain to unlicensed personal care homes.APS professionals there estimate three reports or complaints about unlicensed personal care homes every month in the metro Atlanta area, and about one complaint or report about unlicensed personal care homes every three months in rural areas of the state. One interviewee,who interacts with residents of unlicensed care homes on a daily basis, estimated that for every licensed personal care home in Georgia there is one unlicensed care home. Several examples of unlicensed personal care homes were described by key informants during the site visit. Most commonly, interviewees depicted unlicensed personal care homes operating in residential areas within single family houses that are rented by the unlicensed care home operator, but some interviewees described unlicensed care homes operating in a variety of other structures (e.g., closed churches and schools). Notably, most key informants said the operator of a licensed home may also operate one or more unlicensed homes, often in the same neighborhood and often in collaboration with friends or family members. One example, described by multiple key informants, looked like a nice physical environment and was affiliated with a local church, but the operator of the home was taking the residents' money while abusing, imprisoning, and exploiting them. This home initially drew the attention of the authorities because of a sexual assault case in which one of the residents was raped by a sex offender. Other issues were identified during the subsequent sexual assault investigation, including abuse at the hands of the operator who beat the residents, false imprisonment in which individuals were locked inside rooms, and financial exploitation.According to several key informants in the state, including APS and law enforcement officials, the property, which they referred to as a boarding home, was being rented by the operator, members of the church served as the representative payees for the residents, and the money was then pooled together and given to the operator. They described this as an example of operators running unlicensed care homes strictly for the money. One key informant reported that during the investigation of this home, it also was discovered that the operator was taking the residents' food stamps. One of the key informants, who operatesa day program that serves many individuals who are residents of unlicensed care homes, also described the 20 year history surrounding the operation of unlicensed care homes. State and local funding that was designated for clean-up activities in preparation for the 1996 Summer Olympic Games in Atlanta was used to encourage homeless individuals (often with mental illness) to leave the city. According to the key informant, these individuals were given one-way bus tickets out of the city under the stipulation that they never return. Those individuals who remained in the city were placed in day programs. Following the Olympics, funding for these day programs was not renewed, and all but one of these programs ceased operations. Presumably, this led to an increase in need for LTSS for these populations. More recently within the City of Atlanta, the gentrification of some neighborhoods has resulted in increased property values and rents, which has caused some unlicensed care home operations to relocate to less expensive areas. Thus, unlicensed care homes close and leave one area of the city, but reopen in another area, contributing to the difficulty of identifying and permanently shutting down these places, while also disrupting the residents' access to day services and other community-based sources of support nearby the original care home location. In the past few years, Georgia has developed an interagency task force including law enforcement and social services agencies which has trained and prepared many staff to deal with these homes. This task force has also coordinated raids on unlicensed homes and has pushed for changes to laws regarding these homes. In August 2013, the law to prosecute an unlicensed personal care home operator was used for the first time. State and Local Policies Related to the Supply of and Demand for Unlicensed Care Homes According to one key informant in the state, moving individuals from institutions for mental illness with an inadequate plan for housing these individuals has contributed to an increase in the numbers of people available for unlicensed personal care homes to serve, thus motivating the opening of unlicensed care homes. In many cases, the cost of care in other settings is too high for what individuals with severe and persistent mental illness can able to afford on their SSI stipend. State policies do not require hospital discharge planners to discharge patients to licensed care homes, thus permitting discharge to unlicensed care homes. Individuals who are poor, experiencing homelessness, or individuals with a mental illness who cannot return home orhave no home to return to after being discharged from the hospital are a source of clients for unlicensed care homes. Several key informants reported that unlicensed care home operators "troll" the psychiatric wards of facilities like Grady Memorial Hospital, looking for residents. Hospital discharge planners are not required to check the licensure status of the place to which they are discharging patients, and often discharge them to unlicensed homes. According to many of the key informants interviewed, hospitals are increasingly under financial pressure to discharge patients to free up beds, which is believed to contribute to the ability of unlicensed care homes to fill beds and stay in business. Thus, unlicensed care home operators are known to directly market themselves to hospitals and to pick up patients at the hospitals when they are discharged, and some hospitals have been known to pay a month of the residents' fees at the unlicensed home to secure a quick discharge from the hospital. However, the long-term placement of individuals after discharge to an unlicensed care home may be unstable, and no follow-up by the hospital with the patient after placement was described. Motivations to Be Unlicensed As described by the majority of key informants, the primary motivation to maintain an unlicensed care home is to maximize profit. Obtaining licensure would require operators to pay the costs of additional and qualified staff and service provision. In the view of the majority of key informants, the operators of unlicensed homes do not want to have to pay for more staff to provide needed services. The inability or unwillingness to provide appropriate care for residents at an affordable cost also was noted by key informants as a motivator to not pursue licensure. Ultimately, several key informants acknowledged and emphasized that remaining unlicensed is lucrative if the care home operator successfully avoids detection by the authorities. Characteristics of Residents and Unlicensed Care Homes Findings from the interviews suggest that the majority of unlicensed care home residents in the metro Atlanta area have severe and persistent mental illness and are highly vulnerable to exploitation. One key informant noted that residents of unlicensed care homes commonly require assistance with activities of daily living (ADLs), such as getting dressed, as well as assistance with instrumental activities of daily living (IADLs), such as taking medications and managing and accessing transportation to medical appointments. In addition to the church-affiliated home described above, examples of the types of places where unlicensed homes operate included an old elementary school as well as single family homes in residential neighborhoods.Although the majority of key informants described unlicensed care homes as unsafe environments where residents are abused, neglected, or exploited, it also was noted that some unlicensed care homes may provide quality care in safe and clean environments. Health and Safety Concerns Health and safety concerns for residents were a major topic of interview discussion. Concerns expressed across several interviews included providers locking residents in rooms; locking food away so that it is inaccessible to residents; using basements to house individuals, including individuals who are unable to climb the stairs and those on hospice; providing accommodations that are unclean, infested with bedbugs, and lack heat, air conditioning or running water. In addition, one key informant indicated that operators of unlicensed care homes have illegally obtained electrical service utilities through covert connections with neighboring homes. The Scope of Abuse and Exploitation Concerns Interview results indicate that the majority of unlicensed care homes investigated by state officials and local APS agencies involve situations in which residents are not being cared for properly. The majority of examples of mistreatment included resident physical and emotional abuse, neglect, or financial exploitation. In multiple interviews, unlicensed care home operators were described as being involved in human trafficking, and also were specifically noted by APS and law enforcement officials to traffic residents across state lines, specifically into Florida and Alabama, to avoid legal action in Georgia.A core pattern of exploitation described in interviews included the operator of unlicensed homes finding vulnerable individuals who need housing and supportive services (such as from hospitals or homeless shelters), requiring these individuals to transfer their SSI payments to the operator or one of the operator's agents in order to become a resident of the unlicensed care home, severely limiting the residents' ability to leave the facility, and relocating the residents to alternate locations to avoid detection. Unlicensed care home operators also were described as sometimes having select residents act in a role of authority over other residents, such as beating the other residents to control their behaviors. One key informant described a recent(2015) case of human trafficking in which a care home operator who was closing a home was explicitly selling residents for$100 each to other personal care home operators. Interviewees noted that unlicensed care home operators often take the residents' identification cards and personal paperwork upon admission. This was described as limiting the capacity of the resident to relocate. If the homes are closed and the residents' identification cards and personal paperwork are not able to be retrieved, this poses challenges for residents to get SSI payments and medications.Although recognized as important, the state has not yet begun investigating cases of financial exploitation. To reduce abuse, several informants indicated that state officials should target closing unlicensed care homes. Strategies to Identify Unlicensed Care Homes Currently at the state level, the primary strategy used in Georgia to identify unlicensed care homes is through complaints, including complaints from neighbors, residents, residents' family members, and hospitals serving residents of unlicensed care homes. These complaints may be made to the police,APS, ombudsmen, and the Department of Community Health,HFR Division. Key informants in metro Atlanta also indicate that the state conducts interviews with residents during investigations and closures of unlicensed home to gain a better understanding of how individuals end up in these homes.According to findings from these interviews, there are a few different pathways into unlicensed care homes, including unlicensed homes receiving residents directly from hospital discharges, representatives of unlicensed homes picking up residents from homeless shelters, and owners of licensed facilities taking residents to unlicensed homes. Given their direct linkage to unlicensed care homes, these three sources (hospitals, homeless shelters, and licensed personal care homes) are potential sources of information for identifying unlicensed care homes. Strategies to Address Unlicensed Care Homes To address the issues surrounding quality and safety in unlicensed care homes, key informants described a process involving the investigation of complaints by visiting the home and interviewing residents and staff(which may necessitate getting an inspection warrant if denied entry upon arrival), then providing a written cease and desist letter if the investigation results indicate that the home should be licensed, issuing fines of$100 per day per resident, and prosecuting the operator. The main goal of these efforts is to shut down facilities where residents are financially exploited, abused, neglected, or subject to unsanitary and unsafe conditions. Informants consistently emphasized the critical need for collaboration between multiple agencies, including law enforcement,APS, ombudsmen, the Department of Behavioral Health, and HFR, in order to address the potentially unsafe environments in unlicensed care homes, ensure the needs of the residents are met, address the criminal acts of the operators, and attend to the buildings themselves. In addition to the $100 per resident per day fine placed levied against unlicensed facilities, a representative of the state reported that the Georgia legislature has added operating an unlicensed personal care home, which is a criminal offense, to the list of crimes that make it impossible to apply for a license to operate a personal care home. Areas for Future Research and Potential Data Sources In Georgia, much of the current focus on unlicensed personal care home investigations involves cases of resident abuse and neglect. Few of the investigations focus solely on financial exploitation. Key informants indicated financial exploitation in unlicensed care homes is an area for future research. Cross-state human trafficking is another area for future research. Some interviewees reported that unlicensed care home operators sometimes run homes in more than one state, across state borders to avoid arrest, and may be trafficking residents across state borders as well.According to key informants from APS and law enforcement, care home operators and residents crossing state borders poses several challenges that make it difficult to ensure the safety of residents and