Adult Care Homes in Portland (aka Adult Foster Homes) are residential homes which have been licensed and generally provide a private bedroom, a private or shared bathroom, meals, and care and services for up to five adult residents. The homes are regular homes located in residential neighborhoods. Each home has a single operator who sometimes employs additional caregivers and employees; often the staff are family members. All staff have experience and receive training, but do not necessarily have a specific medical credential. Some homes are operated by registered nurses, physicians, or other medical professionals.
Adult Foster Homes are homelike with common living areas, home cooked meals, interaction with the operator’s family, and the opportunity to socialize with the other residents. A resident’s friends and family may visit regularly. The operator’s children may be present in the home.
Adult Foster Home care typically includes assistance with bathing, dressing, eating, walking, getting out of bed or out of a chair, personal hygiene, using the toilet or incontinence products (such as adult disposable briefs), medication management, and memory or behavior support, such as repeated reminding for a person with dementia, or distraction for someone who is overly focused on a negative thought. Laundry service is provided. Residents typically need to be independent at night, although some homes can provide limited assistance at night, such as assistance to the bathroom, or repositioning someone in bed. Many homes offer assistance for those with mild to moderate dementia. Some homes have been custom built as Adult Care Homes with widened hallways and doorways, roll in showers, and large living areas which allow for easy wheelchair maneuverability. Others are modest, established single family homes which may have been remodeled to various degrees to accommodate residents’ needs.
Adult Care Homes sometimes allow the person needing care to bring a pet. Smoking may or may not be allowed outside, and if it is, then often in a covered area. In many homes, multiple languages may be spoken, although the operator and other staff are required to be able to speak English. If the person needing care speaks a language other than English, it is often possible to find a home with a care provider and possibly other residents who can speak that language.
Adult Foster Home residents generally do not own or drive a car. If able, they are free to leave the home during the day. Tri Met Lift is a service which provides transportation to persons unable to ride regular public busses due to a disability or disabling health condition.
The majority of Adult Foster Care residents live out the remainder of their lives in the Adult Care Home they have selected. Many homes can provide complex, extensive care because of the training and experience of the providers, and support from visiting nurses. Hospice services can be put in place to support someone who is near the end of life. If 24 hour skilled nursing care is needed, a resident may need to move to a nursing home. You can expect that a significant increase in needs will trigger an increase in the monthly cost of care.
Adult Foster Homes in Oregon are licensed by County Aging and Disability Services. The Program licenses homes which serve the elderly, younger disabled individuals, persons with Developmental Disabilities, or with Mental Illness.
When should an Adult Care Home be considered?
Adult Foster Home care could be appropriate when any of the below are true for the person needing care. They may require assistance when they have, or need help with, the following:
- Difficulty preparing meals or maintaining adequate nutrition
- Forgetting to take medications or taking the wrong amounts
- Difficulty managing daily personal needs such as bathing, dressing, shopping, cooking, laundry, or transportation
- Bruises, scratches, injuries from falls
- Ongoing illness or a need for rehabilitation
- Difficulty coping with feelings of depression, anxiety or fear
- Difficulty remembering people, places, or other things that were once familiar
- Family or friends are no longer able to provide adequate care and support
Advantages of an Adult Care Home
- Physical environment more like a home than an institution
- Care is more affordable than other residential options
- A private bedroom is generally available, often with a private half bath
- Maximum of five residents allows for a prompt response to requests for help
- Care is individualized, preferences can be respected
- Maximum independence is encouraged, increasing quality of life
- Sense of belonging to a family and being cared for by people who really know and care about you
- A minimum of caregivers get to know preferences and needs of the resident; care quality can be more consistent as a result
- Homes are regularly monitored and inspected
- A quiet setting without call lights beeping, intercoms blaring, noisy comings and goings
- Homelike with home cooked meals, common living space, children and pets, people sharing their lives and personal stories, privacy available when preferred
- In many cases, the resident can stay until the end of life, not needing to move to another care setting
Adult Care Home Operators and other staff
The Operator, Resident Manager and all other staff of an Adult Care Home must be adults in good physical and mental health. A criminal record check is run on all staff, frequent visitors and regular occupants (not including residents) of Adult Care Homes. Staff who are left alone with residents in the home must be able to read, write, speak, and understand English. The Operator and Resident Manager must be at least 21 years old and have documented experience (varying amounts depending on the position and the classification of the home) providing care to elderly or disabled persons. Other caregivers must be at least 18 years old.
