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About
Adult Family Homes
Overview
Over the past decade, there has been little new state funding for supported residential services for people with developmental disabilities. Adult Family Homes (AFH's) may be available when other services directly funded by Developmental Disabilities Services (DDS) are not. Originally, Adult Family Homes were created as a state service category to provide residential supports primarily for elderly people and people with physical disabilities needing a high level of services and supports. However, as state funded residential supports have become less available, Adult Family Homes have become the primary option for residential services for many people with developmental disabilities needing a significant amount of services and supports.
Definition
Adult Family Homes are residences
which care for two to six people age 18 or older. AFH's provide room,
board, laundry, necessary supervision, assistance with activities of daily
living, personal care, and social services. Some Adult Family Homes also provide
nursing services. AFH's are licensed, regulated and inspected by the Aging
and Adult Services function of the Washington State Department of Social and
Health Services Disabilities and Long Term Care Administration..
AFHs are available to people with functional limitations, such as the elderly and people with disabilities (e.g. developmental disabilities, mental illness, physical disabilities). Homes may choose to care for only one group, such as aging adults, or have a mix of residents.
Adult
Family Home operators who serve clients of Developmental
Disabilities Services must provide a written service plan that states the needs of the
individual and what assistance will be provided. The individual, family, AFH
provider, and DDS jointly prepare the plan, preferably prior to the individual's
move into the home. If the service plan is not done prior to placement, it is a
DSHS licensing requirement that it be done within 14 days following the move
into the home.
AFH operators (called providers) may be individuals (at least 21 years old), for-profit companies/corporations, nonprofit organizations, or other partnerships or associations. Providers must meet all state qualifications and requirements for an initial license, and yearly renewals. These requirements include:
- 22 hours of pre-service training and 10 hours per year to renew their license
- Criminal background check
- Home inspection (to meet specific health and safety standards as defined by law) and re-inspections approximately every 12 months
- Homes found to violate rules must make corrections to retain their license
- Specialty training is required when a provider desires to serve people with developmental disabilities, dementia or other special conditions (defined by law).
Adult Family Home operators may provide care themselves, or hire and supervise caregivers who provide care. Caregivers who are not providers must be at least 18 years old, and meet the same personal background check requirements as providers, and many of the same training requirements.
Locating an Adult Family Home
Your DDS Case Manager can put together a referral packet and forward it to the Adult Family Home Team. A Case Manager from the Adult Family Home Team will contact you and suggest homes that have vacancies and that may be able to meet the special care needs of your family member. The DDS Adult Family Home Team is knowledgeable about the experience and skills of most of the providers within King County who care for people with disabilities. The team is informed on complaints and/or licensing issues within a given home, and the experience and skill of the providers working with people with different kinds of needs. The Adult Family Home Team works closely with Licensing Investigators and have knowledge regarding licensing violations, training needs, etc.
If you or someone you know is looking for an Adult Family Home but is not a client of Developmental Disabilities Services:
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You may contact the Aging and Adult Services Administration (AASA) for a list of homes in your area. Be sure and tell the person you talk with what you are looking for in an Adult Family Home: whether or not a foreign language is spoken there, whether or not skilled nursing care is available, whether a provider has experience working with people with developmental disabilities or particular diagnoses are all criteria you may want to consider to narrow your search. You may also visit the on-line Adult Family Home Locator at http://www.aasa.dshs.wa.gov/Lookup/AFHRequestv2.asp . This database allows you to search for a list of homes based on criteria you define.
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In King County, you may contact Senior Information and Assistance at (206) 448-3110 for a King County Directory, which includes background information on AFHs. For example, it specifies whether homes take people with developmental disabilities, if the homes permit smoking, and whether they are wheelchair accessible.
- If you have access to a fax machine, you can call the state Community Resource System at (800) 372-0186. This service has a system for Faxing AFH listings. It is an automated menu answering system, which asks questions, such as, desired county or zip code locations, wheelchair accessibility, and language spoken.
Who Pays for Adult Family Homes
Room and board for someone living in an Adult Family Home is usually paid for out of the individual's Supplemental Security Income (SSI). This is also called "participation". The Medicaid Personal Care (MPC) Program pays for an individual's care in an AFH. There are four MPC levels of care and payments; level one care is for the most capable individual, and level four people have the most needs. DDS may have limited dollars for people with exceptional care needs (level four) as determined during the comprehensive assessment. AFH providers can also serve people who are only "private pay", or who are not using Medicaid Personal Care funds.
Under some circumstances, private funds can supplement the standard state payment, if the private funds are clearly purchasing services not covered by the standard payment, which includes room, meals, and personal care services. For example, people could pay the AFH privately for helping their family member participate in Special Olympics.
Be sure to contact the DDS Adult Family Home Team prior to any final decision. Unless you are planning to pay for the placement without any state funding, be sure to contact the DDS Adult Family Home Team. DDS must agree with the placement before Medicaid Personal Care services are authorized. This is especially important because the amount of payment to the AFH provider is determined by the Comprehensive Assessment done by the DDS Case Manager. Determining the payment amount prior to placement is important to avoid any misunderstandings with the AFH provider about payment expectations.
Quality and Safety
The Washington State Department of Social and Health Services is responsible for ensuring the health and safety of all residents of Adult Family Homes. The following are some examples of the protections and safeguards guaranteed by law:
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If an individual has a history of doing harm to others or poses a threat to other vulnerable AFH residents, they cannot be placed in an AFH.
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An individual can be asked to leave an AFH at any time if there is behavior unacceptable to others in the home. A 30-day notice is required when a provider asks an individual to leave the home.
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DDS is required to fully disclose all client information to the provider. DDS will not place anyone if the client or family does not agree to, release all client information in the client file to the provider. By law, HIV/AIDS information cannot be divulged.
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Neither DDS nor the AFH provider can release information to families or other residents about any resident in their home (confidentiality).
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All AFH providers, caregivers, and corporate directors must have background checks through the Washington State Patrol. Additional criminal checks are done with other states where they are known to have lived. In addition, checks are made with these other states to determine if they have ever been licensed for children or adult services and had their license revoked or denied for reasons of abuse or neglect.
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Residents, families, and others can contact the King County Long Term Care Ombudsman (206) 623-0816) or the Washington State Abuse and Neglect Hotline at (800) END-HARM to file a complaint. All complaints are investigated.
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Unless stipulated in the resident's service plan, the AFH must provide 24-hour on-site supervision.
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DDS has AFH Quality Improvement Resource Managers who will visit each home we use at least once per year to assess the quality of services being provided and assist the provider in accessing services and information. These visits are almost exclusively unannounced.
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Medicaid Personal Care (MPC) provides a nurse oversight visit for one to three times per year to assess the provision of the MPC tasks.
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The DDS case manager must reassess residents at least once per year, and when there is a significant change in condition.
Other Information Links:
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Adult Family Home Locator
http://www.aasa.dshs.wa.gov/Lookup/AFHRequestv2.asp -
Guide to Choosing Care in an Adult Family Home or Boarding Home
http://www.aasa.dshs.wa.gov/Library -
Residential and In-home Support Services for Individuals with Developmental Disabilities (download)
http://www.arcofkingcounty.org/guide/downloads/residential1.doc
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This page last updated: Sunday, November 25, 2007