Neighborhoods in Protest: Understanding Unlicensed and Unchecked Homes in Nevada
Across the state of Nevada, unlicensed and unregulated homes are increasingly operating within residential neighborhoods without licensure or oversight, taking over neighborhoods, and Nevada residents are asking why. Why are psychiatric patients allowed to be treated in homes in residential neighborhoods? Why are residential homes housing Nevada’s most vulnerable citizens in unsafe and unsanitary conditions? Why are group homes starting residential hospices and “encouraging” their residents to go there instead of legitimate hospice facilities? And why are our children still being shipped across state lines for psychiatric treatment?
The Problem
Unlicensed homes, overcrowded rentals, illegal short-term rentals, or properties violating safety codes can cause safety hazards, noise, and community disruption. Neighbors of these homes are left dealing with nightly police and emt visits, runaways trespassing their backyards, illegal activities, and fights heard throughout the neighborhood. Some short-term rentals have been reported to hold up to 16-18 people at a time. In Clark County alone, they anticipate responding to over 1100 short term rental complaints in 2025.
Neighbors can complain, but county officials are often left with tied hands due to the ADA and FHA (Fair Housing Act), which protects patients' rights to be allowed to be in residential areas and prevents discrimination against those with disabilities—ensuring that everyone has a right to live in good neighborhoods. However, the state that licenses these homes can shut them down if the operators are unable to properly manage the patients, and it becomes a danger to the neighborhood.
That is how the system should function. If an operator manages patients properly, the patients can be treated in any neighborhood, consistent with the ADA. But if the operator creates a danger, the state should intervene and shut the operator down.
The state of Nevada is more than capable of shutting down residential treatment facilities. Just earlier this month, state workers showed up to Moriah, a teenage residential treatment facility, and things escalated to the point where a “standoff occurred between state workers and staff.” However, Moriah states that the state unfairly targeted them while it continues to struggle to respond to complaints or maintain proper regulation of many of the other homes across Nevada.
The Evidence
In 2018, a state legislative audit revealed serious problems with the number of unlicensed homes in Nevada—many of which had no inspections, no regulations, and no support, despite housing clients with severe mental illness. After the damning report became public, state officials closed 18 state-regulated community-based living arrangement homes in 2018. News 8 reported on the ongoing problem in 2021, and no change was made then. Now, more than seven years later, documented complaints and whistleblower reports have not resulted in sustained enforcement action.
Since 2022, Nevada has been in trouble with the Department of Justice for violating the ADA and unnecessarily segregating children with behavioral health disabilities in institutional settings like hospitals and residential treatment facilities. Earlier this year, the state and the Department of Justice came to a settlement agreement to “allow Nevada’s children with behavioral health disabilities to access the services they need without being forced to leave their homes, schools, and communities.” However, progress has been slow, even with the DOJ checking in. Despite repeated audits, media investigations, and federal intervention, Nevada lacks a centralized system to track, inspect, and enforce compliance among residential group homes operating outside licensure.
As previously reported, “DHHS has not yet implemented the infrastructure necessary to regulate or track; they have failed to regulate or even track the growing number of unlicensed group homes across every Nevada county.” The Medicaid Fraud unit reports that one of their biggest problems is unlicensed facilities—group homes, sober living homes, residential psychiatric treatment homes—and they are preying upon Nevada’s most vulnerable citizens. In fact, many hospitals continue to discharge patients to these unlicensed homes without taking the due diligence to check whether they are licensed, let alone safe.
Setting up residential treatment facilities outside of our communities isn’t the answer. The notion of sending kids out of state is completely antithetical to quality care for kids because it doesn’t help Nevada develop needed resource and it retraumatizes the children and isolates them to be placed out of Nevada and so far from home.
Nevada needs more facilities capable of managing these patients without harming neighborhoods. The state ranks 51st in the Nation for youth mental health services and 50th on the Senior Living Report. If Nevada facilities are properly managed, everyone is okay. But when improperly managed in a peaceful neighborhood, neighbors have a right to be concerned, and families should have better care options in Nevada for their loved ones. The environment is ripe for bad actors who will exploit vulnerable citizens for financial gain. The good news is the state is taking those steps to revoke several homes with psychiatric patients where the operator is unable or unwilling to properly manage the patients. The bad news is that there aren’t enough beds, workforce, or resources to support the mental health crisis Nevada is facing.
The Solution
In January 2025, Gov. Joe Lombardo and the Nevada Department of Health and Human Services announced the launch of the Nevada Health Authority as part of Lombardo's reorganization of the state's health agency. Stacie Weeks is the director of the Nevada Health Authority, and she and Nevada lawmakers have been active in making changes to improve funding for youth residential mental health facilities in the state.
As of July 2025, Nevada's Bureau of Health Care Quality and Compliance (HCQC) streamlined Medicaid under the Nevada Health Authority, focusing on reducing costs and improving access, plus recent regulations for facility licensing. With these changes, the Nevada Medicaid Fraud Unit anticipates more oversight and has already seen improvement. However, 8 News reports that “Weeks also told legislators that policy changes and additional resources are needed” to improve regulation of these homes. While HCQC is responsible for licensing and compliance, enforcement actions frequently lag behind the volume of complaints, allowing unlicensed homes to continue operating without oversight. Moreover, having the same agency responsible for monitoring state-run facilities creates a clear conflict of interest and raises questions about impartial oversight.
Policymakers and advocates might be wondering what to do next. Some action items might include creating:
Mandatory public registry of licensed residential facilities
Cross-reporting requirements between hospitals, Nevada's ADSD , CPS, and HCQC
Increased funding for inspectors and unannounced site visits
Penalties for hospitals discharging patients to unlicensed homes
Meaningful reform will require statutory authority, adequate enforcement staffing, cross-agency data sharing, and accountability for facilities and referral sources that bypass licensing requirements.
Outside the state’s actions, Nevadans have stepped up to make these problems public so action and accountability can happen. The Nevada Citizens For Public Health Oversight and the soon-to-launch Four Horseman Media Group are designed to increase oversight and promote health and wellness across Nevada. As these stories continue to come to light, so will the need for oversight, accountability, and the change that Nevada desperately needs.