Adult Care Home operators need at least two years of verifiable, full time, hands-on care giving experience in a professional setting, such as an Adult Care Home, Assisted Living Facility, or Nursing Home. Many operators have been in business for several years or more, and have extensive experience meeting a variety of needs. Some operators or another care giver in their home may have a medical credential such as Registered Nurse, Certified Nursing Assistant, or Certified Medical Assistant. In addition to hands-on experience, the Adult Care Home Program requires that the operator complete a variety of trainings and tests before being licensed. These include an English competency test, a 32 hour basic training course, and a qualifying test. Continuing education is required at an average of 14 hours a year.
What does it cost to live in an Adult Care Home?
Adult Care Home residents either pay using their own funds (private pay) or receive assistance in paying a portion of the payment from the Medicaid program (public pay). Private pay rates in adult care homes fall into an average range of $3,000 to $4,000 per month. That rate includes room, meals, services, care and assistance with needs such as dressing, bathing, toileting, eating, walking and getting out of bed or a chair. The rate is established by the individual operator and may be lower or higher than the average range given above. The rate goes up if the operator determines that a resident’s care needs have increased. You will need to discuss the private rate with each individual operator. You will want to look over the private pay contract carefully. Be sure to find out if the operator will allow the person needing care to stay in the home if they run out of funds and need public assistance. (Medicaid). The operator’s policy regarding this should be in the contract. Do not rely on a verbal commitment from the provider; make sure that this provision is spelled out in the contract. It is unpleasant to have to move someone out of a home they are comfortable in because they cannot afford to pay the monthly charges.
What is Medicaid and how does it factor into the financial considerations?
Medicaid is a federal program which apportions money to the State to help pay for care for those who qualify in a variety of care settings, including an Adult Care Home. The person needing care must qualify financially, and must also have their care needs assessed by a Medicaid worker to determine whether those needs are high enough to qualify for the Medicaid program. A screening by phone can help determine whether or not a person needing care should apply for the Medicaid program. You may call the Aging and Disability Services helpline (Social Services) for more information. (Find your county under “Help Sources”).
Touring the Homes or Facilities
We will typically identify 2-4 homes which appear to match your needs most closely and give you names, addresses and phone numbers. You should call each operator to confirm that they still have a vacancy and make an appointment to see their place (If you need transportation, we can help). Include the person needing care in these visits whenever possible. This decision affects them more than anyone else involved. We will have already described the needs of the person needing care to the operator. When you interview the operator during your home tour, let the operator ask you questions about the person’s needs and answer them to the best of your ability. You may be tempted to conceal unpleasant or embarrassing information regarding the person’s behaviors or habits. You will save everyone involved time and trouble if you include any potentially unattractive information somewhere in that initial conversation. The operator may surprise you by having experience in accommodating that particular need. If you and the provider conclude that it would be an appropriate place for your senior, they will discuss their contract with you. This, you should read and understand.
Whenever possible, (and sometimes it is not) it may be important for the person needing care to view more than one home, participate in making a choice, and to have the final say in the selection process. Others who are important to the person seeking care need to participate in the selection process as well and “buy off” on the final selection. The more people in that person’s life who support the choice, the more likely the new living situation is to be a success. If the person needing care is having a tough time deciding on a home, ask the operator if it would be possible for the person to come by a second time for a meal, and to visit with the other residents in the home.