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Adult Foster Care

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Your Guide to Adult Foster Care Homes

Adult foster care homes might also be called group adult foster care, adult foster care homes, or adult group homes.  They might also be known more formally as Adult Residential Care Homes (ARCH) or Elderly foster care.  These adult foster care homes are similar to assisted living, but with a few distinctions.

What are Adult Foster Care Homes?

Adult foster care homes (AFC) are single-family homes which house, feed and care for adult residents on a daily basis.  They are usually residential houses with shared living spaces, such as living and dining rooms, kitchens, and bathrooms.  Adult foster care homes are typically limited to 1-5 residents.  Personal services offered by onsite caregivers include help with bathing, dressing, eating, moving/mobility, recreation, housekeeping, laundry and transportation.

Adult foster care homes may or may not help with medication.  State guidelines establish what caregivers are allowed to do, or specifically prohibited from doing.

It’s important to realize that there is no federal standard for adult foster care homes.  These homes are subject to state-level licensing and requirements.

Many states use the licensing standard of a facility that “provides personal care, supervision, and protection” of unrelated people for compensation.  Common licensing requirements of adult care homes applicants include satisfactorily passing a criminal history check for caregivers, being of the age of 21, the physical home passing multi-tenant occupancy requirements and health inspection.

Some states require AFC home licensing applicants to have a doctor certify to the applicant’s health state and specifically clear of tuberculosis.  Commonly required is a written house guideline stating how the adult care home will operate.  An evacuation plan is also a regular requirement.

Some states require a minimum level of training or certification of caregivers.  This is usually tied to requirements or restrictions on actions or services able to be offered at different types of senior care homes.

Who lives in an Adult Foster Care Home?

A resident of an adult foster care home typically cannot live alone, but does not need continuous care.  Residents are often seniors, or persons who are physically or mentally disabled in some way that impedes daily activities.  Often an adult foster care home specializes care to meet a specific need.  This might be only seniors or only disabled, or mentally ill.

AARP estimates that 11 million Americans need help with daily activities and that number is expected to continue to grow, so both adult foster care homes and assisted living facilities are in high demand.

Adult Foster Care Homes vs Assisted Living

Adult foster care homes and assisted living are very similar and are often on par with the services provided.  Both offer aid with daily living needs, but adult foster care homes are in a more residential, homelike setting and are limited to 1-5 residents.  An assisted living facility does not have that minimum or maximum number of residents.  It’s important to know if your state makes this distinction when seeking financial assistance.

Both assisted living and adult foster care homes have caregivers that are available 24 hours a day, but there is a distinction.  Assisted living facilities are required to have caregivers awake and on duty 24 hours a day.  In most cases, adult foster care home caregivers live in the home also, so they are often available, but they do not have to be awake.  Assisted living staff does not usually live at the facility.

Adult Foster Care Homes vs Nursing Homes

Adult foster care homes are significantly different from nursing homes or skilled nursing facilities, in terms of residents, facility style, services provided and costs.

An adult foster care home is like living in a home.  Residents need daily help with things and can’t live on their own, but they do not require constant medical assistance.  On the other hand, a nursing home provides medical assistance.  Many residents in a nursing home not only need daily help and supervision, but medical care as well.  A nursing home is more like a hospital facility than a residential home.  A nursing home accepting Medicare must also meet federal guidelines, while adult foster care homes are only subject to state regulations.

Comparing Costs of Adult Foster Care

Paying for senior housing can be expensive and can be a shock to the budget.  Adult foster care is normally half the cost of a nursing home and still less than assisted living.  Pricing varies depending on geography and care needs, but costs are usually less expensive in the south and Midwest and more expensive in the northeast and west coast.

An adult foster care home usually charges $1,500 to $3,000 per month.  Some facilities might cost as much as $6,000 per month.  It’s important to note that this price normally includes daily care services as well as room and board.  Assisted living and nursing homes usually itemize services separately on an a la carte basis.

Paying for Adult Foster Care

Medicare is a federally administered program and adult foster care homes have no federal guidelines.  Medicare generally does not offer financial assistance for adult foster care, nor does supplemental or the PACE Program.  Medicare does not cover room and board charges, only care services.  It could still cover in-patient care, medical appointments and prescriptions if provided by an accepted provider outside the home, just like it would if a resident lived in a regular residence.

Medicaid is administered at a state level and therefore is more flexible and likely to offer financial assistance and programs to assist with adult foster care home costs.  Just like Medicare, Medicaid can only pay for the care services.  It will not cover room and board costs.

Some states offer Medicaid Waivers.  These waivers can specifically offer financial assistance for services provided outside of nursing homes, but there are often enrollment caps due to the budget constraints.  This can cause lengthy waiting lists.  Some states require a minimum number of residents to distinguish between adult foster care and assisted living facilities.  If no distinction is made in a state, it allows more flexibility of choice in using these assisted living waivers.

Some states offer Medicaid State Plans.  These are specific plans that have no enrollment caps and no waiting lists.  However, they are rare.

