Nadine Carlson of Care Provider Solutions talks about adult foster care (AFC), including what it is, services provided, and the differences between AFC and other long-term care options. She emphasizes the importance of early planning for families considering AF, the role of Medicaid in funding, and how to find the right facility for your loved one.
Nadine Carlson (00:07)
Wonderful thanks Katie for inviting me and many people know individuals who can no longer live independently and one of the options that they have to get supported living is an adult foster care facility. That's a licensed facility in a residential home. Well, what our organization does is help the operators of those facilities run their businesses better so that they have less stress and ultimately can provide better care to the residents living inside of them.
Katie Wilkinson (00:40)
That's awesome. Yeah, can you say more about, you know, what is adult foster care? What kind of services someone might get in adult foster care and how it differs from other long-term care services?
Nadine Carlson (00:51)
Yeah, that's a really good question because it can be confusing and frustrating because depending on the state that you live in, a license facility can go by different names. So in Michigan, it's adult foster care and others that might be residential assisted living or group homes or family care homes, adult family homes. There's a whole bunch of different names, but no matter what the term is used by your state, they are licensed facilities in a residential neighborhood.
which will meet the regulations of the state in which they operate out of. And just for consistency, I'll just use AFC for the rest of our discussion. But ultimately to define it, it's a type of license. These facilities are in neighborhood settings, very home-like, where personal care and supervision is provided 24 hours a day, seven days per week.
There are four individuals who are over the age of 18 with conditions such as traumatic brain injury, intellectual, mental, and or physical limitations. And the staff that works there provides help with the activities of daily living and instrumental activities of daily living like shopping and money management and those things. And some actually specialize just in working with the aged. But I think it's really important.
to know that they're not skilled nursing facilities or facilities who provide nursing care. Now, if we compare that against other options, there's homes for the aged that goes by HFA. Those are specifically for people over the age of 55. There's nursing home and skilled nursing facility. So unlike the residential setting of an AFC, these are more of a hospital like setting. You have in-home care.
And that's agencies that will come to the home to provide the care that your loved one needs. And then of course, there's day centers, kind of like childcare, but for adults where they can go for the day to partake in enriching activities.
Katie Wilkinson (02:59)
Awesome. Can you share a little bit about who are the staff at an AFC and like who's running them? Are they run by the state? Are these privately run? Et cetera.
Nadine Carlson (03:08)
Typically, they're privately run. Some are run by large corporations, but the vast majority are individuals coming from a care background who just really want to run their own business and provide care to make a difference in people's lives.
Katie Wilkinson (03:26)
Yeah, I love that. At Givers, we are trying to provide education and information to caregivers of all sorts. But most specifically, we see caregivers whose loved ones are on Medicaid. Can you talk a little bit about, you know, do AFC programs accept Medicaid? What do people need to know about that interaction?
Nadine Carlson (03:44)
Mm-hmm, yeah, that's a really good question. I think to start, it's probably good to know what the definition is of Medicaid waiver. That's a term that a lot of these agencies use, but it's a long-term care program that provides service and support to individuals in the community who meet nursing level facility, nursing facility level of care, but they don't require 24 hour nursing care.
So it's available for those over 18 that are certified disabled or 65 and older who meet eligibility requirements such as financial criteria and medical criteria. Now, does every AFC accept waiver funding? Not necessarily. Some will just take care of individuals that are paying out of pocket. We call that private pay. But some will contract with agencies such as Area Agency on Aging.
in which the agency provides funding to that AFC to provide supervision and assistance to the qualified adult in the home.
Katie Wilkinson (04:53)
That's really helpful. Thank you. What is the process? You've just described a couple of different scenarios. So some people are going through Medicaid, some are going through private pay, other channels. So maybe this question differs depending on your particular situation. But what's the process of applying to adult foster care? How does someone get into a program like this?
Nadine Carlson (05:10)
And that's an important question. And like you said, there's different avenues of which you can approach it. But first you have to find them. And most states have a database of the licensed facilities you can access to find a facility near you. Some facilities will have a website where you can submit a referral for consideration or to request a tour once you know their names.
You can work with the placement agencies. So whether it's the community and mental health or the waiver organizations, they will provide you referrals to see whether or not it's a good match or placement agencies who work with the families in person and set up tours in facilities they have pre-screened to see if it's well-suited option for placement is also another option to consider.
