Adult Family Homes Defined


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Definition | History | Choice & variety | Levels of care offered | Limitations of care | Cost | Licensing requirements.

Definition of an adult family home

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.

Adult Family Homes play a vital role in Washington State's long-term care, providing round-the-clock care to more than 16,000 seniors, and relieving a tremendous burden for thousands of families. They save WA State nearly $250 million per year in Medicaid care costs.

Current challenges for adult family home providers include over-regulations, low reimbursement rates for Medicaid clients, and undue political pressures from the WFSE and SEIU unions.

History of adult family homes in Washington state

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 by the department of Social and Health Services (DSHS) to care for frail seniors or developmentally disabled persons (DD).

DSHS 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 many colors and offer one of the best long-term care option for our aging population. 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 greatest appeal for consumers is a familiar, real home setting that is comfortable and secure. The staff-to-resident ratio is 1 staff to 6 residents at minimum, compared to nursing homes or assisted living facilities where one caregiver may routinely be assigned 6 to 14 residents, and sometimes more!

Settings vary from very luxurious million dollar homes with water views, to smaller 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. Don’t assume that a "fancy" AFH or high cost reflects greater skills, abilities, or quality of care.

King County, followed by Snohomish County, has the highest concentration of ASH's in Washington state.

Levels of care offered

As long as state requirements are met (WAC 388-76), providers can offer as much or as little care as they are capable or qualified to provide. However, homes that are owned and operated by nurses are typically able to provide care to higher acuity residents. There are plenty of ‘average-looking’ homes owned by excellent caregivers who can 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 care, wound care, insulin-dependent clients, awake night care, or two-person transfers, to name a few.

It's common 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. If not done automatically, be sure to bring it up!

Washington has 3 specialty certifications which are noted on the provider's license: Mental Health, Dementia, or Developmental Disabilities.

Limitation of care

Because adult family homes are small 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 the AFH setting.

Generally speaking, residents in adult family homes should be in stable and predictable medical condition. Residents with more complex medical issues should be admitted to homes owned and operated by RN or LPN providers who have the necessary training, experience, and staff to deal with more acute and complicated medical issues.

Cost of care in adult family homes

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.

Average Cost of long-term care in Washington State - Seattle Area.

Adult Family Homes $115 - $215 per day ($3,500-$6,500) Includes room, board, and personal care (private pay).
Nursing Homes* $217 - $345 per day ($6,600-$10,350) ~45% NH surveyed, private room.
Assisted Living* $1,400 - $5,400 per month ~30% AL surveyed, care not included.
Home care* $24 - $33 per hour ($192-$264 for 8 hours) Some agencies do offer special rates for 24 hour coverage.

*Source Genworth Financial 2012.

Licensing requirements

Washington state has one of the most stringent licensing requirements in the nation ensuring that our seniors receive excellent care. Adult family home providers must be licensed by DSHS (Department of Social Health Services) and adhere to strict rules and regulations (over 105 pages worth) 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 10-to-18 months average. Inspections occur without notice - licensee must be in compliance at all times.

Additionally, the Washington Residential 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 further enhances the quality of care for seniors in Washington State and gives providers yet more skills to deal with the ever-increasing complexity of their residents' health needs.

Requirements to become a provider include:

  • DSHS orientation course (8 hrs);
  • fundamentals of care (20 hrs);
  • nurse delegation course (10 hrs);
  • first aid (6 hrs);
  • CPR (4 hrs);
  • Administrator course (48 hrs);
  • Ten hours of continuing education yearly (10 hrs);
  • Criminal background check;
  • Specialty training in dementia care (8-12 hrs + testing), mental health (8-12 hrs + testing), or developmental disability (8-12 hrs + testing) for those respective residents.

For caregivers and staff, the requirements do not include the 48 hour administrator training.