address the criminal activities of the operators. These challenges include differences in laws and regulations pertaining to care homes across states, and the lack of cooperative arrangements across states to facilitate tracking residents or operators who traverse state borders. By interviewing residents of unlicensed care homes, HFR is trying to understand the pathways that individuals take to end up in these situations. Most key informants noted that hospital discharge is a critical juncture at which individuals can be directed to, or end up in, unlicensed care homes. Future research examining the role of hospital discharge planners and strategies to prevent discharge to unlicensed care homes appear warranted. Interview findings also suggest that research is needed on the best strategies for identifying unlicensed care homes and effectively closing them down. Interview findings indicate that a key element of a successful strategy is collaboration across multiple agencies. Key informants expressed a desire for future research that helps to categorize the necessary organizations and the number of personnel hours needed from each organization at each phase of the processes to identify, investigate, and close unlicensed homes; determine the optimal tactics to effectively implement investigation and closure; and develop a safe and seamless relocation and follow-up plan for residents. A.2. North Carolina Site Selection Information gathered from the environmental scan and SME interviews revealed reports that unlicensed care homes exist in North Carolina. The state has also been in the news based on actions resulting from state compliance with the Olmstead decision which has moved adults with mental illness from institutional settings into less segregated settings in the community. We chose the Raleigh/Durham area for the site visit because it is where the state licensing agency is located and because of recent media reports of unlicensed group homes. We conducted most key informant interviews in Durham, with some additional interviews across the region, including Raleigh. Key Informants We conducted nine total interviews with ten key informants, including state licensure officials and staff from the North Carolina NAMI in Raleigh. In Durham County we interviewed key informants from APS, Group Care Monitoring Services, a local hospital discharge planner, a local ombudsman, and one local law enforcement official, who also serves on a crisis intervention task force. State Regulations In North Carolina, facilities providing or arranging for housing, food service, and 24-hour scheduled and unscheduled personal care services to two or more unrelated adults must be licensed as an adult care home or a group home. Licensure for adult care homes and mental health group homes falls under two separate state statutes, and therefore two separate regulatory offices oversee different types of licensed care homes. North Carolina's Adult Care Licensure Office licenses two levels of adult care including family care homes and adult care homes. Family care homes serve 2-6 residents and adult care homes serve seven or more residents;both can choose to serve only elderly persons (55 years or older or any adult who has a primary diagnosis of Alzheimer's disease or other form of dementia) or to serve a mixed resident population.At least one administrator, on-site manager, or responsible person must be on duty 24 hours per day, seven days a week, and all staff must be trained as personal care workers within 60 days of hire. The North Carolina Mental Health Licensure Office licenses group homes for adults with mental illness.5 These homes also serve two or more adults. Local Context Overall, key informants were able to provide little information about the prevalence of illegally unlicensed care homes (henceforth referred to as unlicensed care homes); informants we spoke with at both the state, local licensure office and APS reported that they do not currently systematically monitor or track unlicensed care homes. We were only able to obtain an estimate on the number of unlicensed care homes from the Durham County Group Care Monitoring Office. Durham County key informants estimated that since 2012, approximately five calls have resulted in cases being investigated as potential unlicensed care homes. Of these, three were determined to be unlicensed care homes. There were no reports of varying frequencies of unlicensed facilities between urban and rural areas. Key informants at the state level were able to provide estimates of the number of complaints they have received pertaining to unlicensed care homes, but not estimates of the number of unlicensed care homes. One state key informant stated that her office receives one to two calls a month pertaining to unlicensed adult care homes, but she noted that these calls are sporadic.Another state-level key informant was unable to estimate how many calls the agency receives that result in investigations of unlicensed group homes for persons with mental illness. However, a representative from a state advocacy agency estimated that about 2%-3% of their 4,800 calls annually, or approximately 120 calls statewide per year, were related to unlicensed facilities. Key informants described both state and local infrastructure issues related to the prevalence of unlicensed care homes in the state. Two key informants thought that the ongoing statewide mental health reform, which began in 2002, has exacerbated issues related to the general lack of infrastructure and knowledge about needs of persons with mental illness. They indicated that they are unaware of any assessment of need related to licensed mental health group homes in the state. They speculated that there may not be enough licensed mental health group homes available to care for persons with mental illness, and that unlicensed group homes can potentially fill that gap. All key informants described how the Local Management Entity-Managed Care Organization (LME-MCO) oversees the provision of mental health services in Durham County. The LME- MCO oversees contract services in a four county area. While we were specifically told by two key informants that the LME-MCO can only contract mental health services and supports to licensed group homes, these same key informants also shared specific examples of the LME- MCO unknowingly contracting services to unlicensed group homes. This implies that the LME- MCO does not always check licensure status before coordinating services in unlicensed group homes. We were told that after discovering a group home is unlicensed(via information from the state), the LME-MCO will ask the state to fast track licensure because there are no other licensed housing options available to this vulnerable population. State and Local Policies Related to the Supply and Demand for Illegally Unlicensed Care Homes Two key informants mentioned that changes to the state's Medicaid Personal Care Services program had a direct impact on available funding for group homes that serve individuals with mental illness. In 2013, the minimum number of ADLs needs required for individuals to qualify for reimbursement for personal care services in group homes increased. This had a direct impact on the operating budgets of licensed group homes. The state made bridge funding available to those group homes impacted by this funding change, but one key informant said that according to • a recent report, very few group homes accessed this bridge funding. This key informant was concerned this had contributed to group homes closing, which may have resulted in a gap that unlicensed facilities are filling. U.S. Department of Justice settlements were also discussed by one key informant. In 2012, the state mandated that large adult care homes(seven or more beds) housing only individuals with mental illness had to close because they were considered institutional settings. As a result, 3,000 individuals with mental illness were transitioned into community-based supported housing. This key informant indicated that this change likely increased the need for licensed group homes, and unlicensed group homes may have also opened as a way to fill the need created as a result of these closures. Motivations to Be Unlicensed Many of the key informants stated that individuals who operate unlicensed care homes are motivated by economic opportunities;but they also stated that in some cases, these operators may not know they need to be licensed. For instance, they may start by caring for one resident, and gradually take in more individuals without realizing there are state regulations governing homes caring for two or more unrelated adults. Costs for bringing the building up to code to meet state regulatory requirements may be another reason why operators of care homes choose to remain unlicensed. Characteristics of Residents and Unlicensed Care Homes Multiple key informants described unlicensed care homes as primarily serving persons with mental illness. Very little was mentioned about elderly residents living in unlicensed homes; only one informant reported that unlicensed adult care homes may serve a mixed population (e.g., elderly residents in addition to residents with mental illness). Informants noted that unlicensed care homes vary in their appearance and condition. Some key informants reported that the living conditions in these places can be subpar. Others described instances where the unlicensed care homes can be located in either low-income neighborhoods or higher-income neighborhoods, and that they blend in with other houses, which makes them difficult to identify or locate unless reported by the community. One key informant shared a specific case of a repeat offender that operates an unlicensed adult care home out of a double- wide trailer. Per state regulations, this is not considered a permanent structure, and therefore does not meet the appropriate building requirements to be a licensed facility. Health and Safety Concerns Overall, the local agency representatives described the condition of unlicensed care homes as unsafe. State informants did not provide information on the services provided in the unlicensed care homes stating that that the sample of unlicensed care homes they see is too small to make an accurate approximation of the conditions. Local key informants primarily expressed concerns regarding inadequate nutrition provided to residents and inappropriate medication management practices. Anecdotal examples of residents wandering outside of their home and onto neighbor's property, which typically generates a complaint call from the neighboring homeowner, were also provided.Although licensed homes were generally depicted by key informants as safer than unlicensed homes, one key informant emphasized that quality of care is not contingent on licensure status; licensed homes may also have health and safety concerns. The Scope of Abuse and Exploitation Concerns Multiple key informants reported that financial exploitation was the biggest concern surrounding unlicensed care homes. For example, one key informant described a recent case of a representative payee in an unlicensed care home who was not managing a resident's money correctly, by providing food on a specific schedule and not providing it when the resident was hungry and requested food. In contrast, a key informant stated that complaints of physical and mental abuse are the issues that most often draw attention to unlicensed care homes. State key informants emphasized that they could not make estimates about the scope of abuse and exploitation issues because unlicensed care homes are not systematically monitored. Strategies to Identify Unlicensed Care Homes Identification of unlicensed care homes is triggered by complaint calls to state or local authorities by community members or family members. These calls spur investigations that sometimes result in the identification of unlicensed care homes. In several cases at both the state and local level, unlicensed facilities were reported to authorities or licensure offices by the operators of licensed facilities. In these cases, licensed operators were reportedly worried that the unlicensed operators would house residents from whom the licensed homes operators could have profited. One potential strategy suggested by an interviewee for proactively identifying unlicensed care homes is to hold community meetings to inform community members about unlicensed care homes, including ways to identify them and how to notify APS and licensure officials if they suspect an unlicensed home operation.Another key informant suggested that it would be key to involve the LME-MCO because they cover a four county area and must receive calls that are about unlicensed care homes. Strategies to Address Unlicensed Care Homes Key informants described a coordinated effort between the state licensure offices and the local group care monitoring office once there is recognition that a complaint call is about an unlicensed facility. One key informant stated that if a call comes in and the name of the care home that is being reported is unknown, then the next step is to call the state licensure office. Next, the local group monitoring office or the state would attempt a site visit. Unlicensed care homes are not required by law to open their doors to the state licensure office because the state licensure office does not have the legal authority to enter them. However, key informants at the state said that operators of suspected unlicensed care homes usually do open their door for inspection. The state investigates the types of services that are provided to residents on site in order to determine if a license is required. If the facility is providing licensable services in an unlicensed setting, the state then sends a cease and desist letter, copying the LME-MCO and the local APS. One key informant noted that the state or the LME-MCO can conduct follow-up to assess whether a facility that received a cease and desist letter does, in fact, close down. If the facility does not close, law enforcement (not the state licensure offices) fines the illegal operation $50 for the first offense and $500 for each additional offense. However, even if the home continues to operate, the fines are rarely enforced