More Out-of-Home Living Options

This past week, I had another client who was a caregiving spouse who entered the hospital. She was trying to keep her husband out of the nursing home by caring for him at home and she was the one who had to go to the hospital. And because she was no longer at home and able to care for her husband, he still ended up in a nursing home, which is what she was trying to avoid.

Unfortunately, this happens with alarming frequency and I see this on an all too regular basis. We have discussed caregiver burnout at length the past few weeks and earlier this year. Caregivers, especially caregiving spouses, often don’t recognize when they are in over their heads, and get to a breaking point because they wait too long to seek assistance. The caregivers themselves become candidates for a long-term care facility, or worse, they pass away before their disabled spouses.

If you are a caregiver, seek assistance before caregiver burnout sets in. In prior columns we have discussed various living arrangements and assistance both in and out of your home. But what if you cannot live alone because you need 24 hour personal care, protection or supervision, and do not need the medical care provided by a nursing home? Adult Foster Care (AFC) homes and Homes for the Aged (HFAs) offer non-nursing home options for you.

In Michigan, AFC homes and HFAs are licensed and regulated by the Department of Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS). A facility generally needs to be licensed as a home for the aged (HFA) if it provides housing, meals and supervised personal care to 21 or more unrelated people who are 60 years of age or older. Supervised personal care means guidance (cuing, prompting, reminding) or assistance with eating, toileting, bathing, grooming, dressing, transferring, mobility, medication management, activity reminders and tracking a resident’s whereabouts. According to the LARA website, there is only one HFA in St. Clair County, Sanborn Gratiot Memorial Home in Port Huron.

An facility needs to be licensed as an AFC if it provides personal care, supervision and protection in addition to housing and meals to 20 or fewer unrelated persons who are aged, mentally ill, developmentally disabled, or physically disabled, for 24 hours a day, 5 or more days a week, for 2 or more consecutive weeks for compensation. Some facilities are limited to 6 or 12 residents. According to the LARA website, there are 73 AFCs in St. Clair County. Of those, there are three larger facilities that have two 20 bed licensed AFCs as part of their facilities, River Bend in East China and Sanctuary at Mercy Village and Barss, Inc. in Fort Gratiot.

A licensing requirement and for your protection, AFC homes and HFAs must perform criminal background checks for all the workers in the facility who have direct access to you or your property, financial information, medical records, treatment information or any other identifying information.

There are various levels of services that AFC homes and HFAs can provide. There are some facilities that provide only minimal assistance and require residents to be fully mobile. There are other facilities that offer more intensive care and supervision and may provide all the non-medical services that are typically provided by a nursing home.

But how do you choose a facility? Well, one of the things that you can do first is get a list of the licensed AFC homes and HFAs in your area by going online on the state website at You can then search by zip code, county, etc. You can also view recent complaint investigative reports for each of the facilities. You can also ask for referrals from people you know who have had family members in these homes. Check with local senior agencies who may also offer some referrals.

When choosing a home, make sure the home has a process for addressing concerns and complaints about the staff or the administration and a procedure to resolve conflicts. You do have certain rights when you are in an AFC home or an HFA and those rights include:

  • be free from discrimination because of race, religion, national origin, sex, age, handicap, marital status, or source of payment.
  • exercise constitutional rights, including the right to vote, to practice the religion of your choice, etc.
  • to send and to receive unopened and uncensored mail.
  • participate in social, religious and community activities, as well as the right to not participate.
  • contacts with relatives and friends, and to receive visitors in the home at a reasonable time.
  • private communications and consultations with a physician, attorney, or any person of your choice.
  • choose a physician, psychiatrist, or dentist for needed services.
  • refuse treatment and services, and to be told of the possible consequences of that refusal.
  • private use of a telephone every day.
  • access to your own room at your discretion.
  • voice complaints and make recommendations for change without fear of retaliation.
  • be treated with consideration and respect, with recognition of personal dignity, individuality and the need for privacy.
  • nutritious, appetizing meals,
  • be free from harm and punishment by restraint, isolation, personal humiliation, or by having food, water, or clothing/personal items withheld.
  • review and discuss your records with the home’s staff, including the assessment and care plans.
  • use the services of advocacy agencies and to attend other community services.
  • request and receive assistance form a responsible agency to relocate to another living situation.

If you have an issue with the home, you can file a complaint with BCHS who will investigate the complaint and can require the home to prepare a plan of correction, fine the facility, or suspend, modify or revoke the facility’s license.

At the time of admission to one of these facilities, you should be completing a residential care agreement with them. The agreement must be reviewed at least annually, but can be reviewed anytime there is a concern about or a change in your care.

AFC homes and HFAs are generally private businesses or non-profits that set their own rates. You are typically responsible for privately paying your monthly cost of care. There are also certain long-term care policies that will provide reimbursement for your care in licensed facilities, such as AFC homes or HFAs.

The cost of an AFC home or HFA is generally less than nursing home care. I have seen some of these homes with monthly rates less than $1,500 to more than $5,000, with everything in between. The costs vary depending upon location of the home and the level of care provided.

You have a lot of options for non-nursing home care. Those options include AFC homes and HFAs. With the options available, you can choose the facility that is right for you depending upon the level of care you need and what would best fit your budget.

By: Matthew M. Wallace, CPA, JD

Published edited May 8th, 2016 in The Times Herald newspaper, Port Huron, Michigan as: More Out-of-Home Living Options

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