What is Adult Foster Care?

Adult Foster Care is a setting in a home or facility where adults receive supervision, personal care and protection.

Foster Care - the provision of supervision, personal care and protection in addition to room and board for 24 hours a day, 5 or more days a week and for 2 or more consecutive weeks for compensation provided at a single address.

Supervision – guidance of an individual in the activities of daily living, including reminding them of important activities and appointments, scheduled medications, and being aware of the individual’s general whereabouts even if they may travel independently in the community.

Personal care – assistance with dressing, personal hygiene, grooming, maintenance of a medication schedule, or the development of those personal and social skills required to live in the least restrictive environment.

Protection – actions taken to insure the health, safety, and well-being of an individual, including protection from physical harm, humiliation, intimidation and social, moral, financial and personal exploitation.

Room and Board – provisions of housing and meals. Room could be a bedroom, an apartment, a suite, etc. Board is any involvement in the purchase or preparation of meals.

Types of Adult Foster Care

There are different types of Adult Foster Care homes depending on the number of individuals receiving care in the home, what types of services are provided and whether or not the licensee lives in the home.

A licensee is the person that has been issued a license to operate the Adult Foster Care home.

Adult Foster Care Family Home is a private residence with the approved capacity of 3-6 individuals that are living in the home and receiving care. In this type of setting the licensee must also live in the home.

Adult Foster Care Small Group Home is a home or facility that has the approved capacity of 3-12 individuals that are living in the home and receiving care. There will always be caregivers in the home to attend to the individuals needs but the caregivers do not live in the home.

Adult Foster Care Large Group Home is a home or facility that has the approved capacity of 13-20 individuals that are living in the home and receiving care. There will always be caregivers in the home to attend to the individuals needs but the caregivers do not live in the home.

Who regulates Adult Foster Care Homes?

Adult Foster Care homes in Michigan are licensed and regulated by the Michigan Department of Licensing and Regulatory Affairs (LARA) Bureau of Community and Health Systems (BCHS).

There are no national guidelines for this type of home so licensing rules and regulations vary by state. In the state of Michigan on site inspections are made by a licensing consultant to ensure that the licensee is in compliance with all the rules and regulations in operating an Adult Foster Care Home. These inspections consist of reviewing all business operating statements, financial statements, personnel policies, routine procedures, resident files, employee files, menus, schedules, fire drills etc. The licensing consultant also speaks with employees, residents of the home and any other visitors that are in the home to get a feel for how they believe the home is ran.

Services available in Adult Foster Care Homes?

The type of individuals that Adult Foster Care services are available for are those that are aged, mentally ill, developmentally disabled or physically disabled. These individuals require supervision on an ongoing basis but not continuous nursing care, although they can receive nursing services or hospice care from an outside agency.

Each Adult Foster Care home can differ in the services that are provided depending on how the home is managed and what type of individuals they provide service to. Some will provide additional services as an individual’s health needs change while others prefer that individuals function somewhat independently and will suggest alternative placement should physical or cognitive health decline.

Some Adult Foster Care homes have staff that work 8 hour shifts while others have staff that work more than 24 hours on duty being able to sleep during the night hours.

Most Adult Foster Care homes share the same common philosophy of providing personalized supportive assistance with social interaction and assistance with activities of daily living in a home like environment. Activities of daily living consist of the following:

· Personal hygiene - bathing/showering, grooming, nail care, oral care

· Dressing – ability to make appropriate clothing decisions, physically dress/undress

· Eating – ability to feed self, capability to prepare food

· Maintaining continence – mental and physical capacity to use a restroom, including the ability to get on and off the toilet and cleaning self

· Transferring/Mobility – moving oneself from seated to standing, getting in and out of bed, the ability to walk independently from one location to another

In addition to the assistance of activities of daily living some Adult Foster Care homes offer a wide range of services that monitor an individual’s health and well-being including managing medical appointments and administering medications.

What is required?