or collected. It was noted that many sheriffs and District Attorneys do not want their resources to go to cases of this nature unless serious and numerous complaints lead them to believe the group home is a major problem. No other coordinated agency efforts beyond the state licensure office,APS, and the LME-MCO were described by key informants. Areas for Future Research and Potential Data Sources One informant suggested research that examines the homeless population and the availability of affordable housing as a way to better understand the environment that may be conducive to supporting unlicensed care home operations.Additionally, interviewee discussions revealed a lack of ombudsman involvement in unlicensed care homes, which is another area for future research. A review of state regulations around long-term care ombudsmen could reveal gaps and opportunities in how ombudsmen can access and advocate for residents in unlicensed care homes. Key informants did not offer any information on potential ways to identify unlicensed care homes or existing databases of these places. A.3. Pennsylvania Site Selection Pennsylvania was selected as a site visit location because of the staters past and current experiences with illegally unlicensed personal care homes. In 2005,Pennsylvania state regulations for personal care homes were changed, reducing the minimum number of residents a personal care home could serve from seven to four. The new regulations were implemented to monitor and provide oversight of personal care homes with four or more residents, while reducing the number of homes that legally did not require licensure.As a direct result of this regulation change, many personal care homes in Pennsylvania became illegally unlicensed and either shut down, became licensed, or continued to operate illegally. Multidisciplinary PCRR teams were then formed at the county level to address the relocation of residents to licensed facilities and to investigate illegally unlicensed personal care homes in coordination with the state licensure office.Allegheny County was specifically chosen as the site visit community because of their currently active PCRR team, which continues to address illegally unlicensed personal care homes. The state is also unusual in that it allows a category of care homes to operate as legally unlicensed homes. Key Informants The research team completed seven interviews with eight participants that included both state and local community stakeholders. Key informants included representatives from the state licensure office. In Allegheny County we interviewed key informants from APS, and local ombudsmen and placement coordinators from the local Area Agency on Aging (AAA)who work directly with licensed and unlicensed personal care homes, as well as other staff from a local disability advocacy agency and a local fire department. State Regulations In Pennsylvania, facilities providing or arranging for housing, food service, and one or more personal care needs for four or more unrelated adults must be licensed as personal care homes. Licensed personal care homes are required to assist with personal services including ADLs and IADLs, and can include supervision of medication administration and provision of social activities, as needed. Per state regulations, residential settings providing room, board and personal assistance with three or fewer residents who have at least one personal care need do not meet the requirements for licensure as a personal care home and are legally unlicensed. Dom Care homes, • which also provide care to three or fewer individuals, are governed and regulated by the state with the authority to certify, supervise and monitor delegated to the local AAA. Local Context At the state level, Pennsylvania investigates a relatively low number of illegally unlicensed personal care homes per year. One key informant estimated that approximately 25 cases are investigated annually, with about half that number determined to be illegally unlicensed personal care homes. The state's annual Personal Care Homes Report provides the number of illegally unlicensed personal care homes that result in enforcement actions and details the historical trend of the number of enforcement actions taken against illegal unlicensed personal care homes. From 2008 to 2013, Pennsylvania reported a stable trend of investigating about ten illegally unlicensed care homes per year with the exception of 2010 when they investigated 27 cases, about three times more than in other years.6 At the local level, one key informant estimated that members of the Allegheny PCRR, along with the state licensing office, have investigated approximately five illegally unlicensed personal care homes in their specific geographic region over the past two years. Key informants stated that many illegally unlicensed personal care homes they investigate are being operated by repeat offenders who have done this in the past; these same operators just open new illegally unlicensed personal care homes once they are found out. Key informants noted that it is important to know the history of Pennsylvania's personal care home regulation changes in order to understand why and how the state has addressed illegally unlicensed personal care homes.Although these regulatory changes occurred ten years ago, multiple key informants reported that many more licensed personal care homes have continued to close in recent years.One key informant estimated that approximately 3,000 licensed personal care homes have ceased operations in Allegheny County since the 2005 regulatory changes. Most interviewees also agreed that there are likely more illegally unlicensed personal care homes than they are aware of. They indicated that these unlicensed personal care homes are filling the gap left by the closing of licensed personal care homes. It is important to note that most key informants did not speak to or have direct experience with very small (1-3 beds) legally unlicensed personal care homes, and therefore could not estimate the prevalence of these types of homes or compare them to illegally unlicensed personal care homes. Multiple key informants spoke about a reduction in the number of Dom Care homes in the state and how this reduction may also give rise to illegally unlicensed personal care homes. One key informant estimated there are approximately 526 Dom Care operations in the state. Interviewees had varying opinions on the causes for Dom Care homes closing. One key informant indicated that this reduction is due to the increasing numbers of HCBS waivers giving potential Dom Care residents the option to live alone in apartments.Another interviewee suggested that it is becoming more difficult to recruit individuals to be Dorn Care operators because of the competing demands on their time. Informants stated that Allegheny County has other specific contextual issues that may contribute to the existence of illegally unlicensed personal care homes. Many key informants regarded the closing of Mayview State Psychiatric Hospital in 2008, which was located in Allegheny County, as an important factor contributing to the gap of services and affordable housing available for individuals with mental health diagnoses. One interviewee estimated that at its peak, this hospital served 3,700 patients. Multiple key informants spoke about the significant impact of the closure of this hospital in Allegheny County and the western part of the state as it relates to the possible continued proliferation of illegally unlicensed personal care homes. Multiple key informants also spoke about the lack of affordable housing in Allegheny County. One key informant stated that one in four residents of Allegheny County are over age 60, and that this population presents a growing need for affordable residential care homes. In addition to the aging population,many key informants agreed that the lack of affordable supportive housing options for individuals with a mental health diagnosis is also a concern for Allegheny County and surrounding counties. The aging housing stock in Allegheny County was also a cause of concern for a few key informants, as it relates to the number of pre-existing buildings that cannot meet the state regulatory building code requirements for licensed personal care homes. This, they fear, could lead owners to operate illegal unlicensed personal homes. Key informants mentioned that state funding and regulatory mechanisms specific to Pennsylvania had a direct influence on the state's capacity to address illegally unlicensed personal care homes. The Pennsylvania State Lottery funds the Pennsylvania Department of Aging.A few key informants noted that this funding arrangement affords state and local agencies the resources and time needed to investigate illegally unlicensed personal care homes. The state's BHSL office also has the legal authority to act as an enforcement agency.This department can request administrative search warrants to enter suspected illegally unlicensed personal care homes. State and Local Policies Related to the Supply of and Demand for Illegally Unlicensed Care Homes All of the key informants shared their perspectives about what is driving the closure of personal care homes. Most interviewees reported that the personal care home regulation change in 2005 caused a loss,of small personal care homes due to the increased costs associated•with meeting the standards set forth in the regulations. Costs for operating a licensed personal care home can include state fees for licensure, structural renovations or changes to meet required building codes, paying for staff to be on-site 24 hours per day, and paying for and providing adequate staff training. These increased costs have also impacted the populations that licensed care homes will accept, according to multiple key informants. One interviewee estimated that licensed personal care homes used to reserve 50% of their beds for individuals who only had SSI benefits and now this amount has decreased to fewer than 25%, leaving S'SI recipients with fewer licensed options. In more extreme cases, other personal care homes have stopped accepting any persons whose sole source of income is SSI. Multiple key informants suggested that, as a result, these residents are primarily being served by illegally unlicensed personal care homes. Key informants also cited the process of discharging patients from hospitals in Allegheny County as a potential source for linking individuals with illegally unlicensed personal care homes. These key informants agreed that because discharge planners are under pressure to quickly discharge hospital patients to contain hospital costs, they must have a list of care homes (including licensed and illegally unlicensed personal care homes) that they can reference if the discharge planner has no other option for placement. The Allegheny County PCRR has sent letters to hospitals and their discharge planners informing them about known illegally unlicensed personal care homes to which they should not discharge patients; however, according to two key informants, discharges to these homes have continued. One key informant provided additional information, stating that hospitals in Allegheny County use placement agencies to help find residential settings for discharges, and that illegally unlicensed personal care homes are used as an option. In these cases, the hospital reportedly pays the placement agencies a fee to find a personal care home, and the placement agencies also receive monetary incentives from the personal care homes for referrals. This key informant shared a list of seven placement agencies that work with hospitals in Allegheny County. Multiple key informants expressed concern about other state policies related to reductions in funding for mental health services and supports as potential contributors to a gap that illegally unlicensed personal care homes can fill. One key informant specifically mentioned a 10% cut to state finding for mental health in 2012 while another key informant mentioned block grants as a potential contributor to lower funding amounts for mental health services and supports. Many key informants noted that regulatory loopholes provided potential ways that operators of illegally unlicensed personal care homes can persist and evade licensure. The Pennsylvania BHSL provides specific documentation to potential operators and consumers outlining situations that do not have to be licensed by the state. Multiple key informants said some operators know the regulations better than the state regulatory agency and can therefore find creative ways to evade licensure. Local key informants gave more specific examples of how operators evade licensure by having a mixed population living in their homes. For example, a care home with three persons with at least one personal care need might also house three people with personal care needs whose community housing arrangement is covered by the U.S. Department of Veterans Affairs. This results in different payment streams and different regulatory agencies that have responsibility for different residents in the same residence.An operator with this population mix can avoid licensure because each agency is only responsible for the residents that are enrolled in their program or waiver. In another example of differing payment sources, a key informant described a housing situation with three Dom Care residents plus three other residents who can live independently; this care home did not require state licensure as a personal care home. However, in Allegheny County, key informants stated that locally the regulation is interpreted and applied differently, and that a Dom Care facility could not have more than three residents total,regardless of the case mix or payment mix. Motivations to Be Unlicensed Key informants were divided in their opinions on the motivations for operating illegally unlicensed personal care homes. Many interviewees mentioned monetary motivations of operators as one factor. Interviewees pointed to financial incentives related to managing SS1 recipients' checks as one specific motivator.Another motivation to operate an unlicensed care home, equally mentioned by key informants, relates to costs directly associated with meeting building code