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Adult Foster Care Definition
Purpose
Adult Foster Care (AFC) programs support community-based living arrangements for adults in need of long term-services and supports, matching them with in-home caregivers.Definition
Note:Caregiver refers to the individual(s) operating the residence, specifically those responsible for the care of the service recipient.
Note:Activities of daily living (ADL) refers to daily self-care activities, such as eating, toileting, dressing, grooming, etc. Instrumental activities of daily living (IADL) are those supports that are not necessary for fundamental functioning, but allow for an individual to live independently in the environment of their choosing and include cleaning, cooking, shopping, taking prescribed medication, etc.
Note:There are references to family members throughout the standards, however family should be defined by the individual and includes any supportive relationships that make up an individual's informal support network.
Note:Please see AFC Reference List - Private, Public, Canadian for the research that informed the development of these standards.
Note:For information about changes made in the 2020 Edition, please see the AFC Crosswalk.
Adult Foster Care (AFC) 1: Person-Centered Logic Model
Logic models have been implemented for all programs and the organization has identified at least two outcomes for all its programs.
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- Logic models need improvement or clarification; or
- Logic models are still under development for some of its programs, but are completed for all high-risk programs such as protective services, foster care, residential treatment, etc.; or
- At least one client outcome has been identified for all of its programs; or
- All but a few staff have been trained on use of therapeutic interventions and training is scheduled for the rest; or
- With few exceptions the policy on prohibited interventions is understood by staff, or the written policy needs minor clarification.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Logic models need significant improvement; or
- Logic models are still under development for a majority of programs; or
- A logic model has not been developed for one or more high-risk programs; or
- Outcomes have not been identified for one or more programs; or
- Several staff have not been trained on the use of therapeutic interventions; or
- There are gaps in monitoring of therapeutic interventions, as required; or
- There is no process for identifying risks associated with use of therapeutic interventions; or
- Policy on prohibited interventions does not include at least one of the required elements.
- Logic models have not been developed or implemented; or
- Outcomes have not been identified for any programs; or
- There is no written policy or procedures for the use of therapeutic interventions; or
- Procedures are clearly inadequate or not being used; or
- Documentation on therapeutic interventions is routinely incomplete and/or missing; or
- There is evidence that clients have been harmed by inappropriate or unmonitored use of therapeutic interventions.
AFC 1.01
- needs the program will address;
- available human, financial, organizational, and community resources (i.e. inputs);
- program activities intended to bring about desired results;
- program outputs (i.e. the size and scope of services delivered);
- desired outcomes (i.e. the changes you expect to see in service recipients); and
- expected long-term impact on the organization, community, and/or system.
Examples: Information that may be used to inform the development of the program logic model includes, but is not limited to:
- needs assessments and periodic reassessments;
- risks assessments conducted for specific interventions; and
- the best available evidence of service effectiveness.
AFC 1.02
- change in clinical status;
- change in functional status;
- health, welfare, and safety;
- permanency of life situation;
- quality of life;
- achievement of individual service goals; and
- other outcomes as appropriate to the program or service population.
Interpretation: Outcomes data should be disaggregated to identify patterns of disparity or inequity that can be masked by aggregate data reporting. See PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes.
Adult Foster Care (AFC) 2: Personnel
- With some exceptions, staff (direct service providers, supervisors, and program managers) possess the required qualifications, including education, experience, training, skills, temperament, etc., but the integrity of the service is not compromised; or
- Supervisors provide additional support and oversight, as needed, to the few staff without the listed qualifications; or
- Most staff who do not meet educational requirements are seeking to obtain them; or
- With few exceptions, staff have received required training, including applicable specialized training; or
- Training curricula are not fully developed or lack depth; or
- Training documentation is consistently maintained and kept up-to-date with some exceptions; or
- A substantial number of supervisors meet the requirements of the standard, and the organization provides training and/or consultation to improve competencies when needed; or
- With few exceptions, caseload sizes are consistently maintained as required by the standards or as required by internal policy when caseload has not been set by a standard; or
- Workloads are such that staff can effectively accomplish their assigned tasks and provide quality services and are adjusted as necessary; or
- Specialized services are obtained as required by the standards.
