What are Adult Family Homes?

Definition

Adult Family Homes (AFH) are residential homes licensed to provide personal care for up to six non-related individuals (commonly called “residents”). They provide room, board, laundry, supervision, and necessary help with activities of daily living, personal care, and limited social services.

History

Adult family homes have been around in many states for a long time; they are also known as Adult Care Homes, Adult Foster Homes, and Residential Care Homes. Although there are some differences in how these names are used, Adult Family Homes in Washington state are specifically licensed to care for frail seniors or developmentally disabled persons (DD).

DSHS (department of Social & Health Services) has used AFHs for many years as the least restrictive--and least expensive--place to care for the aging population.

Choice & Variety

Adult Family Homes come in as many colors as you can imagine, and offer one of the best long-term care option for our aging culture. Some are owned by registered or licensed nurses (RN’s or LPN’s), certified nursing assistants (CNA’s or NA-C’s), while others are started by individuals who first care for a parent then decide to continue helping other seniors.

The appeal for most is that a family setting offers residents a familiar, real home setting that is comfortable and secure. The staff-to-resident ratio is 1:6 at minimum, compared to a nursing home where 1 caregiver may routinely be assigned 10 to 14 residents, and sometimes more!

Settings can vary from very luxurious million dollar homes with views, to small run-of-the-mill houses. Homes offer private rooms, rooms with baths, or shared rooms. Some homes offer larger spaces with more privacy but they may only be accessible by stairs; such space are most appropriate for residents who are ambulatory and more physically able. Consumers beware: don’t assume that a "fancy" home or high cost reflects the skills and abilities of the provider or his staff.

King County, followed by Snohomish County, has the highest concentration of AFH's in Washington state, about 1100 licensed homes.

Levels of care offered

As long as state requirements are met (WAC 388-76), providers are free to offer as much or as little care as they feel comfortable. However, homes that are owned and operated by nurses are typically able to provide care to higher acuity residents. Also many ‘average-looking’ homes are owned by excellent caregivers who are able to provide higher levels of care.

Consumers must inquire as to what type of care a provider offers and what care is not available, such as hospice, wound care or insulin-dependent clients to name a few.

It's not unusual for a provider to coordinate skilled oversight with Visiting Nurse Services, Occupational Therapy, Physical Therapy, or hospice care providers. Mental Health Therapy can be also be brought into the home when indicated.

Limitation of care

Because adult family homes are small family settings, residents who are noisy, disruptive, or aggressive may not be appropriate for most homes, but some providers are be able to accommodate such resident if they specialize in this type of care. If a resident poses a safety risk to himself or others, s/he is usually not a good candidate for this type of setting.
Generally speaking, residents in adult family homes should be stable and predictable. Residents with more complex medical issues should be admitted to homes owned and operated by RN or LPN providers who have the necessary training and experience to deal with more acute and complicated medical issues.

Cost

The cost of care in adult family homes compares very favorably to the other available settings such Nursing Homes, Assisted Living and even home care. The cost is usually driven by the price of the home itself as well as the level of care someone requires.
In Seattle, the cost varies from $90 to $200 per day ($2,800 to $6,000), the average daily cost being around $130 per day.

Keep in mind that the average nursing home cost in Seattle for a shared room is $220.00 per day and around $255 for a private room. The national average nursing cost is $203 per day (semi-private room $176).

Licensing requirements

Washington state has one of the most stringent licensing requirements in the nation ensuring that our seniors receive some of the best care available. Adult family home providers must be licensed by DSHS (Department of Social Health Services) and adhere to strict rules and regulations as described in WAC 388-76. DSHS issues one license per provider and per home. Licensed homes/providers are inspected by DSHS licensors on a yearly basis, and these inspections occur without prior notice - licensee must be in compliance at all times.

Additionally, the Washington Residental Care Council (WSRCC) recently introduced a professional certification program with training provided by the UW's Northwest Geriatric Education Center. After obtaining this additional 52 credits including over 20 geriatric-related health topics, a provider will become a "Certified Adult Family Home Provider". This new program greatly raises the quality of care for seniors in Washington State and gives providers better tools to deal with the ever-increasing complexity of their residents' health needs.

General requirements to become a provider include: DSHS orientation course; fundamentals of care (20hrs); nurse delegation course (20hrs); first aid; CPR; administrator course (48hrs); ten hours of continuing education yearly; and a criminal background check. Many providers also have a specialty training in dementia care, mental health, or developmental disability.

For caregivers and staff the requirements are similar but do not include the 48 hour administrator training.