requirements specified in the regulations. Homeowners, for example, may have property they cannot rent because the building is not up to code, so to generate income from the property, they begin operating an illegally unlicensed personal care home. Other key informants stated that some operators do not want the state regulating or monitoring their business. In contrast, most key informants agreed that some operators start out with a smaller one to three bed legally unlicensed home and gradually end up caring for more residents, not realizing that doing so requires the home to be licensed.A few interviewees agreed that in cases such as this, the operators are motivated by their desire to care for people; they are just not aware of the licensure requirements. Characteristics of Residents and Unlicensed Care Homes As described by the majority of interviewees, the primary populations residing in illegally unlicensed personal care homes are vulnerable, with few financial resources. While many key informants stated that illegally unlicensed personal care homes primarily serve adults with a wide spectrum of mental health disorders, they also noted that some of the residents in unlicensed care homes are frail and elderly individuals. Some residents were also described as transitional or homeless, while others were described as persons with substance use disorders. Multiple key informants provided details of two specific cases of illegally unlicensed care homes. One was a fairly large ranch style house that accommodates 15-23 individuals at any one time. According to one key informant, this illegally unlicensed care home had recently housed a mix of residents and family members, including four related family members (two children and two adults), two persons under the care of a local hospice, and one individual who was receiving methadone treatment. This key informant also noted that the residents frequently transition in and out of the home, as is often the case with illegally unlicensed personal care homes. Multiple key informants also described another illegally unlicensed personal care home with several tenants, including a 91 year old man who had been tied to a chair with a sheet so he would not fall when the owner had to leave the home. Health and Safety Concerns With regards to the safety of unlicensed care homes, the majority of key informants agreed that the lack of clean and safe housing was a primary safety concern. Some key informants described illegally unlicensed personal care homes as filthy and potentially filled with rodents and insects; they also noted that these homes are unsafe structures that could be condemned. Some operators use homes that do not meet personal care home building code regulations; for example,the home may lack proper ramps for wheelchair access. Key informants were also concerned about a lack of specific services inside illegally unlicensed personal care homes. Improper medication assistance and management were most commonly noted by key informants as problematic; informants were concerned that operators or staff of illegally licensed care homes may not be properly trained in medication management and administration. Key informants also mentioned other resident health concerns including neglect, lack of water, malnourishment, and bed sores or pressure ulcers resulting from inadequate care. Two key informants noted that they only see the worst cases of illegally unlicensed personal care homes, so they could not offer examples of adequate or good care that may occur in those they do not investigate. In contrast, one key informant stated that one repeat illegally unlicensed facility had housed residents who had thrived there and had benefited from living in the home. The Scope of Abuse and Exploitation Concerns The majority of key informants interviewed cited emotional abuse including intimidation and neglect as the most common forms of abuse observed or reported in unlicensed care homes. Financial abuse was the most commonly cited form of exploitation and the fastest growing form of abuse in illegally unlicensed personal care homes. Examples of financial exploitation described by key informants include the operator becoming a resident's representative payee and then withholding a resident's money, and pocketing profits while providing inadequate care and services or no services at all.Another specific example included a resident moving from a home where the operator was their representative payee and the operator continued to collect their SSI check. Strategies to Identify Unlicensed Care Homes The state primarily uses reports to their complaint system to identify illegally unlicensed personal care homes. The state and local agencies mostly rely on complaints from the general public and county agencies. The agencies do not typically get complaints from residents inside the home, although if the home is bringing in services such as home health or hospice nurses, those outside agency staff could file reports that result in the identification of an illegally unlicensed personal care home. The AAA office,APS, Disability Rights Network, and state or regional licensure offices can receive complaints concerning resident care that may lead to the discovery of illegally unlicensed personal care homes. The PCRR team shares the complaints they receive about potential illegally unlicensed personal care homes between the AAA,APS, Disability Rights Network, code enforcement and state licensure office. Lists of both known illegal and potentially (identified but not yet confirmed) illegal operations are maintained by APS and the local ombudsman who lead the team. Once an illegally unlicensed personal care home is identified, it is tracked at the local level to see if it has moved, or, in the case of closure, if it has reopened. The regional and state licensure offices are closely involved in this process. In the recent past,the state has had public education campaigns to inform the public about illegally unlicensed personal care homes. One key informant shared that, as part of such a campaign in 2012, advertisements were placed in metropolitan areas warning the public against placing people in illegally unlicensed personal care homes. The same message was also sent to hospital discharge planners and to rehabilitation discharge planners.At the local level,APS and the ombudsman have informational brochures on their agency websites for the purpose of educating individuals and families about residents' rights. One key informant stated this posted information, as well as general education sessions out in the community; for example, in senior centers or nursing homes, leads to some complaints that can generate investigations into personal care homes that may be identified as illegal operations. A few key informants suggested cross-referencing different agency lists as another potential source for identifying unlicensed care homes. One key informant suggested that lists of available housing maintained by a local homeless housing assistance program may include illegally unlicensed personal care homes.Another safety official stated that their department can keep automated notes on potentially dangerous places, like unlicensed personal care homes, so that if they are called out to a repeat offender, the team on call automatically gets the notes. He also noted that they were not currently using the system in fhis way, and that it is mostly used to note unsafe locations (e.g., places known for drug trafficking and drug use, or for having dangerous dogs). Strategies for Addressing Unlicensed Care Homes A few strategies exist in the state for addressing illegally unlicensed personal care homes. Key informants described the regulatory agency's ability to work with an operator of an illegally unlicensed personal care home to help facilitate the home obtaining licensure. However, we did not hear any specific examples of this from the state or local level.The state regulatory agency can send letters to illegally operating facilities and fine them $500. If an illegally unlicensed personal care home continues to operate, the state regulatory agency has the authority to take out a warrant on the operator ordering her to cease operations. One state key informant told us that the state licensure office is currently working on an amendment to add a graduated fine system which would increase fines overtime for those operators who are repeat offenders which could potentially serve as a deterrent to continuing illegal operations. Multiple interviewees suggested that it was important to quicklyinvolve code enforcement and P gg P local health departments in efforts to close an illegally unlicensed personal care home. If the illegally unlicensed personal care home can be deemed unsafe, code enforcement has the authority to condemn the building and shut the illegal operation down. In this example, the residents would have to be relocated, and the PCRR team would assist in this effort. However, key informants told us that often in these cases,the operator may have another building where the residents could be moved. If residents are able to self-determine and choose where they want to live, they may choose to go with the operator to a new residence. Local health departments can also get involved in trying to shut down illegally unlicensed personal care homes. They can fine the operator directly which may lead to the unlicensed care home being forced to shut down. Areas for Future Research and Potential Data Sources Key informants suggested interviewing individuals from other agencies to learn more about illegally unlicensed personal care homes or to obtain potential lists of illegally unlicensed personal care homes. Due to services being brought into these homes, interviewees thought further interviews with home health staff or hospice staff may yield additional information or lists of unlicensed personal care homes that may include illegally unlicensed establishments. As noted above, placement agencies work with Allegheny County hospitals and discharge planners, therefore these agencies may also have lists that include illegally unlicensed personal care homes. Community safety personnel recommended interviewing local code enforcement divisions for thoughts on illegally operating unlicensed care homes, and consulting EMS personnel because they go out on every 911 call to a house or home and may have more experience with unlicensed care homes compared to firefighters. Multiple key informants also stated that interviews with small licensed personal care home operators may result in learning more about the motivations for operating an illegally unlicensed personal care home. Multiple key informants also stated that a Dom Care operator with the maximum of three individuals may be considering adding other residents or has possibly tried it before, therefore interviews with some Dom Care Operators may yield a unique perspective on the motivations to operate unlicensed care homes. Owners of current small licensed personal care homes are also potential sources of information; they will be able to fully describe the monetary costs associated with licensure, and these costs appear to be one reason why some people choose to operate illegally. APPENDIX B. FINDINGS FROM THE ENVIRONMENTAL SCAN B.1. State Regulations Affecting Unlicensed Residential Care Facilities From our review of states' regulatory information on licensed residential care categories during the development of the sampling frame for the 2014 National Study of Long-Term Care Providers, and our review of ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy (2015), we found the following. No Legally Unlicensed Residential Care Homes Are Allowed in Some States • Thirty states require residential care homes to be licensed if they have at least one bed.7 Massachusetts exempts small private-pay homes from licensure. However, Legally Unlicensed Residential Care Homes Are Possible in Several States • One-bed and two-bed residential care homes are lawfully allowed in several states. Ten states (Delaware, Georgia, Louisiana,New Jersey,New Mexico,North Carolina, Oklahoma, Rhode Island, South Carolina, and Washington) require residential care homes to be licensed if they have at least two beds. Six states(Colorado, Iowa, Illinois, Maine, Missouri, and Vermont) license starting at three beds, noting that Vermont, like Massachusetts, exempts small private-pay homes. • Three-bed residential care homes are lawfully allowed in at least one state. One state, Pennsylvania, begins licensure with four beds,but the state has locally certified Dom Care homes that serve 1-3 residents. • Licensure regulations lack clarity regarding requirements for minimum bed size. Three states (District of Columbia, Maryland, and Mississippi) have no minimum bed size for licensure, implying that some residential care homes can be lawfully unlicensed. Two states (New Jersey and Tennessee) have a category that specifies a maximum but not a minimum. Using the 2012 annual Medicaid LTSS expenditures report produced by Tnrven, we identified ten states that spent the highest percentage of their LTSS expenditures on HCBS and those that spent the least. We then looked to see if those percentages might be related to the number of number of unlicensed care facilities in those states. Targeted searches of media reports in states with the lowest percentages (New Jersey, Mississippi, Indiana, Florida, and Michigan) did not yield a higher number of reports on unlicensed care facilities than those with the highest spending rates for HCBS (Arizona, Vermont,Alaska, Minnesota, and Oregon). The same held true, with one exception (Georgia), for the top ten states with the greatest increase in HCBS spending since 2010: Virginia, Ohio, Maine, Rhode Island,Alabama, Tennessee, Georgia, New Hampshire, Massachusetts, and Delaware. B.2. Legal versus Illegally Unlicensed Residential Care Facilities A few articles described the difficulties in identifying unlicensed residential care, such as distinguishing them from places called boarding homes, shelter care, sober homes,rehabilitation homes and publicly subsidized housing that arranges services for residents. In addition, as one ombudsman report noted, it is often difficult to determine