- A significant number of staff (direct service providers, supervisors, and program managers) do not possess the required qualifications, including education, experience, training, skills, temperament, etc.; and as a result, the integrity of the service may be compromised; or
- Job descriptions typically do not reflect the requirements of the standards, and/or hiring practices do not document efforts to hire staff with required qualifications when vacancies occur; or
- Supervisors do not typically provide additional support and oversight to staff without the listed qualifications; or
- A significant number of staff have not received required training, including applicable specialized training; or
- Training documentation is poorly maintained; or
- A significant number of supervisors do not meet the requirements of the standard, and the organization makes little effort to provide training and/or consultation to improve competencies; or
- There are numerous instances where caseload sizes exceed the standards' requirements or the requirements of internal policy when a caseload size is not set by the standard; or
- Workloads are excessive, and the integrity of the service may be compromised; or
- Specialized staff are typically not retained as required and/or many do not possess the required qualifications; or
- Specialized services are infrequently obtained as required by the standards.
AFC 2.01
- a bachelor’s degree in a human service field and experience in direct services;
- an associate’s degree in a human service field and two years’ experience in direct services; or
- five years experience in direct services.
AFC 2.02
- an advanced degree in social work or a comparable human service field and a minimum of two years’ experience in direct services;
- a bachelor’s degree in a human service field and five years’ experience in direct services; and/or
- licensure as a registered nurse and a minimum of two years’ experience in direct services.
AFC 2.03
AFC 2.04
- special needs related to working with the identified service population;
- signs of abuse or neglect;
- advance directives;
- coordinating services as part of a team;
- disaster relief resources, planning, and procedures.
AFC 2.05
AFC 2.06
- assigning a worker at intake or early in the contact; and
- avoiding the arbitrary or indiscriminate reassignment of direct service personnel.
AFC 2.07
- a flexible response when problems arise in a placement;
- a schedule of regular contact, including in-person visits; and
- responsiveness to the differing needs of individuals and caregivers.
- the qualifications, competencies, and experience of the worker, including the level of supervision needed;
- the work and time required to accomplish assigned tasks and job responsibilities; and
- service volume, accounting for assessed level of needs of persons served.
Adult Foster Care (AFC) 3: Intake and Assessment
Interpretation: For organizations that solely support homes with a ready-made caregiver, the organization should still have screening and intake procedures to ensure that the arrangement is appropriate for receiving the level of supports Adult Foster Care programs provide.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- In a few rare instances, urgent needs were not prioritized; or
- For the most part, established timeframes are met; or
- Culturally responsive assessments are the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Urgent needs are often not prioritized; or
- Services are frequently not initiated in a timely manner; or
- Applicants are not receiving referrals, as appropriate; or
- Assessment and reassessment timeframes are often missed; or
- Assessments are sometimes not sufficiently individualized;
- Culturally responsive assessments are not the norm, and this is not being addressed in supervision or training; or
- Several client records are missing important information; or
- Client participation is inconsistent; or
- Intake or assessment is done by another organization or referral source and no documentation and/or summary of required information is present in case record.
- There are no written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 3.01
- how well their request matches the organization’s services; and
- what services will be available when.
AFC 3.02
- gather information necessary to identify critical service needs and/or determine when a more intensive service is necessary;
- give priority to urgent needs and emergency situations;
- clarify needs and preferences including the choice to execute an advance directive, as appropriate;
- support timely initiation of services; and
- provide placement on a waiting list or referral to appropriate resources when individuals cannot be served or cannot be served promptly.
AFC 3.03
- is completed within established timeframes;
- includes the individual’s view of his or her current health and functioning;
- includes baseline functional, mental, emotional, and physical status information, including prescription medication use and recent or progressive functioning to confirm capacity, decline, or progress;
- is updated as needed based on the needs of persons served; and
- focuses on information pertinent for meeting service requests and objectives.
