Neighbors could hear yelps from inside a 10-by-10-foot shed behind a house on Grand Avenue in west Jackson on an October afternoon in 1982.
The location was a known unlicensed personal care home — facilities meant to care for adults, often with mental illness, who cannot live on their own, but which have never been regulated by any state agency.
Local police said they couldn’t enter without a warrant and called Mendal Kemp, then-chief of licensing for the Mississippi State Care Commission, the precursor to the Mississippi State Department of Health.
Kemp arrived and, finding the property locked, borrowed a ladder from a neighbor and scaled an eight-foot wooden fence.
He made it past two vicious guard dogs, opened the storage room door and found eight severely emaciated individuals sitting on a cot and on the floor around the dark, unlit room. There was no running water or electricity, and the owner had given the residents a bucket to use as a bathroom. One had sores all over his back, another was completely blind.
Kemp, his colleague from the Mississippi Department of Mental Health named Janne Patterson Swearengen and others spent four hours at the scene rescuing the individuals, who were transported to licensed facilities.
But the health officials were no strangers to these conditions. A few years earlier, the U.S. Supreme Court found state mental health hospitals could no longer hold nondangerous patients against their will, and thousands of patients from the nearby Mississippi State Hospital wound up in Jackson.
To answer, unlicensed personal care homes started cropping up, especially along West Capitol Street in large multi-story houses that had otherwise been abandoned, absent safety assurances like fire extinguishers or appropriate staffing.
“We couldn’t license them. So what do you do?” Kemp told Mississippi Today in a recent interview. “They couldn’t comply with any kind of standards. And these people were so helpless. They had been treated like dogs — ‘go lay down, stay in your room, don’t do this’ — and they’d been institutionalized for all this time, so they obeyed.”
Kemp’s office often received anonymous complaints about these facilities. His workers would go door to door and issue letters: get a license or close down.
“We’d go back, it’d be an empty house. She’d just moved down the street,” Kemp said.
The Grand Avenue discovery by Kemp and his colleagues made national news, resulted in the creation of the Coalition of Boarding Homes, and led to the passage of the Vulnerable Persons Act in 1986, which strengthened laws around protecting abused or neglected vulnerable adults.
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Forty years later, an underground network of unlicensed personal care homes in Jackson — and the horrors perpetuated against vulnerable residents living in some of them — persists.
In 2010, a woman living in an unlicensed personal care home in west Jackson died of hypothermia after being kept in a room with no heat and a broken window. In 2017, the health department raided three illegally-operating homes, finding that residents were living with no heat, toilets or bed linens, according to news reports. That home operator still has an active home health care business license. In 2021, three residents died after a man set fire to another unlicensed personal care home in north Jackson.
In January, Disability Rights Mississippi, a nonprofit and the state’s designated legal advocacy agency for people with disabilities, released a report detailing widespread misconduct in the industry of unlicensed personal care homes across Mississippi, where, unlike in other states, these facilities “have the ability to comfortably engage in illegal practices without the threat of licensing agencies penalizing them.”
State law requires that any home caring for more than four individuals not related to the homeowner be licensed by the Mississippi State Department of Health, adhering to a set of often costly safety requirements and inspections. Residents of these homes typically don’t need the level of care offered by a nursing home, but still need assistance to stay fed and bathed, take medicine, or get to and from appointments.
The health department licenses 11 of these homes in Jackson, according to an agency directory — down from 17 in 2017, according to the Clarion Ledger. The health department said in that time, smaller homes have been replaced with larger ones, so the reduction only accounts for a net loss of 15 beds.
Then there are unlicensed homes operating legally with fewer than four residents and those operating illegally with more than four residents – same as forty years ago. Disability Rights found that some owners try to skirt this rule, such as by placing residents in tents on their property, “to claim that only three people are ‘actually inside the house.’”
The Legislature saw a bill this session to get rid of this distinction, requiring homes with any patients to be licensed, but it quickly died.
There’s no way of knowing for sure how many of these homes are operating under the radar, but Disability Rights estimates there could be two to three times as many unlicensed homes as licensed.
Individuals living in these facilities often have nowhere else to go. They sometimes sign over their monthly SSI checks, $900 of federal assistance for people with disabilities and often their only income, to the homeowner in exchange for paltry services and little to no allowance. Disability Rights found a home caring for six individuals pulling $4,800 per month in rent, far above the market value for the property, and it did not have a smoke detector or sprinkler system.