whether a place is an illegally unlicensed residential care home because of the difficulty of obtaining access to the suspected home to make the determination. For example, one ombudsman report from Florida noted the difficulty in identifying an unlicensed care home due to the quantity and quality of evidence needed to obtain a search warrant in order to enter the home and positively identify a place as providing unlicensed care or housing residents who must be cared for in a licensed facility. In addition, many unlicensed care homes operate as family businesses in single family dwellings allowing shifting of residents to avoid detection by regulators (Tobia, 2014). Below we present a sample of the varying state definitions of lawfully unlicensed and illegally unlicensed residential care homes. About Legally Unlicensed Facilities • Some states allow legally unlicensed facilities to assist with ADLs and administer medication, but do not allow them to provide 24-hour supervision. In California, assisted living services can be provided by a licensed home health agency in unlicensed publicly subsidized housing(low-income housing projects, apartment houses, retirement hotels, village models, and private homes). These legally unlicensed residential care homes are exempt from licensure because they do not provide 24-hour supervision, though residents may be receiving intermittent skilled nursing care, and help with ADLs, medication administration, and social activities. • Some states allow them to assist with ADLs, but do not allow them to administer medication. In Indiana, legally unlicensed residential care homes serving fewer than five residents can provide assistance with at least one ADL, assistance with medications or meal reminders, or two scheduled supportive services, but cannot administer the medications. • Some states allow them to assist with medication storage but not with ADLs. In Maryland, licensure is not required for a provider who serves individuals who are dependent on the provider for room,board, and control and security of their medication but do not need assistance with any ADL. Further, it is the responsibility of the owner to determine whether the home needs a license. • In some states, residents can pay for their own personal or medical care in an unlicensed facility. In Michigan, residential care homes that provide room,board, supervision, and protective oversight, but not personal assistance with ADLs or medication assistance (residents can contract out for personal care), are not required to be licensed. However, residents may pay for such services or receive them through Medicaid waivers. In Iowa, boarding homes serving three or more individuals who require supervision or need assistance with ADLs are registered but not licensed. Residents in need of medical assistance such as nursing care can pay for such care from an outside provider, and the facility does not have to be licensed as "assisted living." Some larger facilities operate as unlicensed "residences" by requiring residents to contract with a separate corporation for provision of all ADL or nursing services. • In some states,facilities that provided room, board, and "control and security of medication"could be legally unlicensed. The facility operators were authorized to make the decision on their own (Tobia, 2014). In addition to legally unlicensed residential care homes, there are a variety of places that operate illegally. In some cases they avoid licensure by holding themselves out as not providing services or housing residents that would require a license under state law. In other cases, the unlicensed facility simply ignores the law and operates below official "radar." About Illegally Unlicensed Facilities • Some illegally unlicensed facilities deny services are being provided. In Florida, operators of illegal homes use a variety of schemes to hold themselves out as not requiring licensure. They deny services such as assistance with medication are being provided to residents, or assert they are only providing housing for alcoholics, ex-convicts or people with mental health issues to avoid having to become licensed. One Florida media report estimated there were hundreds of congregate living facilities across the state that escaped state oversight because no agency regulates them(Savchulc, 2013). Called shelters, rooming houses, sober homes, they have names like Home Sweet Home, House of Joy and Nurse's Loving Heart. Some have residents that receive Medicaid funded services. • Some continue to operate after their license expired or was revoked. Media reports described operators that continued to operate after their licenses expired or were revoked. • Legal homes serve as conduits to illegally unlicensed homes in some instances. Media reports described operators with licensed facilities who also operated a series of unlicensed homes in secret. In Georgia, they advertised themselves as licensed and admitted residents to the licensed facility and then shifted residents to their illegally unlicensed homes. • Some operators remain undetected by moving residents from one facility in one state to another facility in another state. In one case well publicized by the media, residents of one unlicensed facility in Pennsylvania were moved between Pennsylvania, Texas, Virginia and Florida to escape law enforcement. According to a six-state study conducted by Hawes& Kimbell for the U.S. Department of Justice (National Institute of Justice) in 2010, when seriously substandard quality, neglect or abuse were discovered in unlicensed facilities, some closed the home in question but shifted residents to other legally or illegally unlicensed care homes to avoid detection or penalties. This shifting of residents from one unlicensed home to another to avoid detection and oversight was also described by the media in Texas and Georgia. Reasons for Not Seeking Licensure The study by Hawes &Kimbell also provided reasons operators do not seek licensure, including: inability to meet fire safety codes (e.g., installing sprinklers), lack of state supplemental payment for SSI residents or Medicaid waiver funds (which can be restricted to licensed facilities), and avoidance of inspections and sanctions/fines for not meeting state regulation.An earlier study by Perkins, Ball, Whittington, & Combs (2004) provided these reasons from the perspective of one small unlicensed care home operator: • Regulatory requirements meant for large assisted living facilities are too stringent and expensive for small residential homes. • There is a lack of knowledge regarding the licensure requirements or about how to navigate the different government agencies. • Government staff lack of respect for the care provided in small residential care homes by non-professional licensed staff. • Public funds, like state supplements, are inadequate. B.3. Concerns about Safety, Abuse, Neglect, and Financial Exploitation We found reports of Medicaid fraud in unlicensed care homes in Florida and Nevada between 2009 and 2014 involving charges of false imprisonment, resident neglect, grand theft, and/or operating an unlicensed assisted living facility (National Association of Medicaid Fraud Control Units, n.d.). Texas and Georgia had numerous cases of unlicensed homes in deplorable conditions: infested with insects, lacking air conditioning or heat, residents sleeping on the floor, faulty wiring, no bathroom access,residents deprived of food or fed scraps, and theft of medications. There were several reports of false imprisonment of residents who were kept locked in residential homes, sometimes deprived of their identification papers in Florida, Georgia, Indiana and Texas. Theft of government benefit checks (e.g., SSl, Social Security, food stamps, Medicaid, veteran's checks) was common, with one case in which operators diverted more than $790,000 to themselves. Other charges included: murder, sex trafficking, sexual abuse from staff or other residents who were registered sex offenders, racketeering, forced labor, and fire setting by residents with severe and persistent mental illness. Poor quality of care, instances of physical abuse, toxic combinations of medication, and use of stun guns, were also reported (National Association of Medicaid Fraud Control Units, 2015). • Georgia: In one expose,the Atlanta Journal-Constitution analyzed thousands of inspection reports and interviewed state and local official, social service providers, and advocates, and then published an article on the status of affairs in unlicensed personal care homes. The reporters described cases of abuse in which residents were being beaten and burned, locked in basements/rooms, given buckets for toilets, and had their benefit checks stolen from them (Schneider& Simmons, 2012a; Schneider& Simmons, 2012b; Schneider& Simmons, 2012c). • Illinois:A story released on the This American Life radio podcast described a scam where individuals with substance use disorders were sent from Puerto Rico to supposed rehabilitation centers in Chicago where they were to be provided with housing, food and counseling services, only to find themselves in crowded, unlicensed rehabilitation centers, their passports and other identifying information taken from them.A follow-up story revealed that these unlicensed rehabilitation centers may have been selling the identities of the victims on the black market for as much as $2,500. Some victims later found that their credit had been mined by someone who illegally used their identity (Glass, 2015). Fraud reports have been filed with the U.S Department of Housing and Urban Development for the misuse of funds to send users from Puerto Rico to unlicensed rehabilitation centers in the United States. • Pennsylvania: In 2012, the Secretary of the Department of Public Welfare stated that the state continues to struggle with illegal operators and asked all Pennsylvanians to join in the fight and report any unlicensed homes or activities because "unlicensed care is deadly." B.4. What Are States Doing to Address the Problem? There appears to be a general lack of recognition about the extent of the problems with unlicensed residential care homes in the United States. Licensure agencies in only three (Texas, Alabama, and New Mexico) of the six states studied in the U.S. Department of Justice Report (Hawes & Kimbell, 2010) acknowledged a significant problem with unlicensed facilities. In another state in that study, only consumer advocates and ombudsmen reported the existence of unlicensed facilities. In another report, a representative of the Arizona Department of Health Services stated that unlicensed assisted living facilities were not a problem because licensed operators monitor the industry and report illegal activity (Arizona Department of Health Services, n.d.). This conflicted with other media reports that describe Arizona citizens calling for closing the loopholes in state laws to prevent "imposter" senior living facilities that use false advertising (Azrnfairall, 2013). Positive Actions by States to Improve Oversight of Unlicensed Facilities Several states have taken steps in improve oversight of unlicensed facilities, often as a result of newspaper exposés on unlicensed residential care homes. • Some legislatures made it a felony to operate an unlicensed care home. The first conviction in Florida is a felony; in Georgia, first conviction is a misdemeanor, second is a felony. • Some assess fines jbr continuing to operate an unlicensed facility. Florida can impose fines of up to$1,000 a day, however it was noted that owners often disappear when discovered to avoid being fined). • In some states (Arizona and Vermont), it is illegal to refer an individual to an unlicensed facility. • Some publish notices of how and where to report unlicensed care facilities. o California, Pennsylvania, Maryland, and Mississippi publish notices of how and where to report unlicensed care homes, which implies that these states may be experiencing problems with unlicensed homes. o .Florida publishes a listing of unlicensed homes but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. o The Texas Department of Aging and Disability Services (DADS) website(2015) states that the agency is aware of some unlicensed residential care homes and is either working to get the homes licensed and to comply with health and safety requirements or is in the process of closing them.A phone number is provided if someone has a question about the licensure status of a facility. • Cooperative efforts are underway amongst state and local agencies in some states. o In Florida, the Secretary of the Agency for Health Care Administration told a senate committee that the agency wanted to work more with law enforcement. o In Georgia, efforts are now under way to provide workshops for law enforcement that clarify the new laws about unlicensed care homes and how law enforcement and agencies, such as aging and licensure can work together to identify and investigate crimes against at-risk adults and prepare the necessary components for successful prosecutions. o In the District of Columbia, an ombudsman reported that they were involved in collaborative efforts with University Legal Services, Department of Mental Health, Department of Accountability and other groups, such as APS. • Funds are being allocated to relocate residents out of unlicensed residential care. o In Georgia, the number of complaints about unlicensed facilities rose from 253 in fiscal year 2013 to 293 in fiscal year 2014, with at least one-third of claims being substantiated. One prominent case required more than 40 people in law enforcement and social service agencies to investigate and close a home, find placements for the residents being displaced, and prosecute the violators. In response, the legislature has appropriated$260,000 to relocate residents identified as living in unlicensed care homes. • Enforcement actions are being taken. o A 2010 report from the Pennsylvania BHSL noted that enforcement actions against illegal personal care homes had increased from four homes in 2009 to 27 in 2010 (most were located in the Philadelphia area). However, as recently as 2013, the number had decreased to ten enforcement actions.8 The Department of Public Welfare can take action against