Building Adult Foster Care: What States Can Do

Building Adult Foster Care:

What States Can Do

Robert L. Mollica Kristin Simms-Kastelein National Academy for State Health Policy

Michael Cheek Candace Baldwin NCB Capital Impact

Jennifer Farnham Rutgers Center for State Health Policy

Susan Reinhard Jean Accius

AARP Public Policy Institute

Building Adult Foster Care:

What States Can Do

Robert L. Mollica Kristin Simms-Kastelein National Academy for State Health Policy

Michael Cheek Candace Baldwin NCB Capital Impact

Jennifer Farnham Rutgers Center for State Health Policy

Susan Reinhard Jean Accius

AARP Public Policy Institute

AARP's Public Policy Institute informs and stimulates public debate on the issues we face as we age. Through research, analysis and dialogue with the nation's leading experts, PPI promotes development of sound, creative policies to address our common need for economic security, health care, and quality of life. The views expressed herein are for information, debate, and discussion, and do not necessarily represent official policies of AARP. 2009-13 September 2009 ? 2009, AARP Reprinting with permission only AARP Public Policy Institute 601 E Street, NW, Washington, DC 20049

ACKNOWLEDGMENTS

The authors gratefully acknowledge the individuals and organizations that provided comments, suggestions, and guidance in completing this report. We are particularly grateful to our external reviewers, Janet O'Keeffe from RTI International and Emily Rosenoff from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Disability, Aging and Long-Term Care Policy Division. We also appreciate the generous assistance of our AARP colleagues in the state offices and at the national office for their comments and suggestions. We would like to thank our PPI colleagues, Enid Kassner and Don Redfoot, who reviewed the report.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS ................................................................................................... ii EXECUTIVE SUMMARY ................................................................................................ vii

Key Findings............................................................................................................... vii Conclusions and Recommendations ............................................................................ ix

INTRODUCTION AND BACKGROUND .......................................................................... 1 METHODOLOGY.............................................................................................................. 2 WHAT IS ADULT FOSTER CARE?................................................................................. 3 WHAT ARE THE CHARACTERISTICS OF AFC RESIDENTS? ..................................... 5 HOW MANY PEOPLE ARE SERVED IN AFC?............................................................... 6 THREE APPROACHES TO REGULATING AFC ............................................................ 8 ADMISSION/RETENTION CRITERIA ............................................................................ 11 ASSESSMENT AND CARE PLANNING PROCESS ..................................................... 12 STATES REGULATE SERVICES THAT CAN BE PROVIDED..................................... 14 NURSE DELEGATION: THE ROLE OF AFC PROVIDERS IN ADMINISTERING MEDICATION ................................................................................................................. 14 RESIDENT AGREEMENTS............................................................................................ 18 STAFFING ...................................................................................................................... 19 TRAINING....................................................................................................................... 20 DEVELOPMENT OF AFC: THE PROVIDER'S PERSPECTIVE.................................... 22 HOW DO RESIDENTS PAY FOR ADULT FOSTER CARE? ........................................ 23 PROVIDER BUSINESS PRACTICES AND OPERATIONS........................................... 26

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