Interpretation:The recommended timeframe is 30 days and should not exceed 45 days unless justification for exceeding that timeframe is provided in the case record.
Interpretation: The Assessment Matrix - Private, Public, Canadian, Network determines which level of assessment is required for COA’s Service Sections. The assessment elements of the Matrix can be tailored according to the needs of specific individuals or service design.
Adult Foster Care (AFC) 4: Caregiver Recruitment and Assessment
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- For the most part, established timeframes are met; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Timeframes are often missed; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 4.01
- former and current service recipients and caregivers;
- workers;
- community leaders; and
- other organizations in the community.
AFC 4.02
AFC 4.03
- awareness of the recruitment-to-placement timeline and available supports;
- timely, sensitive, personal, and culturally-responsive follow-up at each step of the process;
- personalized contact with existing caregivers; and
- accessible and inviting open houses, orientations, and training sessions.
AFC 4.04
- personal characteristics;
- motivation for providing adult foster care;
- willingness to provide responsive care for the characteristics and needs of the population;
- willingness and ability to support the service recipient’s ties to family, peers, and community;
- family relationships and family functioning, including alternative providers for relief;
- mental and physical health;
- relevant strengths, skills, and experience;
- social support networks; and
- the home environment.
Interpretation: Health assessments include the individual’s ability to perform lifts. While many service recipients may not require lifts, it is important for the organization to assess for it in case the organization receives an individual who does require lifts.
AFC 4.05
- within two weeks of a reported change in home composition; and
- at least once annually.
- individuals who move in or out of the house;
- death or debilitating illness of a caregiver; or
- legal proceedings affecting the family such as eviction or divorce.
AFC 4.06
- all adults in the home receive criminal background and sex offender registry checks prior to placement in accordance with applicable federal and state law; and
- three non-relative references are provided.
Adult Foster Care (AFC) 5: Home Assessment
Currently viewing: HOME ASSESSMENT
VIEW THE STANDARDS
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- For the most part, established timeframes are met; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Timeframes are often missed; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 5.01
- approving homes in accordance with applicable regulatory requirements;
- frequency of in-person home reassessments; and
- time frames for repairs based upon the necessity of the repair and to what extent it inhibits the service recipient’s independent functioning.
AFC 5.02
- the kitchen area is clean and in good working order;
- clean, private facilities for bathing, toileting, and personal hygiene are provided;
- provision of adequately and attractively furnished rooms with a separate bed for each person, including a clean, comfortable, covered mattress, pillow, sufficient linens and blankets;
- doors are maintained on sleeping areas and bathroom enclosures;
- assistive technology is in place or the ability for assistive technology to be installed;
- heating, lighting, water supply, and ventilation are adequate;
- safety and emergency protections are in place, including fire and carbon monoxide detectors, and an unobstructed emergency exit is available; and
- ease of evacuating the building or moving to an area of safety within the building during an emergency either independently or with minimal assistance.
AFC 5.03
Adult Foster Care (AFC) 6: Placement Planning
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- For the most part, established timeframes are met; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Timeframes are often missed; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 6.01
- the individuals’ and caregivers’ characteristics, strengths, needs, supports, and resources;
- the appropriateness of the home environment;
- any prior relationship between the individual and caregiver; and
- informal support networks of both the individual and the caregiver.
AFC 6.02
- ensures individuals, families, and caregivers are aware of the placement process and receive support and information throughout;
- provides all legally permissible information about the individual’s characteristics, behaviors, needs, and histories to prospective caregivers;
- arranges opportunities for individuals and families to meet prospective caregivers whenever possible;
- responds proactively to challenges associated with placement and assesses the need for services and supports; and
- facilitates workers’ ability to spend more time with individuals, families, and/or caregivers after a new placement or when challenges arise.
AFC 6.03
- outlines both parties’ expectations of household functioning; and
- includes both parties’ signatures.
- meal times, including when and where meals are provided;
- expectations around having visitors to the home;
- the use and decoration of personal and common spaces; and
- support for purchasing personal belongings.