boarding homes and similar facilities that house four or more people if they are providing personal care services because they are considered illegally unlicensed.A judge deemed a "boarding house" as an unlicensed personal care home because four of the six residents needed personal care services and not based on the three residents actually receiving the services (under the legal limit required for licensure). o In Texas, when the bill that would have authorized DADs to inspect and license • unlicensed residential care homes, legislation was enacted that permitted cities to license RCFs not licensed by the state licensure agency. The City of Houston established legislation that requires boarding homes housing three or more individuals to register with the city. Boarding homes are allowed to provide the following services beyond room and board: light housecleaning, transportation, money management, and assistance with self-administration of medication, but no personal care service. Failed Legislative Efforts to Improve Oversight • In Arizona, a bill to strengthen the elder abuse and fraud laws failed to pass again after being introduced in three previous sessions. • In Iowa, legislation to restrict the actions of some operators of large licensed assisted living facilities to recategorize or redefine themselves as a "residence," (e.g., boarding home) that does not require licensure was proposed but did not pass. Ongoing Issues for Licensure Agencies Frustrations continue among licensure agencies and advocates with unlicensed care homes, and residents are largely unprotected by licensing agencies (Hawes &Kimbell, 2010). • Agencies have inadequate resources or authority. o Licensure agencies in many states lack the legal authority to inspect, require plans of correction, or fine these unlicensed facilities. Further, when a licensed facility surrenders its license(or the license is revoked) but it operates as an unlicensed residential care home, regulatory and advocacy agencies no longer have the authority to inspect the facility, unless there is a complaint filed(Tobia, 2014). o Licensure staff only leamabout the unlicensed residential care homes when someone reports them. State inspection staff, already overwhelmed with large caseloads, are required to obtain warrants to execute searches, a time-consuming process, when trying to follow up on reports of unlicensed homes and determine whether the home is illegal. o Concerns remain that agencies do not have the resources needed to monitor and follow through with the appropriate actions to cope with unlicensed care homes (e.g., finding emergency placements for residents, prosecuting violators, ensuring that the illegally unlicensed residential care home remains closed and has not reopened in another location). Licensure and APS have the same difficulties in terms of moving residents out of unlicensed facilities into good supportive housing sites (Hawes &Kimbell, 2010). • There exists confusion over the authority of other agencies. o In some states,APS has very limited responsibility and involvement. If a home is illegally unlicensed, they tend to refer the case to the licensure agency for resolution. However, as in some other states,APS in Pennsylvania can act on referrals of abuse for elderly residents (age 60+).And APS often plays a critical role in relocating residents with an illegally unlicensed home is closed.As noted,jurisdictional disagreements exist as to whether licensure agencies or APS agencies are responsible for the illegally unlicensed facilities. • There have been limited prosecutions by the legal system. o Some state have too few inspectors to detect and investigate allegations about unlicensed homes and too little time and manpower to bring a prosecutable case to the AG's office. In one state, the AG only received nine cases in the entire year; in another state they handled only 2-3 cases a year. (Hawes &Kimbell, 2010). o The 2014 annual report for DADS shows that the number of referrals to the AG increased from two to nine for injunctive/other relief and civil penalties. County and District Attorney referralsdeclined from 29 in 2010 to six in 2014. o Our search of state AG reports of unlicensed RCFs identified only six cases of successful prosecutions in New York,Nevada, Florida, and California for operating a residential care home without a license--and in several cases, gross neglect in these homes. • Ombudsman programs are not adequately involved. o Nevada stated that no interagency procedures were in place to handle complaints about unlicensed board and care homes in a timely and efficient manner (Ryan, personal communication). o A local ombudsman in Maryland stated that they had no authority to inspect an unlicensed home and therefore did not have reliable knowledge about whether unlicensed care homes exist, how many individuals are living in such homes or what level of care or assistance those residents needed (Tobia,2014). o Ombudsmen program does not extend to unlicensed facilities (Hawes & Kimbell, 2010). • Safety issues affect local fire departments. o Several reports noted that local law enforcement,EMS, and fire departments had frequent interactions with unlicensed residential care homes. One former fire department battalion chief reported that the elderly living in unlicensed residential care homes are hidden from the view of public health agencies, social service agencies, and ombudsman programs --the entities that generally protect and advocate for older people and individuals with disabilities. He noted that residents with disabilities in unlicensed homes were at risk during fires and natural disasters such as tornados,hurricanes, and severe storms. He argued that comprehensive emergency management planning and proactive practices were needed to protect those at risk in unlicensed homes. He recommends additional research, enhanced coordination and cooperation among local agencies, education for first responders about unlicensed group homes and how to identify at-risk individuals, and stronger advocacy for risk reduction strategies to prevent fires that involve large loss of life (Tobia, 2014). B.S. Prevalence and Which States Are Having an Increase Estimates of the prevalence of unlicensed residential care homes are lacking for most states.A six-state study conducted by Hawes & Kimbell in 2010 for the U.S. Department of Justice, National Institute of Justice, found that unlicensed homes remain a serious, largely unaddressed problem in some states, with the magnitude of the problem remaining unknown. Unlicensed homes tended to flourish in larger cities where there were significant numbers of low-income elderly and people with mental illness released from state mental hospitals.Alabama's APS agency estimated that there were more than 200 unlicensed homes in the state, in contrast to their 400 licensed facilities. Several states (California, Pennsylvania, Maryland, and Mississippi)publish notices on their websites of how and where to report unlicensed care facilities, which implies that these states must be experiencing problems with unlicensed homes. Florida publishes a listing but it does not correspond with the media reports of the number of unlicensed care homes identified by state inspectors. Below are examples from the environmental scan that provide some estimates of the number of unlicensed care homes: • Maryland: A representative of the licensure agency estimated 500 unlicensed illegal assistive living facilities and noted the fine line between a boarding home and assisted living. From a county perspective, one ombudsman and housing officer estimated that perhaps there may be less than 20 lawfully unlicensed facilities and less than five illegally unlicensed, however Tobia's team found that there may be as many as 78 unlicensed care homes serving as many as 400 individuals in that county.An estimate for another locality in Maryland was much higher, with twice as many unlicensed homes as licensed, or about 1,500 facilities, many of which operate out of single family dwellings (Tobia, 2014). • Florida:A media report stated that in 2012 the licensure agency received more than 200 complaints about unlicensed activity and confirmed 62 were unlicensed--a 60% increase since 2010. In the first half of 2013, 37 other unlicensed homes had been identified. • Indiana:An Indianapolis news article stated that the area had far more unlicensed than licensed facilities. • Texas: A 2007 media report, outside the scope of this review but important to mention, notes that city officials in Dallas estimated that there were at least 350 unlicensed, unregulated board and care homes that house 2,500 people across the city, and likely there were more than that(Hancock, 2007). • Maryland, Nevada, and Florida: The National Ombudsman Reporting System noted an increase in unlicensed care homes in these states, but no unlicensed care reports from any state provided evidence on the prevalence of unlicensed care. B.6. Types of Residents Most of the literature or media reports were not specific about the types of residents served in unlicensed residential care. Typically, the reports refer to physically or mentally disabled adults, some with disease specific conditions, or just described as mentally ill or elderly. A California report mentioned that disabled or homeless adults often prefer unlicensed facilities because they have fewer restrictions. Tobia's report (2014) described residents of unlicensed facilities as vulnerable older adults with "hard to place" mental health and paroled individuals who are warehoused. One Maryland media report suggested residents are those released from rehabilitation centers with no families in the area. B.7. How People Find Out that a Facility is Unlicensed There was not much attention paid to the original sources who identified an unlicensed facility, but in some articles or media reports, the case came to light due to a death that occurred in the facility that had to be investigated, neighborhood complaints of numerous vans, ambulances or police cars at the home, or calls from concerned family members about the status of a resident. We did not find any report where a government agency was proactive and discovered the case on its own initiative or because of routine monitoring of unlicensed residential care homes. References azmfairall. (2013). Stop elder abuse petition. Web log.Retrieved from http://www.stopelderabusepetition.blogspot.com/20 k3_06_01_archive.html. Arizona Department of Health Services. (n.d.). Unlicensed assisted living facilities. Retrieved from http://www.azdhs,gov/als/hcb/in ex htm. Glass, I. (Producer). (2015). This American life, episode 554: Not it!Audio podcast. Retrieved from http://www.thisarnericanlife.org/radio-archives/episode/554/not-it. Hancock, L. (2007). Troubled residents languish in flophouses.Dallas Morning News. Retrieved from http://www.dallasmorningnews.com. Hawes, C., & Kimbell,A.M. (2010). Detecting, investigating and addressing elder abuse in residential long-term care facilities. Monograph for the National Institute of Justice, U.S. Department of Justice. Retrieved from http://www.ncimgov/pdffileslinij(grants/229299 piff. National Association of Medicaid Fraud Control Units.Medicaid fraud reports, 2009-2013. Retrieved from http://www.namfcu.net/resources/medicaid-fraud-reports-newsletters. Perkins, M., Ball, M., Whittington, F., & Combs, B. (2004). Managing the care needs of low- income board-and-care home residents: A process of negotiating risks. Qualitative Health Research, 14(4), 478-495. Savchuk, K. (2013).Troubled group homes escape state scrutiny. Miami Herald.Retrieved from http://www.miamiherald com. Schneider, C., & Simmons,A. (2012a). Lax enforcement in personal care homes.Atlanta Journal-Constitution. Retrieved from http://www.ajc.com. Schneider, C., & Simmons,A. (2012b). Perils in personal,care homes. Atlanta Journal- Constitution. Retrieved from http://www.ajc.com. Schneider, C., & Simmons,A. (2012c). Unlicensed homes to face more state scrutiny. Atlanta Journal-Constitution. Retrieved from http://www.ajc.com. Texas Department of Aging and Disability Services. (2015)Assisted living provider resources: Unlicensed facilities. Retrieved from http;//www.dads.state.tx.us/providers/alf/howto.html. Tobia, M. (2014).Personal board and care homes:A hidden population in Anne Arundel County. Anne Arundel County Fire Department, Millersville, Maryland. NOTES 1. State regulations govern whether ombudsmen can access and advocate for residents in unlicensed care homes; thus ombudsmen may be limited in their ability to serve on these teams. 2. We found a number of publications and media reports in both Florida and Texas (e.g., the Miami Herald newspaper series in Florida, and the U.S. Depaiintent of Justice report in Texas), and a few media reports and a research report on unlicensed care homes in Maryland; however, these states were not selected as site visit states. 3. Complaints can also be received by fax, letter, or email. We primarily heard about phone complaints. 4. See http://www.disabilityrightswa.org/stop-fraud-and-abuse-rep-p yees. 5. The North Carolina Office for Mental Health Licensure also licenses group homes for adults with developmental disabilities (5600B) and group homes for adults with substance abuse issues or chemical dependency. However, we did not focus on these populations in the interview. 6. See http://www.dhs.state. . . , es groups/webcontentldocuments/report/c 102850 pdf. 7. These are Alaska,Arizona,Arkansas, Connecticut, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Montana,Nebraska, Nevada, New Hampshire,New York,North Dakota,Ohio, Oregon, South Dakota,Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. 