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Adult Foster Care Definition
Purpose
Adult Foster Care (PA-AFC) programs support community-based living arrangements for adults in need of long term-services and supports, matching them with in-home caregivers.Definition
Currently viewing: ADULT FOSTER CARE
VIEW THE STANDARDS
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 PA-AFC Reference List 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 (PA-AFC) 1: Person-Centered Logic Model
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-AFC 1.01
- needs the program will address;
- available human, financial, agency, 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 agency, 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.
PA-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 PA-PQI 5.02 for more information on disaggregating data to track and monitor identified outcomes.
Adult Foster Care (PA-AFC) 2: Personnel
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-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.
PA-AFC 2.03
PA-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.
PA-AFC 2.05
PA-AFC 2.06
- assigning a worker at intake or early in the contact; and
- avoiding the arbitrary or indiscriminate reassignment of direct service personnel.
PA-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 (PA-AFC) 3: Intake and Assessment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-AFC 3.01
- how well their request matches the agency's services; and
- what services will be available when.
PA-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.
PA-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 (PA-AFC) 4: Caregiver Recruitment and Assessment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-AFC 4.01
- former and current service recipients and caregivers;
- workers;
- community leaders; and
- other agencies in the community.
PA-AFC 4.02
PA-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.
PA-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 agency to assess for it in case the agency receives an individual who does require lifts.
PA-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.
PA-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 (PA-AFC) 5: Home Assessment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-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.
PA-AFC 5.03
Adult Foster Care (PA-AFC) 6: Placement Planning
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-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.
PA-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.
PA-AFC 6.04
- a list of all medical, treatment, and other services needed;
- dietary requirements; and
- any known allergies.
PA-AFC 6.05
Adult Foster Care (PA-AFC) 7: Caregiver Training and Support
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-AFC 7.02
- basic first aid and CPR;
- medication administration, as appropriate;
- safe lifts;
- the agency'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 agency has procedures in place for ensuring the caregivers receive this information.
PA-AFC 7.03
PA-AFC 7.04
- psychoeducation;
- emotional support;
- community services;
- self-help referrals; and
- care coordination resources, as needed.
PA-AFC 7.05
Adult Foster Care (PA-AFC) 8: Placement Monitoring and Reassessment
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-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.
PA-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.
PA-AFC 8.04
- completion of ADLs and IADLs;
- the service recipients physical, mental, and emotional status within the household;
- medication; and
- services utilized.
PA-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 (PA-AFC) 9: Case Closing and Aftercare
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.
- All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance.
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
- The majority of the standards requirements have been met and the basic framework required by the standard has been implemented.
- Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.
- The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.
- Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.
- Service quality or agency functioning may be compromised.
- Capacity is at a basic level.
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.
- The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
PA-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.
PA-AFC 9.02
PA-AFC 9.03
PA-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 agency has an interagency agreement that does not include aftercare planning or follow-up.