Some states offer Consumer Directed (CD) Waivers.  These are extremely rare, but provide a care budget to be spent at the consumer’s discretion.  It only pays for the care portion of services, but it allows the consumer to make more choices for seeking care and handling the costs.

Some states have started programs known as Nursing Home Diversion Programs.  These states have recognized the growing costs of nursing home costs and how they can quickly deplete a retirement fund.  These states have taken action to allow citizens more flexibility in seeking care and lowering costs, while still maintaining the quality care that is needed.

Veterans can access the Veterans Administration for specific care services.  The VA refers to adult foster care homes as Adult Family Homes.  The VA geriatric and extended care program does not cover a veteran’s rent, which is combined with care services, but it can cover the costs of having a nurse come to the home to provide additional services.  This can be helpful as veterans age and require additional care that adult foster care home caregivers are unable to provide as a standard.  This allows the veteran to delay a move to a more advanced care center, disturbing life, routine and budget.

Some states allow for family care.  This is where an aging adult moves into a home and is provided care by a family member.  State programs specifically exclude spouses from receiving reimbursement for costs or services provided.  State requirements differ, but it might be required to attain formal training or provide a designated 24-hour back-up to the caregiver residing in the care home.  Some states require the home to be legalized as an adult care home business which would make it subject to state regulations and safety inspections, as well as licensing fees.  It would then pay tax on any money received through state programs.

Adult foster care homes usually accept long term care insurance.  However, a resident should already be enrolled in this sort of insurance policy before moving to an adult foster care home.  Initiating a long-term care insurance policy after adult foster care is required can be cost prohibitive.

Choosing an Adult Foster Care Home

Choosing a home is a personal choice and often dependent on an individual’s situation.  Adult foster care homes are considered to be the most flexible and versatile in allowing seniors to maintain a homelike environment, while still receiving daily assistance.  It is also usually the most affordable option.

Many people will ask, “How do I find an adult foster care home near me?” When considering senior housing choices, it’s important to first know what is needed.  What services are needed on a daily basis or will be needed soon?  Moving at any age can be disruptive and stressful.  It’s a good idea to find a solution that will meet your needs for the foreseeable future to avoid costly moves and upheavals.

Because adult foster care homes are limited in size and staff, there often isn’t a budget or skills to create a sophisticated marketing plan to advertise availability.  Word of mouth or referrals are often how these homes are found.

Doctors, nurses, or social workers are good sources of quality referrals to adult foster care homes.  States often have elder care directories or agencies for the aging that are able to offer assistance in locating possible solutions.

Consider several options before deciding.  Compare services that are offered, setting of the home, and caregiver staff.  Just like a neighborhood is made up of many different lifestyles, adult foster care homes can vary.  Do not assume that they are all the same.  There will be different personalities and guidelines in each home.

Visit several homes to compare and assess compatibility.  It’s a good idea to take along a checklist to cover specific questions during your visit so you have the information to objectively review if a home meets your needs.

Regret and worry can wreak havoc if left alone.  You want to be confident in your choice.  Even if you are somewhat familiar with assisted living or nursing homes, you should visit at least one of each type of facility.  Any previous experience with senior housing was from a different perspective.  Visit an assisted living and nursing home.  This will help you see firsthand the significant differences in the setting and operation.

It’s tough to put a price on feeling at home, but finally you have to consider the cost.  Can you afford it?  Adult foster care homes are often the least expensive option available, but that doesn’t mean they don’t cost a good amount.  The average mortgage in America is around $1,100 per month.  Paying for a move to any senior housing option will affect the budget.  Are there programs and funds available to cover the costs?

Adult Foster Care Home Documents

It’s important to remember that there is no federal standard, so everything is overseen by individual states.  It’s important to know a state’s requirement before entering a housing agreement.

Some states do not require a contract or agreement when going to an adult foster care facility.  It is beneficial to have one to avoid disputes and misunderstandings, so most homes have some version even if not required.

Adult foster care contract should cover:

  • Services to be provided
  • Cost of services
  • Cost of additional services if needed
  • Rate of increase policy
  • Reasons for agreement termination
  • Discharge/voluntary move policy
  • Resident rights and obligations
  • House policies (access to home, etc.)
  • Grievance procedure
  • Resident personal storage policy
  • Refund and deposit policy

Some states don’t require a written care plan for residents of adult foster care homes.  Having this plan is beneficial because it clearly documents the needs of the resident and makes it known to the adult foster care home caregivers.  It then clarifies if needs cannot be met by the home or caregivers.  Depending on the state, this might include dispensing of medication.

There are many factors that make a good case for choosing adult group homes as a solution to senior housing.  Very high on the list of criteria are the facts that adult foster care homes are often the least expensive, yet least restrictive options available.  It is commonly agreed that a family like, homelike environment is “inherently superior” to institutional settings.

After considering all the criteria of location and services and costs, this is after all a home.  It’s hard to do a mathematical calculation on happiness and wellbeing.  Choosing a home is very personal.  What feels like home to you?  Where did you feel the most attention and genuine kindness?



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