8. See http://www.dhs.state .us c s/groups/webcontent/documents/report/c_102850.pdf. This was report prepared under contract#HHSP23320100021W1 between the U.S. Department of p p Health and Human Services (HHS), Office of Disability,Aging and Long-Term Care Policy (DALTCP) and Research Triangle Institute. For additional information about this subject,you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability ging-and-long-term-care- policy-daltcp or contact the ASPE Project Officer, Emily Rosenoff, at HHS/ASPE/DALTCP, Room 424E,H.H. Humphrey Building,200 Independence Avenue, S.W.,Washington,D.C. 20201. Her e-mail addresses is: Emily.Rosenoff@hhs.gov. T�1 t 4 { , 1 KANE,NORBY&REDDICK, P.C. ATTORNEYS Brian J.Kane 2100 ASBURY ROAD,SUITE 2 ' 3 j.c Les V.Reddick DUBUQUE,IA 52001-3091 Brad J.Heying _ Todd L.Stevenson" Kevin T.Deeny"" Re-chid: d: BradleyB.Kane GaryK.Norby P.Kane Nicholas J.Kane David J.Kane All admitted in Iowa Phone: (563)582-7980 "Also admitted in Illinois Facsimile: (563)582-5312 ''*Also admitted in Wisconsin E-mail:bkane@kanenorbylaw.com September 14, 2023 OBJECTION Honorable Mayor& City Council City Hall 50 West 13th Street Dubuque, IA 52001 Re: Rezoning—Traditional Applicant: William R.Biver,Mary's Inn Maternity Home Location: 1749 Churchill Drive (PIN 1022379005 and 1022379004) Description: To rezone property from R-1 Single-Family Residential to R-3c Moderate Density Multi-Family Residential with conditions Dear Mr. Mayor and Members of the Dubuque City Council: We are counsel for John and Ann Riley (hereafter the "Rileys"), who have resided at the address locally known as 1733 Eden Lane, Dubuque, IA 52001, since 1985. Their residence of 38 years places them directly across the street to the south of the parcels for which rezoning is sought by Mary's Inn Maternity Home. Last week, on September 6, 2023, the Zoning Advisory Commission (ZAC) held a public hearing on the above-referenced application to rezone 1749 Churchill Drive, as well as a neighboring parcel to the north of said residence, from R-1 Single- Family Residential District to an R-3 Moderate Density Multi-Family District. Despite objections from the Rileys and a number of their neighbors,which objections were wholly supported by Iowa law, the ZAC voted in favor of the application 3 to 2. We understand the application will now proceed to a public hearing before the City Council of the City of Dubuque, Iowa at its meeting scheduled for Monday, September 18, 2023. The undersigned requests that you include this letter in your record of the meeting scheduled for Monday, September 18, 2023. The Rileys' objections, as well as the objections of many of their neighbors, are supported by the applicable Iowa laws, including controlling Supreme Court of Iowa case law authorities, with respect to this type of rezoning application. Therefore, we respectfully request that the City Council of the City of Dubuque, Iowa deny this application for the following reasons: KANE,NORBY & REDDICK, P.C. September 14, 2023 Page 2 (1) As other objectors have noted, including Attorney Steve Juergens, who submitted an objection letter as part of the record of the September 6,2023 ZAC meeting,a"maternity home" is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District. In that regard, we would direct your attention to the applicable provisions of the City Code. We attach the applicable provisions of Chapter 5 of the Unified Development Code regarding zoning districts hereto for your reference. "Maternity home" is not included in any of these provisions. (2) The applicant purports that Mary's Inn is a "group home" constituting a permitted F conditional use in an R-3 District; however, at this time we are not aware of any underlying Iowa authority which supports the notion that this type of business which provides temporary support for these women and children actually qualifies as a group home as a matter of law. Group homes, in contrast to Mary's Inn, are permanent places of abode for their residents. For example, Iowa Code §231B governs "elder group homes," Iowa Code § 135C.4 governs "residential care facilities,"and Iowa Admin. Code 661-202.5 governs small group homes for specialized licensed facilities.In each case, residential services(sometimes in conjunction with healthcare services)are provided on a permanent basis—these are not transient guests like those staying at Mary's Inn, an important distinction. We note that the Rezoning Staff Report includes the City of Dubuque's definition of"group home" in footnote 1 on page 3 of said report. "Group home" is defined by the City of Dubuque, per Chapter 2 of the Unified Development Code, as "[a]ny group of persons not meeting the definition of "family" and occupying a single dwelling unit living together as a single housekeeping unit, but not including a boarding or rooming house." It is a leap to suggest that Mary's Inn which, according to its executive director, has served approximately 60 mothers and their children over an eight-year period, with stays that have averaged three to four months (but that have ranged anywhere from one month to eighteen months), constitutes a "group of persons...living together as a single housekeeping unit." On the contrary, Mary's Inn is arguably more akin to a boarding or rooming house, which is specifically excluded from the definition of "group home." Though presented with this distinction between "maternity home" and "group home" by multiple objecting parties, the ZAC apparently decided, as expressed by Chair Mulligan at the public hearing last week, that because Mary's Inn was treated as a "group home" by the ZAC at prior proceedings in 2015 that there is"precedent that the ZAC can rely upon"(to paraphrase Chair Mulligan). We would argue, however, that the ZAC's misinterpretation of the term"group home" in a public hearing that took place eight years ago is not a license to carry that misinterpretation forward to present and future public hearings before the ZAC and the City Council-especially when the distinction has been made clear by the objecting parties. (3) Nevertheless, even if the City Council concurs with the ZAC that there is no distinction between a maternity home and a group home for the purposes of these proceedings (a position with which we strongly disagree), pursuant to a bevy of controlling Iowa case law authorities, the proposed rezoning of the property at issue would be prohibited"spot zoning" and, therefore, invalid. As a general rule, the Supreme Court of Iowa has held that the "[a]ction of imposing restrictions that do not bear alike on all persons living in the same territory under similar KANE,NORBY& REDDICK,P.C. September 14, 2023 Page 3 conditions and circumstances is discriminatory and will not be upheld...That a zoning statute must be impartially applied to all properties similarly situated is beyond dispute." See,Keller v. City of Council Bluffs, Iowa, 246 Iowa 202,213 (Iowa 1954). The Keller Court further opined that"spot zoning when construed to mean reclassification of one or more like tracts or similar tracts for a use prohibited by the original zoning ordinance and out of harmony therewith is illegal."Id.According to the Supreme Court of Iowa, "there must be substantial and reasonable grounds or basis for the discrimination, when one lot or tract is singled out in an amendatory ordinance removing therefrom restrictions imposed upon the remaining portions of the same zoning district."Id. at 214."When the tract is shown to be clearly different in character or use from those around it, discrimination may be legally justified." Id. This exception clearly does not apply in the present case, where the property at issue is not clearly different in character or use from those around it—it has been a part of a single family, owner occupied residential neighborhood for many decades. Additionally, given the "horseshoe" shape of the neighborhood, this particular centrally located residence is inarguably the focal point of the entire neighborhood,with many residences facing these particular parcels. Other more recent cases also illustrate that spot zoning would not be appropriate under the circumstances. In Kane v. City Council of City of Cedar Rapids,537 N.W.2d 718,723 (Iowa 1995), the Supreme Court of Iowa reiterated the Keller standard while also opining: "Spot zoning results when a zoning ordinance creates a small island of property with restrictions on its use different from those imposed on the surrounding property." Spot zoning is not automatically invalid. If it is germane to an object within the police power and there is a reasonable basis to treat the spot-zoned property differently from the surrounding property, the spot zoning is valid. In determining whether there is a reasonable basis for spot zoning, we consider the size of the spot zoned,the uses of the surrounding property,the changing conditions of the area,the use to which the subject property has been put and its suitability and adaptability for various uses."(citing Little v. Winborn, 518 N.W.2d 384,387(Iowa 1994). In Residential and Agricultural Advisory Committee, LLC v. Dyersville City Council, 888 N.W.2d 24,45-46(Iowa 2016),the Supreme Court of Iowa again discussed the issue of spot zoning and held: "Spot zoning is the creation of a small island of property with restrictions on its use different from those imposed on surrounding property."Perkins, 636 N.W.2d at 67. Not all spot zoning is illegal,however, and we have created a three-prong test for determining whether spot zoning is valid. Id. Under this test, we consider whether the new zoning is germane to an object within the police power; (2) whether there is a reasonable basis for making a distinction between the spot zoned land and the surrounding property; and (3) whether the rezoning is consistent with the comprehensive plan. Id; see also Little v. Winborn, 518 N.W.2d 384, 388 (Iowa 1994). When there is spot zoning, "there must be substantial and reasonable grounds or basis for the discrimination when one KANE,NORBY& REDDICK, P.C. September 14, 2023 Page 4 lot or tract is singled out."Perlcins, 636 N.W.2d at 67 (quoting Fox v. Polk Civ. Bd. of Supervisors, 569 N.W.2d 503, 509 (Iowa 1997), overruled in part on other grounds by Sutton, 729 N.W.2d at 799)." (Emphasis added.) The proposed application to rezone fails the second a third tests, respectively. Representatives for Mary's Inn have failed to show (i) a reasonable basis for making a distinction between the spot zoned land and the surrounding property; and (ii) that the rezoning is consistent with the comprehensive plan. They cannot do so because there is no reasonable basis for making a distinction between 1749 Churchill Drive and the rest of the surrounding neighborhood. This has been a fully established R-1 single family residential neighborhood for over sixty years, and arguably for even longer (the subject property itself was built in 1876). There is no reasonable basis for singling out this property. In fact, as others have noted, in March of 2010, the City of Dubuque Zoning Board of Adjustment voted unanimously (3-0) to deny an application to convert a portion of the property(referred to as the"cottage house") into an accessory dwelling unit which would be rented out to unrelated third parties. That Board wisely voted to preserve the character of the neighborhood at that time, and the City Council should now do the same. Despite the fact that the undersigned emphasized the proposed rezoning would be invalid spot zoning at the ZAC meeting last week, it apparently was disregarded by the ZAC. Not one of the Commissioners, in particular those voting in favor of the application,made any mention of the spot zoning issue in their commentary prior to voting on a motion to approve the application. To disregard controlling Supreme Court of Iowa case law authority in arriving at their votes is, quite frankly, arbitrary and capricious and an abuse of discretion on the part of the ZAC. Much of the public hearing before the ZAC was misspent discussing the nature of Mary's Inn and their mission. As the undersigned related to the ZAC, Mary's Inn's mission is not debated—it is certainly a noble and admirable operation. The issue is where they want to operate and how they want to go about it. To disregard the legal issues at play in order to help this organization just because one supports the mission of Mary's Inn is plainly discrimination—it would be equally discriminatory voting practice to deny the application of a business whose mission the City Council does not support. Thus, it is imperative that the City Council focus solely on whether it is appropriate to rezone 1749 Churchill Drive from an R-1 Single-Family Residential classification to an R-3 Moderate Density Multi-Family classification. In light of the foregoing Iowa law, including controlling Supreme Court of Iowa case law authorities, the answer is a resounding no—this is not an appropriate location for this maternity home and any rezoning of this property to accommodate Mary's Inn is discriminatory and not supported by Iowa law. (4) In addition to the foregoing legal arguments, the Rileys wish to echo the concerns of many of their neighbors who are also objecting to this application, which concerns include but are not limited to the following: (a) Most residents in this neighborhood have concerns about the future use of these parcels if they are rezoned to an R-3 classification. Mary's Inn has operated out of its current Balboa Drive location for approximately 8 years and now seeks to move. What happens when, in the event Mary's hui's application does succeed, Mary's Inn decides to move out of the 1749 Churchill Drive location at some undetermined future date? The City would be opening the door KANE,NORBY& REDDICK, P.C. September 14, 2023 Page 5 for a variety of uses which do not belong in this neighborhood and would not be consistent with Ii the comprehensive plan. In response to these concerns, the ZAC and the applicant apparently concurred that approval of this rezoning could be conditional in that aspect and agreed that in the event Mary's Inn sells 1749 Churchill Drive at a later date, that the property would revert back to an R-1 classification. This logic fails for two reasons: (i) even if the property does revert back to an R-1 classification, the neighborhood has no assurance that a future titleholder of the property would not succeed on its own application to rezone the property for whatever use it has in mind; and(ii) the apparent notion, according to the ZAC's comments, that the City would accommodate the rezoning only until Mary's Inn decides to sell the property is evidence of discrimination in and of itself. What legal justification is there for the City to rezone this property for Mary's Inn and to bar all other