Adult Care Homes

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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.

Related: Adult Care Homes and Board and Care- What's the Difference? 

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
  • Accessibility
  • 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
  • Contracts

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:

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.

Bottom Line

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.

The Ultimate Guide to Adult Care Homes: Infographic

A Complete Guide to Adult Care Homes Infographic

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  1. My mom is 92 with dementia. I’m looking for a ACH with reasonable rates in the Phoenix area. She needs assistance with bathing and toileting.
  2. My mom is 65 she need a home with her own space but needs supervision with cooking laundry and medication preparation she has Parkinson’s disease we live in Michigan can i get some help please
  3. Looking for young adult age 34 who has a hard time walking must use walker and his speech is very bad as well as j His eye sight. He has a brain tumor that is inoperable. Getting difficult for me to handle j Him.
  4. I was looking for an adult residential home in the n.y tri state area for my mom who is 63 who still wants her own space but needs supervision that’s professional
  5. I am looking for a place in Washington State, either Port Angeles or Sequim for my Father with dementia. He is very high functioning and needs a place with more higher functioning, more stimulating atmosphere, than the facility he is currently in.
  6. I am looking to turn my 3000 square foot home / with in-law where 89 year old mother lives, into a board and care home in CT. Any help in the correct direction would certainly be appreciated. Thanks, Dan
  7. We have problems with the home care in our neighborhood. Who do we contact. It seems like the people at the house do not care for it is an on going problem.
  8. I’m looking for a board and care home for my father who is 76. She does not want an assisted living or other institution like situation, so I was thinking a board and care may be the best choice for him. We live in NY -Long Island
  9. I’m looking for a board and care home for my mom who is 90. She does not want an assisted living or other institution like situation, so I was thinking a board and care may be the best choice for her. We live in MA.
    1. Me and my daughter are growing our boarding care and currently have Private Master bedroom and bathroom available..with unl im minted caregiver service available..Missouri City TX
  10. It’s great to know more about choosing an adult care center. I like how you said that each home must be licensed and inspected for safety. Finding a good care facility is important for us with our mom right now, so I’ll try to find a place with up-to-date licenses and inspections.
  11. Anyone know of any adult care homes in ocean county New Jersey. My dad is 97 and I am really not interested in a nursing home. If not then maybe we will hire someone to come in and be with him in his house.
  12. I’m looking for a good adult family home in Tacoma. This would be a home for elderly and alert people. It needs to have a Medicaid option. Any recommendations? Thanks!
  13. My mother and I are starting adult foster care in our home. This will not be your typical senior living, out home will be resort living and an active lifestyle. Our home is currently being custom made to be handicapped accessible the home should take 8 to 10 weeks to build. We are nestled between the Gulf of Mexico, which means the beach is near by only 40 min or less drive and the Mexico boarder is near by as well, also a short drive. Out lovely city basks in warm temperatures all year round. Our gated community offers many activities year round including a non denominational church, fitness center, pool, and hot tub as well. As a resident you will have your own room personal services we will offer but not limited to onsite caregivers that live in the home, help with bathing, dressing, meals provided and snacks, cleaning, laundry, transportation, appointments, medication reminders, nurse to come in biweekly. Come be a part of our family.
    1. I am looking for alternate places for my dad besides a nursing home. Can you send me any information?
      1. My name is Stanley and am a nurse by professional. Have 15 years of nursing experience. My wife and I have recently opened an Adult Family where we will dedicate ourselves in helping seniors with their daily activities. We affirm, “Our family is committed to yours”. Please check our website for more information. Website: joystanafh[dot]com
      2. Hi Christine, What you choose depends on what your dad needs to assist him in daily living. If he is able cognitively and physically then maybe a retirement complex would be best. Most of these complexes have call lights connected to a nursing home, in the bathrooms. Some come with garages if your father is still able to drive. If your father has dementia or Alzheimers and needs minimal assistance then an assisted living or CBRF as they are called would be best. You may want to consider an adult family home. This is where 2-5 residents reside in the same house. There is staff usually on site 24/7. I hope this helps.
  14. I am recommending Willamette Oaks, located in Eugene, Oregon is a senior apartment and retirement community providing the finest care and community in the Cottage Grove area. Come home to a welcoming retirement living community, a fir-lined setting, and a Eugene, Oregon location convenient to everything.
    1. Hi Hayk! Im looking to open a new AFH in Clackamas County Oregon. What did you like the most about the place? What qualities could I try to adopt?
  15. Sanborn Manor Adult Care Home is located in Eugene Oregon. We maintain a clean, calm, safe environment and provide all private rooms with some rooms having their own bathroom. Our caregivers currently have 5-30 years of caregiving experience. We have a 1-2 year private pay requirement, but have a Medicaid contract as well so our clients do not have to move. If you are looking in the Eugene area, please give me a call or visit our website at sanbornmanorach[dot]com
  16. Adult Care Home opening in Portland Oregon across from beautiful golf course, stunning view , large room, outstanding fresh home cooked meals and loving care team to help with all your care needs and more
  17. II will be opening an adult residential home next month . I am located in New Orleans LA. I will provide cared forf seniors on all aspects of care. Hope to hear from prospective clients
  18. GRAND OPENING of new clean Adult Care Home in Elberton Georgia. 3 or 4 people only. Large rooms, Jacuzzi tub, own bathroom and closet possible. Private rooms — No doubling up or sharing of rooms. Friendly experienced staff, 3 great meals provided, $3000 minimum per month. Possibly higher cost depending on needs. Great alternative to a nursing home facility. This is a residential home.
  19. Looking for an adult home with independent living & my own room, no roommates. Preferably, Suffolk County South Shore, open to other possibilities as well. Thank-You.
  20. We are looking for total care clients. Champion Adult Family Home, Lynnwood, WA. Husband/wife team, both nurses, combined 45+ years LTC exp. [phone num redacted – admin].
  21. I have a friend who is 62 who lives in Dallas, TX. She has spent her entire life since graduating college, nurturing and caring for her parents. When her last parent died several years ago, the family house had to be sold and she was/is homeless. She didn’t get much money from her father’s will because her siblings took her to court because their father left everything to my friend. Unfortunately, after a couple of years in the court, most of the money she received was given to the attorney. Currently, she is living -and has for a couple of years- on a friend’s sofa with many restrictions placed on her coming and going. The fellow she lives with is so controlling and fearful that she would move out that he insisted she quit her job and take care of him. And, sadly, she was very used to that role. What I was wondering was if there was an adult group home for people who really can’t or don’t want to live alone. Honestly, I am afraid if she isn’t given a hand to get her out of this situation, she might become mentally unwell. Do you know of a home such as I have described? She would have to get on Medicaid, I assume for funding. Thanks for your consideration, Kim
    1. Hello and I’d like to help her . Im opening an Adult Family Care at my house and can try to help her. Let me know!

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