An adult foster care (AFC) provider must not serve anyone whose needs are beyond the scope of its license. Before a person may be admitted into an AFC home, he or she is screened to ensure that his or her needs do not exceed the licensee’s classification. The screen evaluates the person’s ability to self-evacuate and determines whether the prospective resident’s needs can be met in addition to caring for the other residents. Admission requirements include personal information; written orders from a physician or nurse practitioner; and information on medications, treatments, and therapies. Residents may be discharged, transferred, or moved with a minimum 30 days’ notice if their
medical condition becomes too complex and exceeds the provider’s license classification, or they are unable to self-evacuate, or their behavior becomes a danger to themselves or others.
Providers may admit or continue to care for residents strictly on the basis of the impairment levels of residents and the classification level of the provider. Class 1
providers may admit only residents who need assistance in no more than four activities of daily living (ADLs). Class 2 providers may provide care for residents who require
assistance in all ADLs but require full assistance in no more than three ADLs. Class 3 providers may provide care for residents who require full assistance in four or more ADLs.
To receive Medicaid waiver services, beneficiaries must meet one of the service priority levels (SPLs), based on information in the assessment. SPLs rate potential residents according to the cognition and amount of assistance they need with a specified ADL or combination of ADLs. Because of budget constraints, services are provided only to SPL levels 1–13. The levels are as follows:
1. Dependent in mobility, eating, toileting, eating, and cognition 2. Dependent in mobility, eating, and cognition
3. Dependent in mobility or cognition or eating 4. Dependent in toileting
5. Substantial assistance with mobility and assistance with toileting and eating 6. Substantial assistance with mobility and assistance with eating
7. Substantial assistance with mobility and assistance with toileting
8. Minimal assistance with mobility and assistance with eating and toileting 9. Assistance with eating and toileting
10. Substantial assistance with mobility
11. Minimal assistance with mobility and assistance with toileting 12. Minimal assistance with mobility and assistance with eating 13. Assistance with toileting
14. Assistance with eating
15. Minimal assistance with mobility 16. Full assistance with bathing or dressing 17. Assistance with bathing or dressing
18. Independent in the above levels but requires structured living for supervision for complex medical programs or a complex medication regimen
State officials noted that AFC participants have greater needs than other waiver
participants. Fifty-nine percent of the participants in adult foster homes were in SPLs 1–3 in 2005, compared to 35 percent of assisted living residents, 24 percent of in-home services clients, and 76 percent of residential care facility and nursing home residents.
ASSESSMENT AND CARE PLANNING PROCESS
During the first 14 days of a resident’s stay, the provider must continue the assessment process, documenting the resident’s care needs (including social, spiritual, and emotional needs) and preferences, such as diet. The assessment and care plan must be completed within this 14-day period. The care plan must describe the resident’s care needs, preferences, and physical and mental capabilities, and list the treatments, procedures or therapies that the resident will need. The care plan must document the need for
specialized equipment, communication and night needs, ability to exit during an emergency, and use of medications. The provider must reassess the care plan every six months and at any significant change in the resident’s condition. Case managers review care plans at least annually.
SERVICES
AFCs provide services identified in the plan of care, including activities that help residents develop skills to maintain or increase their level of functioning, or that help them with personal care, activities of daily living, or social activities.
The licensee must obtain a medical consultation and an assessment for a resident if a skilled nursing care task has been ordered or the resident has a health concern or behavioral symptom that might benefit from a nursing assessment and provider education; when written parameters are needed to clarify the physician or nurse practitioner’s PRN (as-needed) order for medication and treatment; before the use of physical restraints if the licensee has not been assessed, taught, and reassessed by a physician, nurse practitioner, Christian Science practitioner, mental health clinician, physical therapist, or occupational therapist; before the use of psychoactive medications if the licensee has not been assessed, taught, and reassessed by a physician, nurse
practitioner, or mental health practitioner, before requesting psychoactive medications to treat behavioral symptoms; and when care procedures have been ordered that are new for a specific resident, the licensee, or other caregivers.
MEDICATIONS
Residents who are capable of self-administration of medicine must have a physician or nurse practitioner’s written approval. These residents may keep medications in their own
room in a locked storage container. Providers who administer medications must record all medications, treatments, and therapies in the medication administration record for each resident. Injections may be self-administered by the resident, a relative, or a licensed nurse. Caregivers, trained by a licensed nurse and approved by the Department of Human Services, may give subcutaneous injections; however, nurses may not delegate
intramuscular and intravenous injections.
RESIDENT AGREEMENT/DISCLOSURE/CONTRACT
Before admission, the licensee must disclose policies that limit a resident’s activities or preferences, transfer and discharge policies, and the Residents’ Bill of Rights. Providers are responsible for serving three nutritionally balanced meals a day and posting a menu of the meals for the week. Providers must offer six hours of activities a week, not including movies or television. The provider must inform the resident about the policy on
Medicaid-eligible residents and discuss the availability of long-term care assessment services for private pay residents.
The contract must include but is not be limited to the following:
Services provided and the rates to be charged. A payment range may not be used unless the contract plainly states when a rate increase can be expected based on increased care or service needs.
Conditions under which the rates may be changed.
The refund policy in instances of a resident’s hospitalization, death, discharge, transfer to a nursing facility or other care facility, or voluntary move.
Policies on voluntary moves and whether or not the licensee requires written notification of a resident’s intent not to return.
Storage charges for belongings that remain in the adult foster home for more than 15 days after the resident has left.
A statement indicating that residents are not liable for damages considered normal wear and tear on the adult foster home and its contents.
Notice of general rate increases, additions, or other modifications of the rates must be given 30 days before their effective date.