“Operating these homes does cost money, but the inconsistency and lack of oversight for ensuring residents are receiving adequate care and provisions, after handing over most or the entirety of their limited funds, creates a breeding ground for financial exploitation,” the Disability Rights report reads.
Aurora Baugh, who spent most of her career at the Department of Mental Health, retiring several years ago as the Coordinator of the Division of Recovery and Resiliency, said her agency long quit discharging folks from the mental hospitals to unlicensed personal care homes — but low housing stock is one of the sector’s largest challenges. The agencies that transition people from institutions to the community, like the Department of Mental Health, but also the Department of Corrections, have a stake in the conditions of these facilities.
“They’re the ones who make the difference if people go to licensed or unlicensed, but if you only have (11 in Jackson), what are you going to do? Put them in a hotel?” Baugh said.
And to make matters more complicated, some residents may prefer the lax rules offered in the unlicensed homes, such as the ability to come and go as they please or smoke cigarettes, as opposed to strict conditions in place at some licensed facilities or nursing homes.
“They wanted the freedom, you know, after being housed (in hospitals) for so many years,” Swearengen said.
In exchange, the Disability Rights report identified what residents inside some of these homes are enduring: plastic coverings or boarded up windows, deadbolted doors, no electricity, exposed wiring, bathrooms ill-equipped for disabled residents, no washer, dryer or stoves, locked food pantries and improper cooling and heating to the point where one resident’s body temperature decreased to 78 degrees. Disability Rights found residents that had not been bathed, wearing the same clothes for days, and residents receiving only one meal a day.
Typically, the conditions inside these facilities aren’t brought to light until an incident involving law enforcement occurs or someone makes a complaint, like in the case of Grand Avenue in 1982.
But licensing officials aren’t exactly scaling fences today.
Frances Fair, director of health facility licensure and certification at the Mississippi State Department of Health, said the department’s surveyors – “current day superheroes” – hit the streets every week in tough circumstances to examine conditions and investigate complaints inside the homes licensed by the department.
“But we do need to do it legally, within the framework of our authority,” Fair said, which does not include the same treatment for unlicensed homes.
When the health department receives word of a home operating illegally, Fair said it turns the information over to the Office of the Attorney General, whose responsibility she said it is to investigate.
Michelle Williams, chief of staff for Mississippi Attorney General Lynn Fitch, said the office has received at least 10 of these complaints from the health department since January of 2024, and that the office does investigate in these instances to determine if abuse, neglect of exploitation is occurring. But Williams also said a home simply operating without a license isn’t a crime, that the attorney general’s office doesn’t pursue licensure, and the health department should seek administrative relief in those cases.
The AG’s office investigates thousands of cases of alleged adult abuse, neglect or exploitation each year — most of which do not rise to the level of criminal prosecution — but Williams said the office does not capture data to show how many of those incidents occurred inside personal care homes, licensed or unlicensed.
In the gap, Disability Rights has taken the steps it can, filing civil court complaints to force illegal homes in Jackson to become licensed or close down: four in 2022 and one in 2024.
“Even when these homes are closed, there are no safeguards in place to prevent operators from reopening a new UPCH (unlicensed personal care home) in a different location, leaving residents vulnerable to continued exploitation and neglect,” reads the Disability Rights report.
Fair said solving the issue of predatory unlicensed personal care home owners will require stakeholders to “follow the money.” In the case of residents signing over their SSI checks to the personal care homes, the business owners become the official “representative payee” in the federal government’s records.
“As long as people can make money off of vulnerable adults and say they’re going to take care of somebody, but then they take their checks and commingle those funds with their own personal funds and there’s not a lot of oversight on that, then that can be a problem,” Fair said.
Fair said several agencies have a role to play, such as the U.S. Social Security Administration, which administers the funds ultimately going to these business owners and should be auditing to ensure residents are treated fairly.
The descriptions of the unlicensed homes found today in Mississippi — “inhumane living conditions”, “neglect by other residents and staff”, “unsafe, unsanitary, and uncaring” — mirror language from Kemp’s old papers.
“They were in deplorable conditions and in great need of attention,” Kemp wrote after the incident on Grand Avenue, according to an Oct. 20, 1982, Mississippi Health Care Commission memo obtained by Mississippi Today.
“Things must be a lot better,” Kemp mused during his interview with Mississippi Today.
“I don’t know that they’re better,” Swearengen, his former colleague, responded.
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