Katie Wilkinson (05:59)
Awesome. You've mentioned a couple of times just then about it being a match for families that are looking at adult foster care for their loved one or maybe for themselves. What would make a program a good match? What should they be looking for? What things should they be considering?
Nadine Carlson (06:13)
Yeah, that's really important. And I think first of all, it's really important to understand when you should start looking because there's actually a quote by Gabriel Garcia Marquez, he who awaits much can expect little. So if you wait until that time when it's absolutely necessary to move someone into supported living, there's a high probability it's gonna be a bad choice. So start two years ahead of time.
That reduces your risk of making a bad choice. It gives you the likelihood of finding a desirable place, especially if that facility has a waiting list.
Did I answer that the way I don't think I answer? so what things should you look for? So you start the process early and then you want to interview it just as if you're looking for a new job. You want to check the history of the licensing inspections and whether or not they have citations. You want to visit the facility you're considering. Sometimes seeing is a much different reflection than just hearing.
Ask questions to determine if the AFC home staff is skilled and trained to meet your loved ones needs. And you know, make sure that you like how they communicate. How is that done? How are doctor appointments, transportation? How are all those things coordinated and then confirm all that information. Compare it against all the places you're visiting. Of course you want to compare that against your budget as well, especially if you're paying out of pocket.
And then finally pick your place. And when you follow those steps, then the likelihood of a successful placement is much, much higher, which obviously creates a lot of peace of mind in the family's minds.
Katie Wilkinson (08:05)
Yeah, I really like that quote that you shared. think so often for family caregivers, and sometimes this is at no fault of their own, but caregiving can come at you so fast or an urgent situation. so, you know, in the times when you can plan ahead, I really like that quote. I think that's very important. Can you talk about misconceptions about adult foster care? Are there things that you hear that people are confused about or don't know about that you might want to address and help clear up for people?
Nadine Carlson (08:20)
Yeah, absolutely. I think some individuals might define adult foster care as a vault adult foster scare. Not adult foster care. You know, some would say I'd never go to one of those places, because I've seen the news reports. know, caregivers abusing the residents in some fashion and taking advantage of the individuals under their roof. It's it's so hard to say, but these places do exist and they really make a person cringe.
I, but here's the misconception I want to overcome that is that there are AFC owners and operators and their caregivers that were born to nurture and spoil and care for those that live in their facilities. They desire to know and value each and every one of their residents, regardless of their ability. And as long as you're doing the screening that we talked about before,
then you'll find those places and you won't have to worry about seeing them on the news in one of those horrific stories. And I'm coming from a place of expertise in that I've been in the business of owning, operating, and now consulting for about 15 years. So I say that with experience to back it up.
Katie Wilkinson (09:50)
Yeah, thank you for sharing that. And I can hear your passion and it's clear how you've ended up in consulting to make sure that all or as many of these facilities as possible can be what you've just described. For families, so givers is able to help family caregivers get paid through state programs, one of which is structured family caregiving where you care at home for your loved one in your own house.
That doesn't mean that that's the right situation for everyone. Not everyone is eligible for this. When you've talked to family caregivers that are, or families that are trying to figure out what to do for their loved one, are there any like pros, cons? What's sort of the consideration when you're thinking about, I care for my loved one in my house or putting them into, that's probably not even the right language, but you know, putting them into an adult foster care or a different institution. What are some of the thoughts that you hear?
around that decision making process and is there any like advice or guidance you might be able to give?
Nadine Carlson (10:45)
Yeah,
know, caring for a loved one, especially a parent or someone that raised you is an extremely emotional place to be. And sometimes that care comes from a state of obligation, sense or a feeling of obligation instead of coming from a state of logic. And sometimes we have to separate the two.
And we have to really evaluate how is this arrangement, if I'm providing the care in the home, affecting my ability to love them as a family member so that the relationship doesn't break down and then there's burnout. And then not only is the health of the one that you're caring for at risk, so is yours as the caregiver because you're just trying to do too many things with too little time.
And when it comes to that point of being able to separate those two, then I think you can really approach it from a very intellectual place of making the right decision for that person, not because you're emotionally attached or obligated to, but because it's the right thing to do.
