Adult Care Homes, also called Adult Foster Homes, [ACH or AFH] are single family residences offering care to senior adults. They provide a home-like care setting. Care homes are usually located in residential neighborhoods and look like any other family home. The difference is that the home is licensed to care for older adults who are not family relatives.
A Little History of Adult Care Homes
Historically, our frail elderly lived with family, friends, and neighbors – often with several generations under one roof. Housing and care arrangements were informal. After WWII, nursing homes, formerly “poor houses”, began providing care to the very poor, frail and disabled within a community. In the 1960’s, significant government oversight and regulation of nursing homes was set. Laws enforced compliance with safety codes. The government began funding care through Medicare and Medicaid. Nursing homes became a highly regulated industry and care became institutional.
During the 70’s and 80’s, the informal care provided by families and neighbors shifted. Because care homes provided less institutional care than nursing homes, they became more prevalent. They were a direct competition to nursing homes and so an industry was established. Government regulation, oversight, and supervision expanded too. Adult care homes today are regulated almost as much as nursing homes.
Care homes are limited in how many elders can live in the home. In Oregon, the limit is five residents. A resident is an elder who’s not directly related to the provider. Limiting the number of residents helps maintain the home-like, family atmosphere of care homes.
Care providers live in the home and give personal help and medical care to their elderly residents. Residents can never be unattended – a caregiver must be in the home at all times. Adult care homes provide closer supervision because of the smaller environment. Caregivers can respond quicker to resident needs. In comparison, larger facilities have a higher ratio of residents to caregivers; each caregiver has more residents they’re directly responsible for.
Adult Care Home Licensing and Inspections
Each care home has one primary business owner and operator. Owners are liable and responsible for compliance with all rules and regulations. The owner isn’t required to live in the home or be always present. They may even own more than one home. Owners may employ qualified caregivers and resident managers – who are required to live in the home. Again, the state wants care homes to maintain a home-like environment which means limited shift workers. When caregivers or care providers live on premises there’s a greater sense of bonding and family atmosphere. Some homes are operated by registered nurses or other medical professionals, but it’s not required.
The State licenses both the home and owner.
- Homes must meet structural and safety requirements.
- Care providers must meet certain standards such as documented caregiving experience, pass criminal background checks, complete basic training and pass an exam in English. Yearly continuing education is required to maintain a care provider’s license.
All homes are inspected and licensed by the Department of Human Services on a yearly basis. The inspection is unannounced and conducted by a licensor or other assigned State/County employee.
Inspections include a review of all resident records: medication administration logs, physician orders, written care plans, change of condition notes, contracts, etc. In addition, the inspector will ensure the home’s structural safety compliance, medications are locked, hazardous materials properly stored, water temperature is correct, and much more. The licensor may even conduct a fire drill. In Oregon, caregivers must demonstrate they’re able to vacate all residents within 3 minutes in event of a fire.
Adult Care Home Custom Construction
Homes vary in size, aesthetics, and amenities. Homes may offer private or shared bedrooms. Private bedrooms may have a private en-suite half-bath. In older, converted homes, the bathrooms are often shared. A separate shower room is standard and used for scheduled bathing.
In the last decade, newly constructed custom-built care homes have changed the ACH market. These homes have all the latest innovations: roll-in showers, call systems, security systems, private bedrooms with private bathrooms and aesthetic features. The larger, new construction and amenities meet the higher expectations of today’s consumer. However, homes with all the latest and greatest amenities don’t necessarily provide better care. They may, in fact, reduce the “family factor”.
Homes must provide room and board as part of the month to month rent. Care and personal services are an additional monthly rate and can increase as care needs increase.
Base rent is comparable to assisted living and residential care rates. However, prices don’t seem to escalate as quickly because there aren’t as many cost-of-living increases.
Types of Payment Accepted in Adult Care Homes
Medicare does not pay for adult care homes. Payment for the monthly charges in an Adult Care Home are: private pay, long-term care insurance, and possibly supplemental Veteran’s benefits (Veteran benefits are not enough to cover 100% of rent + care). Some homes accept Medicaid. (a State & Federal low-income assistance program – see article and video, Medicare vs Medicaid)
It’s important to understand Medicaid when considering an adult care home. Owners can choose to maintain a contract with the State and accept Medicaid reimbursement. The State sets the reimbursement rate and it’s much lower than the open market rate. Also, regulations and rules are greater.
However, just because a care home has a Medicaid contract, does not mean they are obligated to accept a new resident who’s on Medicaid. Homes often have a contract so that their long-term clients, who run out of private money, can continue living in their home.
Families often ask if they can pay the difference between the reimbursement rate and the open market rate. The answer is NO. Any “supplemental” payments are considered Medicaid fraud.
Adult Care Homes offer a viable alternative to the larger assisted living and nursing home facilities. Is a care home the right option for you or a loved one? The same things making a care home the right choice for one person can be the same things making it the wrong choice for another.
Call an OSRAA member if you’re considering an adult care home for yourself or a loved one. Get expert guidance, information, and peace of mind.
Coming Soon! Part 2 For More Information on Pros and Cons of Adult Care Homes:
“What Is An Adult Care Home? Part 2” will cover the pros and cons. You’ll gain insight about specifics of care provided and the personality of residents best suited to care homes.