(Pertaining to the licensing rules and regulations in the state of Michigan.)

Prior to the final decision of an individual moving in to an Adult Foster Care home it is important that a written assessment is completed to determine that the home can meet the individual’s needs. (Unless an emergency admission takes place then the written assessment must be completed within 15 days of admission.) Also at the time of admission the following is required:

· A written resident care agreement which will outline the services provided along with the fee for service including any additional costs to the basic fee if any. This care agreement will outline responsibilities of both the licensee and resident and/or their designated representative, how funds will be handled and how transportation will be provided.

· Licensee must provide the resident and/or their designated representative a copy of the admissions policy, discharge and refund policy along with a copy of the resident’s rights and responsibilities.

· At the time of admission a health care appraisal is required that has been completed within the 90 day period prior to the residents admission. (If a health care appraisal has not been completed it must be obtained no later than 30 days after admission.)

· Must provide written physician orders for any current medications the resident will be taking while in the Adult Foster Care home, including over the counter medications.

· Along with any other agreements, legal forms, advanced directives, forms or special requirement documents that may need to be completed at admission.

Cost of Adult Foster Care Services

Just as the services that are provided, the cost of care in Adult Foster Care homes will vary as well. The licensee is able to set up the care cost and can reflect the cost based on the care provided. Some homes have all-inclusive prices and others may have fees for different services.

Typically the cost of care in Adult Foster Care homes include room and board along with the care that is provided. Unlike traditional Assisted Living Facilities where you have what is called an a-la-carte package and the care components often are priced separately.

Actually Adult Foster Care can be a better option as the cost can be less than other options available, especially for someone that has Alzheimer’s or other forms of dementia.

In 2019 rates for Assisted Living Facilities and Adult Foster Care in Michigan range from $2,225.00 to $5050.00 per month, ($74.00 to $168.00 per day) with cost for dementia related care being approximately $1,155.00 more per month ($39.00 more per day).

Nursing Home rates range from $261.68 to $421.30 per day.

Home Care rates average from $13.66 - $22.44 per hour.

Adult Day Care rates range from $80.00 - $115.00 per day.

Medicare provides no financial assistance for Adult Foster Care, although Medicare does continue to pay for in-patient care, medical appointments and prescription coverage as it would if someone was living in their own home.

Most Adult Foster Care Homes are private pay although some do accept state Medicaid waiver programs for payment under the banner of MI choice.

Other resources that some might use to cover the cost of Adult Foster Care are as follows:

· Long term care insurance

· Veterans Benefits

· Proceeds from Real Estate sale

· Bridge Loan

· Reverse Mortgage Loan

· Life Insurance

· Financial help from family

Why choose Adult Foster Care?

This is often a decision a family may not even have thought about until a health crisis has occurred and the realization that a loved one can no longer live alone. Trying to make an appropriate decision can be very complicated especially when it involves an individual with fragile health or cognitive impairment.

It is normal to gravitate to big new buildings with all the fancy amenities but what can be more important is the size and atmosphere of the home or facility, number of residents being cared for (resident to staff ratio) and what kind of caregivers will be providing the care to your loved one.

Adult Foster Care can be one of the best options for some because it is a home-like atmosphere with personalized care where each resident will get more staff attention because there are fewer residents. It is an ideal setting for those that cannot live independently but do not like the idea of a large institutional setting. For those with dementia, living in a smaller place with fewer people can reduce anxiety and stress. They’ll get care from a few staff members who can get to know their specific needs.

Some Adult Foster Care homes will allow an individual to stay in place even as their health care and needs change allowing other services to come in and help provide additional care such as Home Care and Hospice Services, which are generally covered by Medicare insurance.

Adult Foster Care Homes can be an ideal alternative for those requiring 24 hour care. As with everything , there are well managed homes that provide quality care just as there are homes that are not managed as well. It is important that you search, compare, ask questions and know what to look for.

(Watch for “What to look for when looking for a home?”)

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