Katie Wilkinson (12:02)
Yeah, I think that's an excellent barometer of where someone might be in this decision making process. I guess my last question before we ask where we can find more information about you and what you are able to do for AFC, but is it ever too late to look at AFC? in the instance we just described, someone might be caring at home, they're experiencing burnout, they're looking for alternatives. Is there any cutoff for when you might consider an option like this?
Nadine Carlson (12:29)
I'd say anytime is a good time. If you don't do it with the two year recommendation that I made, well then do it when it's appropriate. There are options for respite while you're helping to try to make these decisions and find the right place. There are other options so that you don't have to rush and make a very poor choice.
Katie Wilkinson (12:55)
Perfect. I know you do a lot of education and advocacy and you make a lot of content around adult foster care. If someone wants to learn more about what you do or just more from you, where can they find more information?
Nadine Carlson (13:08)
Absolutely. So a care provider solutions.com is our website and you'll see our blogs, all of the courses and how we support adult foster care home owners in Michigan to succeed at what they want to do best, which is provide excellent care to their residents.
Katie Wilkinson (13:31)
Perfect, we'll be sure to include links to everything in wherever the show notes. Nadine, thank you so much for taking the time to give us sort an overview of adult foster care. I think this will be really helpful to a lot of people.
Nadine Carlson (13:42)
I appreciate it. Now, would you like me to real quickly review the type of support individuals can expect to receive in an AFC?
Katie Wilkinson (13:52)
Yeah, that would be great. Sorry, I jumped right over that. Yeah, if you could tell us a little bit about the supports and services someone might expect to receive at an AFC, that would be awesome.
Nadine Carlson (14:01)
Yeah, I'd love to do that. So I think it'd be helpful if we just give you some scenarios, because then people can relate to it a little bit easier. So I'll give you an example number one. So you have an adult who's always lived at home. This individual has developmental disabilities. can't live independently. The parents are aging. They just can't do it anymore. So in an AFC setting in this situation, they could provide the supervision, the medication management, help with the personal care.
and community living supports to help maintain as much independence as possible, including shopping, money management, and those kinds of things. Now compare that to an elderly person that's becoming more forgetful. They sometimes forget to take their medications, they leave the stove on, they get confused when they're in the community, they're not remembering to change their clothes or take showers. And AFC in this case could provide health and safety.
manage their medications, accompany them in the community, support doctor appointments, and provide the personal care. And then I'll give you one last example, someone with behaviors. This is someone who's aggressive and that they can punch, pull your hair, scratch, or severely harm the individuals they live with, or even harm themselves with self-mutilation. In a specialized AFC where staff is trained to manage high behavior individuals,
They will protect these adults from harming themselves and others, use redirection skills, provide medication management and personal care, and offer other supports that they need. So what you might be gathering here with these examples is that each facility typically has a personality of their own. So when you're taking your time to research and tour each of these locations, then you'll see whether or not that
home's personality matches the personality of your loved one and the care that they need.
Katie Wilkinson (16:01)
Imagine this sort of personality of a facility they're talking about might be intentional, but might also just be how it's evolved over time. Is there a way to parse that out before you go to one or explore an option?
Nadine Carlson (16:17)
Yes, absolutely. So when you make that initial call to set up a tour, you could do a phone interview, kind of like you're interviewing them for a job, and ask some high level questions of the things that are absolutely necessary in order for you to even consider them so you don't take the time to spend the gas and the time to go visit it. Michigan, the state of Michigan has a wonderful cheat sheet that you can use to interview.
facilities and I'd be glad to give you the link to include in the notes for that as well, just to help people as they're deciding to know what questions to ask.
Katie Wilkinson (16:54)
Yeah, that would be awesome. We'd love to include that. I know that your expertise and experiences in Michigan, are there any state differences between AFC that maybe there's specific things, but anything high level that people should be aware about?
Nadine Carlson (17:08)
Each state has their own way of doing it. So a search term I think will help know better what it is that your state provides. And that could be like if it's an aged loved one, area agency on aging that falls right into the waiver or licensed facilities for care supports in and then put in the name of your state.
That way you'll at least get a more targeted answer to what you're looking for.
