Adult Care Homes (ACH) (also known as Adult Foster Care, or Adult Family Homes) are single family residences offering care to seniors. They are located in residential areas throughout many metro cities in the United States.
You may not even recognize an Adult Care Home in your neighborhood unless there is signage for advertising. Homes are usually located in residential neighborhoods and look like any other home. You probably drive by one every day without knowing.
On average, there are no more than five residents at a time living in an ACH. Adult Care Homes may be licensed for different levels of care.
Adult care homes are non-institutional. That’s why many older adults and their families choose a care home over assisted living. Care homes offer “family-style” living which feels comfortable for many elders. Often, they grew up with a grandparent in the home, so it feels natural.
Seniors receiving care are called residents, not patients. Residents aren’t family relatives of the care provider.
Some highly skilled Adult Care Homes specialize in bariatric care, ventilator care, recovery from cosmetic surgery, and psychiatric care. This level of care is often an excellent alternative to nursing homes, but are not common in some geographical areas and can be difficult to find.
All About Adult Care Homes
While care homes feel low key and home-like, they’re still highly regulated by the State.
Almost as much as nursing homes. Each home must be licensed and inspected for structural and safety concerns. The Department of Aging & Disability mandates basic home requirements like:
- Square footage
- Fire and safety systems
- And more
Management of Adult Care Homes
Each home’s owner/operator is also licensed. They may have a background as a licensed medical professional, but it's not required. To qualify for licensing, the owner/operator must have a minimum of experience in providing elder care. Usually, they’ve worked in a nursing home or another care home.
The homeowner is liable and responsible to follow all the State rules and regulations. Providers must at least pass a criminal background check, complete basic training, and pass an English exam. Maintaining a license requires staying compliant and completing ongoing education each year.
Often the home’s owner/operator lives in the home and provides day to day care. But it’s not necessary. Instead, they may hire qualified caregivers. The caregiver works part-time to cover days off or act as daily helpers. The owner may live off premises or even own several care homes. In that case, they hire a live-in caregiver who acts as “Resident Manager.”
The important thing to note is, residents are never left unattended. A qualified caregiver must be on premises always.
Yearly Inspections & Re-licensing of Adult Care Homes
All homes are inspected at least once a year. Inspections are unannounced. A licensor or other State/County employee conducts the inspection.
Inspections include a review of:
- All resident records
- Medication administration logs
- Physician Orders
- Written care plans
- Change of condition notes
Some things checked at inspection are:
- That medications are securely locked
- All hazardous materials remain properly stored
- Correct water temperature is maintained to prevent accidental burns
The licensor may even conduct a fire drill. Caregivers have three minutes to evacuate all residents in the event of a fire.
Services Provided in Adult Care Homes
Basic services included in monthly rent:
- Room and Board
- Meals and Snacks
- Laundry Services
Care providers develop a care plan for each resident. The care plan is based on the diagnoses, daily help needed, and what’s ordered by the resident’s doctor. Typical care plans can include the following:
- Bathing, Dressing, Grooming, and Hygiene
- Toileting Assistance
- Transfer and Mobility Assistance
- Behavior Monitoring and Cognitive Assistance
- Special Diets and Eating Assistance
- Medication Management
- Hospice and Palliative care
When licensed, Adult Care Home are classified by care level. A higher classification depends on the certifications, background, and experience of the provider. Registered nurses, therapists, CNAs or other certified professionals can have higher classifications.
Higher classifications can provide specialized and complex medical care. These care services might include things like:
- Brittle, sliding scale diabetic care
- Wound care
- Aspiration risk
- Bedbound and Dependent care
- Ventilator care
- Psychiatric or Dementia care
Do Adult Care Homes Provide Night Care?
Most homes do not provide an awake caregiver at night. Caregivers live and work in the home but need to sleep at night. They respond to occasional bouts of illness or accidents. If a resident needs consistent night-time help, consider a different care option.
If a home has two live-in caregivers, they may offer night care. Or, a home might hire a caregiver specifically for night care, but you can also expect a significant increase in cost if this is the case.
Amenities in Adult Care Homes
Care homes vary in size and amenities. Some were designed and built as a care home. Others have been retrofitted and modified.