AFC 6.04
- a list of all medical, treatment, and other services needed;
- dietary requirements; and
- any known allergies.
AFC 6.05
Adult Foster Care (AFC) 7: Caregiver Training and Support
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- For the most part, established timeframes are met; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Timeframes are often missed; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 7.01
- specific duties of caregivers;
- identification and reporting of abuse and neglect;
- documentation and reporting requirements;
- reimbursement of services;
- creating a safe environment, responsive to the individual’s trauma and mitigating trauma-related stress responses;
- preventing allegations of maltreatment and procedures when allegations are made;
- complaint procedures;
- community resources, including public transportation; and
- circumstances that will result in the revocation of a caregiver’s license, certification, or approval.
AFC 7.02
- basic first aid and CPR;
- medication administration, as appropriate;
- safe lifts;
- the organization’s policies on restrictive interventions and behavior support and management;
- medical or rehabilitative interventions; and
- operation of medical equipment when required for an individual’s care.
Medication administration training pertains only to the medicines that are relevant for the service recipients in that household and includes dosage, frequency, side effects, and likelihood and signs of abuse, as well as any other relevant information. If another service provider is responsible for overseeing the individual’s medications, then the organization has procedures in place for ensuring the caregivers receive this information.
AFC 7.03
AFC 7.04
- psychoeducation;
- emotional support;
- community services;
- self-help referrals; and
- care coordination resources, as needed.
AFC 7.05
Adult Foster Care (AFC) 8: Placement Monitoring and Reassessment
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- For the most part, established timeframes are met; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- Active client participation occurs to a considerable extent.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Timeframes are often missed; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 8.01
- a frequency schedule of in-person visits made to the home;
- assignment of responsibility for ensuring services are being accessed and are appropriate and satisfactory;
- annual health status reports, either provided by the qualified personnel or documentation by the caregiver’s and service recipient’s primary care physicians;
- documentation to be provided by the caregiver, and
- responsiveness to any complaints or problems that may develop.
AFC 8.02
- within five working days of a precipitating event;
- when there is a significant change in the individual’s status or circumstances, or a new issue arises; and
- within 48 hours of notification when a hospital or institutional discharge is imminent.
AFC 8.03
- conditions of the home environment;
- changes in baseline functioning status of the service recipient, including increased needs;
- community integration, including frequency of the individual engaging in community activities and ability to access community activities independently; and
- changes in the household make up.
AFC 8.04
- completion of ADLs and IADLs;
- the service recipients physical, mental, and emotional status within the household;
- medication; and
- services utilized.
AFC 8.05
- have a schedule of caregiver documentation review; and
- communicate with other service providers to assess service participation and effectiveness.
Adult Foster Care (AFC) 9: Case Closing and Aftercare
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
- Procedures need strengthening; or
- With few exceptions, procedures are understood by staff and are being used; or
- Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
- In a few instances, the organization terminated services inappropriately; or
- Active client participation occurs to a considerable extent; or
- A formal case closing evaluation is not consistently provided to the public authority per the requirements of the standard.
- Procedures and/or case record documentation need significant strengthening; or
- Procedures are not well-understood or used appropriately; or
- Services are frequently terminated inappropriately; or
- Aftercare planning is not initiated early enough to ensure orderly transitions; or
- A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard; or
- Several client records are missing important information; or
- Client participation is inconsistent.
- No written procedures, or procedures are clearly inadequate or not being used; or
- Documentation is routinely incomplete and/or missing.
AFC 9.01
- is a clearly defined process that includes assignment of staff responsibility;
- begins at intake; and
- involves the worker, persons served and others, as appropriate to the needs and wishes of the individual.
AFC 9.02
AFC 9.03
AFC 9.04
- develop an aftercare plan, sufficiently in advance of case closing, that identifies short- and long-term needs and goals and facilitates the initiation or continuation of needed supports and services; or
- conduct a formal case closing evaluation, including an assessment of unmet need, when the organization has a contract with a public authority that does not include aftercare planning or follow-up.