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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