Most homes offer private bedrooms. Many offer bedrooms with private en-suite half-baths. In older, converted homes, bathrooms are often shared. A private room rarely includes a private shower. Instead, a separate shower room is standard and used for scheduled bathing.
Usually, resident bedrooms don’t have separate heat and a/c controls. Most homes have central systems.
Bedrooms can come furnished. But most families bring personal familiar belongings. Homes generally provide basic cable TV service. Premium channels and phones are charged extra.
Its important residents can call for help when needed and that caregivers respond. A variety of call systems work in a care home; hard-wired, baby monitors, buzzers, and bells.
In the last decade, newly constructed custom-built care homes have changed the market. These homes have all the latest innovations:
- Roll-in showers,
- Call systems,
- Security systems,
- Private bedrooms with private bathrooms
- Spacious common areas.
The larger, newer homes, with more amenities meet the expectations of today’s consumer. But, homes with all the latest and greatest amenities don’t necessarily provide better care. They may, in fact, reduce the home-like feel.
What Does the Peer Group Look Like?
The State limits how many residents can live in the home. It varies by state and ranges between 5 to 7 residents.
Limiting the number of residents helps keep the home-like, family atmosphere. The smaller group helps to ensure:
- Consistency of care
- Fewer mistakes
- Closer supervision
- More personalized attention
Adult Care Homes are Multi-generational
Care providers live in the home alongside residents and so does their family. Which means children of wide-ranging ages are often present. Usually, the care home has two distinct sections: a private family side and a resident side. If kids are young, providers must have extra help on site. Also, children must respect elder residents and stay out of their bedrooms.
Interacting with children gives a lot of joy to many elders. Older kids often play games, color at the table, read out loud, or entertain residents with live piano.
Social & Activity Programs
Activity and social occasions are organic in nature and depend on the group’s dynamics. Eating meals, having snacks, and watching TV together is enough socialization for some.
Providers try offering games, sing-alongs, puzzles, and painting. Sometimes volunteers provide live music, or the provider hires a musician to come in. Birthdays and holidays are a chance to party and celebrate. Resident’s families are usually invited.
Care homes don’t generally provide transportation. Outings and field trips are rare. It's expected that families take their loved one to doctor’s appointments. Or, if they can't, providers can arrange other services
Costs & Finances
Adult Care Homes charge month-to-month. A monthly base rate includes room, board, and basic services. Care and personal services (the care plan) are extra to the monthly rate. Care plan charges increase as care escalates.
Monthly base rates vary depending on where you live. Across the US base rates range between $2500 – $6000 per month.
Who Pays for Adult Care Homes?
Medicare does not pay for adult care homes. Payment for monthly charges come from:
- Private funds
- Long-term care insurance policies
- Medicaid, if the home has a Medicaid contract. (See info below)*
Veteran’s may qualify for supplemental help called Aid and Attendance. This is a Veteran's benefit for those serving during a war.
*Medicaid – is a State & Federal low-income assistance program. Please note:
- Not every home has a contract with the State to accept Medicaid reimbursement.
- Also, a home who does have a contract is not obligated to accept a new resident who’s on Medicaid.
- Many homes carry a contract so their long-term residents, who run out of private funds, can stay in their home.
How to Find Adult Care Homes
Finding the right adult care home for your loved one can be overwhelming at best. In areas where adult care homes exist, there can be dozens, if not hundreds to choose from. In the Portland, OR area alone, there are over 1,200 licensed adult care home providers.
Homes will vary in cost, amenities, and care types offered. Additionally, due to the small setting, it's important to consider the personality and manners of the caregivers and how your loved one will engage with them. Think about the peer group as well, what types of behaviors and personalities will be important for your loved one to be around?
Working with someone who is familiar with the adult care homes in your area is imperative to making the right decision. A professional referral agency will have first-hand knowledge of the local senior housing options and will be able to help you narrow down the list to resources that are right for your budget, needs and preferences.
If your loved one would do well in an intimate, family-oriented setting with home cooked meals, an adult care home might be the right choice. There are some key difference between assisted living and adult care homes, make sure you understand your options before making a choice.