rezoning applicants thereafter with respect to this same property (applicants who, unlike Mary's Inn,might hypothetically seek to use the property for a principal permitted use or a permitted conditional use—a"maternity home,"on the other hand,is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District)? The answer is that there is no legal justification for any such discrimination in favor of Mary's Inn. (b) Other miscellaneous concerns of the neighborhood include concerns about the property values and marketability of the surrounding homes in the neighborhood; concerns about an increase in traffic(especially in a neighborhood with so many young children that play near the property at issue); concerns about the uncertainty created about the future use of the property(by Mary's Inn,who could reasonably be expected to expand their operations with a new,bigger space, but also by future property owners); general cosmetic concerns(what does this do to the"look"of the neighborhood when a business is essentially operating out of the focal point of the entire neighborhood?); the potential for other adjacent or nearby parcels to be rezoned to further deteriorate the character of the neighborhood (the City cannot realistically offer any assurances in this regard short of admitting illegal discrimination in favor of Mary's Inn); and general concerns that this rezoning will in any way interfere with the Rileys' and other neighborhood residents' vested property rights and the quiet use and enjoyment of their property as they have all long grown accustomed to. We respectfully request that the City take these concerns of the Rileys and their neighbors under careful consideration. We also note that, to the extent any Council Member is unmoved by these more personal concerns,the City Council of the City of Dubuque,Iowa should still deny this application on the following legal basis: (1) A"maternity home"is not a principal permitted use or a permitted conditional use in either an R-1 District or an R-3 Moderate Density Multi-Family District. (2) The applicant purports that Mary's Inn is a"group home" constituting a permitted conditional use in an R-3 District; however, the distinction between a "maternity home" and "group home" is clearly described above. KANE, NORBY & REDDICK, P.C. September 14, 2023 Page 6 (3) Even if the City Council concurs with the ZAC that there is no distinction between a maternity home and a group home for the purposes of these proceedings (a position with which we strongly disagree), the above-cited Iowa case law authorities make it abundantly clear that the proposed rezoning of the property at issue would be prohibited "spot zoning" and, therefore, invalid. Therefore, as a matter of law, the City Council of the City of Dubuque, Iowa should deny this application. Please do not hesitate to contact us directly should you have any questions. Thank you. Best regards, KANE,NORBY & REDDICK, P.C. rt ByeAir Brian J. K Enclosures cc: Mr. and Mrs. John W. Riley 8/30/23,8:19 AM https://export.amlegal.com/api/export-requests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 16.5-2::R-1 SINGLE-FAMILY RESIDENTIAL:. The R-1 district Is the most restrictive residential district and is Intended to protect low density residential areas from the encroachment of incompatible uses.The principal use of land In this district Is for low density single-family dwellings and related recreational,religious and educational facilities.(Ord. 52-09,10-19-2009) 16-5-2-1: PRINCIPAL PERMITTED USES: The following uses are permitted in the R-1 district: Cemetery,mausoleum,or columbarium. Community gardens. Golf course. Parks,public or private,and similar natural recreation areas. Place of religious exercise or assembly. Public,private or parochial school approved by the state of Iowa(K-12). Railroad or public or quasi-public utility,including substation. Single-family detached dwelling.(Ord.52-09, 10-19-2009;amd.Ord.17-13,3-18-2013;Ord.19-20,5-18-2020) 16-5-2-2:CONDITIONAL USES: The following conditional uses may be permitted in the R-1 district,subject to the provisions of section 16-8-5 of this title: Accessory dwelling unit. Bed and breakfast home. Keeping of horses or ponies. Licensed adult day services. Licensed childcare center. Mortuary,funeral home,or crematorium. Off street parking. Tour home. Tourist home. Wind energy conversion system.(Ord.52-09, 10-19-2009;amd.Ord.66-14, 11-17-2014) 16.5.2.3:ACCESSORY USES: The following uses are permitted as accessory uses as provided in section 16-3-7 of this title: Detached garage. Fence. Garage sale,provided that not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)consecutive days per sale. Home based business. Keeping of hens for egg production. Noncommercial garden,greenhouse or nursery. Off street parking and storage of vehicles. Satellite receiving dish. Solar collector(freestanding arrays are limited to not more than 100 aggregate square feet and 10 feet in height). Sport,recreation,or outdoor cooking equipment. Storage building. Tennis court,swimming pool or similar permanent facility. Wind turbine(building mounted).(Ord.52-09, 10-19-2009;amd.Ord.47-14,7-21-2014;Ord.54-15,8-17-2015) 16-5-2-4:TEMPORARY USES: Temporary uses shall be regulated in conformance with the provisions of section 16-3-19 of this title.(Ord.52-09, 10-19-2009) 16.6.2.5:PARKING: Minimum parking requirements shall be regulated in conformance with the provisions of chapter 14 of this title.(Ord.52-09,10-19-2009) 16-5-2-6:SIGNS: Signs shall be regulated in conformance with the provisions of chapter 15 of this title.(Ord.52-09,10-19-2009) 16-5-2-7: BULK REGULATIONS: Minimum Maximum Setbacks Minimum Lot Maximum R-1 Residential Lot Front Lot Area Coverage Minimum Minimum Height Frontage (Lot Area) Mlnimum2 Maximum Side Rear g https://export.amlegal.com/api/export-requests/d2476f8b-d4b2-47f1-a23f-3049741983b0/download/ 1/2 8/30/23,8:20 AM https://export.amlegal.com/api/export-requests/b6f7027a-92ed-4ab0-88b4-c6cfa7bda29e/download/ 16-5-5:R-3 MODERATE DENSITY MULTI-FAMILY RESIDENTIAL: The R-3 district Is intended to provide locations for a variety of dwelling types ranging from single-family to low rise multi-family dwellings.The R-3 district also serves as a transition between residential and nonresidential districts.(Ord.52-09,10-19-2009) 16-5-5-1:PRINCIPAL PERMITTED USES: The following uses are permitted In the R-3 district Cemetery,mausoleum,or columbarium. Community gardens. Golf course. Multi-family dwelling(maximum 6 dwelling units). Parks,public or private,and similar natural recreation areas. Place of religious exercise or assembly. Public,private,or parochial school approved by state of Iowa(K-12). Railroad or public or quasi-public utility,including substation. Single-family detached dwelling, Townhouse(maximum 6 dwelling units). Two-family dwelling(duplex).(Ord.52-09,10-19-2009;amd.Ord.17-13,3-18-2013;Ord.19-20,5-18-2020) 16-6-5-2:CONDITIONAL USES: F The following conditional uses may be permitted in the R-3 district,subject to the provisions of section 16-8-5 of this title: Accessory dwelling unit. Bed and breakfast home. Group home. Hospice, Housing for the elderly or persons with disabilities. Individual zero lot line detached dwelling. Licensed adult day services. Licensed childcare center. Mortuary,funeral home,or crematorium. Nursing or convalescent home. Off premises residential garage. Off street parking. Rooming or boarding house. Tour home. Tourist home. Wind energy conversion system.(Ord.52-09,10-19-2009;Ord.20-22,5-20-2022) 16-5-5-3:ACCESSORY USES: The following uses are permitted as accessory uses as provided in section 16-3-7 of this title: Detached garage. Fence. Garage sale,provided that not more than three(3)such sales shall be allowed per premises per calendar year and not more than three(3)consecutive days per sale. Home based business. Keeping of hens for egg production. Noncommercial garden,greenhouse or nursery. Off street parking and storage of vehicles. Satellite receiving dish. Solar collector(freestanding arrays are limited to not more than 100 aggregate square feet and 10 feet in height). Sport,recreation,or outdoor cooking equipment. Storage building. Tennis court,swimming pool or similar permanent facility. Wind turbine(building mounted).(Ord.52-09,10-19-2009;amd.Ord.47-14,7-21-2014;Ord.54-15,6-17-2015) 16-6.6-4:TEMPORARY USES: Temporary uses shall be regulated in conformance with the provisions of section 16-3-19 of this title.(Ord.52-09, 10-19-2009) 16-5-5-5:PARKING: Minimum parking requirements shall be regulated in conformance with the provisions of chapter 14 of this title.(Ord.52-09,10-19-2009) 16-5-5-6:SIGNS: Signs shall be regulated in conformance with the provisions of chapter 15 of this title,(Ord.52-09,10-19-2009) https://export.amlegal.com/api/export-requests/b6f7027a-92ed-4ab0-8864-c6cfa7bda29e/download/ 1/3 STATE OF IOWA SS: DUBUQUE COUNTY CERTIFICATE OF PUBLICATION I, Kathy Goetzinger, a Billing Clerk for Woodward Communications, Inc., an Iowa corporation, publisher of the Telegraph Herald, a newspaper of general circulation published in the City of Dubuque, County of Dubuque and State of Iowa; hereby certify that the attached notice was published in said newspaper on the following dates: 09/08/2023 and for which the charge is 47.47 Subscribed to efore me, a Notary Pub is in and for Dubuque County, Iowa, this 8th day of September, 2023 Notary P v in and for Dubuque County, Iowa. JANET K. PAPE y Commission Number 199659 My Commission Expires 12111 /2025 Ad text : CITY OF DUBUQUE, IOWA OFFICIAL NOTICE PUBLIC NOTICE is hereby given that the Dubuque City Council will conduct public hearings on the 18th day of September, 2023, at 6:30 p.m., in the Historic Federal Building, 350 W. 6th Street, 2nd floor, Dubuque, Iowa, on the following: REZONINOS 1, Request from William R. Biver, Marys Inn Maternity Home to rezone property located at 1749 Churchill Drive from R-1 Single -Family Residential to R-3c Moderate Density Multi -Family Residential with conditions, 2, Request from Cory Ranson to rezone property located at 25 Bissell Lane from OR Office Residential to C-3 General Commercial. 3. Request from Richard Sova; Landover Corporation to rezone property located at Radford Road from Planned Unit Development with PC - Planned Commercial designation to OC Office Commercial, 4, Request from Kim Adams, DuTrac Community Credit Union to rezone property located at 3465 Asbury Road from Planned Unit Development with PC - Planned Commercial designation to C-3 General Commercial 5. Request from Capra Bank to amend the Unified Development Code to allow Drive -Up Automatic Bank Teller as a Permitted Use in the C-3 General Commercial zoning district, as a Conditional Use in the C-4 Downtown Commercial zoning district, and to establish signage regulations for a Drive -Up Automatic Bank Teller use. At the meeting, the City Council will receive oral and written comments from any resident or property owner of said City on the above action. The official agenda will be posted the Friday before the meeting and will contain public input options. The City Council agenda can be accessed at https://cityoRlubuque.novusagenda.com/AgendaPublic/ Written comments regarding the above public hearings may be submitted to the City Clerk's Office via email at ctyclerk©cityofdubuque.org or by mail to City Clerk's Office, City Hall, 50 W, 13th St., Dubuque, IA 52001, or by contacting the City Clerk's Office at 563-589-4100 before said time of public hearing. At the said time and place of public hearings the City Council will receive any written comments, Copies of supporting documents for the public hearings are on file in the City Clerk's Office and may be viewed Monday through Friday between 8:00 a.m, and 5:00 p.m. Individuals with limited English proficiency, vision, hearing, or speech impairments requiring special assistance should contact the City Clerk's Office at (563) 589-4100, ctyclerk©cityofdubuque.org as soon as feasible, Deaf or hard -of -hearing individuals can use Relay Iowa by dialing 711 or (800) 735-2942. Trish L. Gleason, Assistant City Clerk It 9/8 STATE OF IOWA SS: DUBUQUE COUNTY CERTIFICATE OF PUBLICATION I, Kathy Goetzinger, a Billing Clerk for Woodward Communications, Inc., an Iowa corporation, publisher of the Telegraph Herald, a newspaper of general circulation published in the City of Dubuque, County of Dubuque and State of Iowa; hereby certify that the attached notice was published in said newspaper on the following dates: 09/27/2023 and for which the charge is 23.18 Subscribed to be f e me, a Notary Public in and for Dubuque County, Iowa, this 27th day of September, 2023 Notary in and for Dubuque County, Iowa. 0Pst/A a /OWk JANET K. PAPE r Commission Number 199659 • My Commission Expires 12/11/2025 Ad text OFFICIAL PUBLICATION ORDINANCE NO, 39 - 23 AMENDING TITLE 16 OF THE CITY OF DUBUQUE CODE OF ORDINANCES, UNIFIED DEVELOPMENT CODE, BY RECLASSIFYING HEREINAFTER DESCRIBED PROPERTY LOCATED AT 1749 CHURCHILL DRIVE FROM R-1 SINGLE-FAMILY RESIDENTIAL DISTRICT TO R-3C MODERATE DENSITY MULTIPLE -FAMILY RESIDENTIAL DISTRICT WITH CONDITIONS AS ESTABLISHED IN THE ATTACHED MEMORANDUM OF AGREEMENT NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. That Title 16 of the City of Dubuque Code of Ordinances, the Unified Development Code, is hereby amended by reclassifying the hereinafter -described property from R-1 Single -Family Residential district to R-3c Moderate Density Multiple -Family Residential district with conditions, to wit: Lot 1 of Block 6 of Churchill Heights Subdivision, in the City of Dubuque, Iowa, according to the recorded plats thereof, subject to easements of record and to the centerline of the adjoining public right-of-way, all in the City of Dubuque, Iowa. Section 2. That the foregoing amendment has heretofore been reviewed by the Zoning Advisory Commission of the City of Dubuque, Iowa. Section 3. This Ordinance shall take effect immediately upon publication, as provided by law. Passed, approved, and adopted this 18th day of September 2023. /s/Brad M. Cavanagh, Mayor Attest:/s/Trish L. Gleason, Assistant City Clerk Published officially in the Telegraph Herald newspaper on the 27th day of September, 2023, /s/Trish L. Gleason, Assistant City Clerk it 9/27