Family caregivers are devoted to keeping frail, older family members safe, comfortable and healthy. Foster homes have long served as community alternatives to institutions. A growing movement combines these concepts to help ailing older adults remain as independent as possible within homes headed by motivated, supported caregivers.
This type of care goes by different names — adult foster care, medical foster homes, residential care homes, among others — and details vary. If you’re considering long-term care options for yourself or a loved one beyond nursing homes, you might want to include adult foster care. Here are some ways it can work.
[See: 7 Red Flags to Look for When Choosing a Nursing Home.]
Serving Veterans
For veterans who can no longer safely live independently, the VA Medical Foster Homes Program may serve their needs. Veterans who qualify have serious, chronic disabling conditions that meet the nursing home level of care. These vets require health care coordination and increased access to VA services.
According to a VA overview, the medical foster home program “brings together a person who is willing to open their home and serve in the role of strong family caregiver” with a VA coordinator who manages the program, and a multidisciplinary home care team that provides in-home care to the veteran and training to the caregiver. The medical foster home is matched to the veteran’s physical, social, emotional, supervision and safety needs.
To date, 126 VA medical centers in 44 states and U.S. territories are operating or developing medical foster homes. More than 1,000 veterans are enrolled, with about 700 caregivers who own or rent and live in these homes participating in the program. With a maximum of three residents (both veterans and nonveterans) receiving care in these homes, a therapeutic yet familial environment is possible.
The small group of residents, 24/7 live-in caregiver and home-cooked meals combine to create a personalized atmosphere. Residents can feel they’re part of their surrounding neighborhood and community.
“We want this to be a personal home,” says Dayna Cooper, director of home and community care geriatrics and extended care with the Department of Veterans Affairs. “We want it to be family-like.” Households often include the caregiver’s spouse and children, she says, or it could be a single person with a back-up caregiver. Veterans become part of the household. “Some of these families will take the veterans on vacation with them,” Cooper says. “So it really is a second family to some of these veterans.”
Health care outcomes may improve for vulnerable veterans who move into a medical foster home. A study of about 600 such participants, published November 2016 in the American Journal of Medical Quality, found the rate of avoidable hospitalizations decreased from 18.5 percent to less than 15 percent when comparing the six-month periods before and after individual veterans enrolled in the program.
In particular, hospitalizations for congestive heart failure and chronic obstructive pulmonary disease, or COPD — conditions in which patients adhering to treatment guidelines makes a big difference — were significantly reduced for residents in the study.
[See: 8 Ways to Reduce Hospital Readmissions.]
Young veterans with traumatic brain injuries, complex patients on ventilators or older veterans with cognitive health issues can be matched to medical foster homes that meet their needs, Cooper says. It’s just a matter of finding the right home and the right caregiver.
These homes can be a good fit for veterans with Alzheimer’s disease or other types of dementia. “We’ve actually found that the medical home environment is a better environment for them than a community nursing home,” Cooper says. “Because they receive more individualized attention and there’s a reduction in overstimulation.”
Caregivers are highly attuned to residents’ preferred routines and emotional needs. Familiar possessions brought in from residents’ previous homes — and even much-loved pets — contribute to reassuring, welcoming surroundings.
In addition to meeting standard licensing requirements in their state, caregivers in the VA program undergo extra levels of ongoing training, include training targeted to each resident veteran’s unique needs.
Some caregivers come to medical foster homes with previous health care experience, Cooper says, including careers as registered nurses, social workers and other staff positions in hospitals or nursing homes. Others have long experience with family caregiving. In some cases, members of military families express a deep desire to help veterans in need.
The home-based primary care team is an integral part of the program. Teams include a primary care provider (either a physician or nurse practitioner), a dietitian to help with meal planning, social workers and a variety of therapists, all of whom make home visits.
Depending on their location, veterans pay the medical home foster caregiver an average of $2,400 a month, or roughly $80 per day for room, board and personal assistance. “One-fourth of these veterans are eligible for fully VA-paid nursing home care, yet they choose to spend their personal funds for [medical foster homes] because they greatly prefer this type of care,” the VA summary notes.
Supporting Caregivers
You don’t have to be a military veteran to benefit from adult foster care. With “civilian” in-home care programs, the caregiver can be an actual family member or friend in many instances. Every state does it differently, says Rachel Richards, vice president of government relations with Seniorlink, a health services company that works with states and Medicaid-managed care organizations to support family caregiving.
Oregon, which has been at the forefront in setting standards for adult foster care, and other states largely use unrelated caregivers, Richards says. In Massachusetts, however, the program is based on residents living in their original homes with a family member as the designated caregiver.
Up-to-date national figures aren’t available for adult foster care, Richards says. To get a sense of its prevalence, more than 12,000 people are served by this model in Massachusetts alone. One factor making it difficult to quantify this type of care across the U.S. is that it goes by different names, like the “Right at Home” program in Rhode Island.
“We’re meeting the family caregiver where they’re at,” Richards says. “They’ve been doing it informally. Now we’re going to formalize it and provide them with some structured education and oversight. It’s really about being motivated. We try to be sure they’re doing it for the right reasons. And then we’ll come in and provide support to that caregiver, both with professional services, nurses and case managers, and financial support. So they will be paid a stipend to provide caregiving.”
[See: 11 Things Seniors Should Look for in a Health Provider.]
Programs begin with an in-home visit to assess needs of both the recipient and caregiver and formulate a plan of care. The program maintains regular contact with follow-up visits and ongoing caregiver coaching.
“We want them to understand how to reconcile medications,” Richards says. “We want them to understand how to transfer somebody from bed to out of bed. We want them to be able to assess for fall risks. We want them to know when they need to call the doctor.”
Keeping seniors involved in the community is another goal. “We don’t want them isolated at home any more than we want them isolated in a nursing home,” Richards says. “How do we make sure the participant stays engaged: goes to bingo; goes to church; does the things that were important to her before she became frail and needed a caregiver to live with her?”
Satisfaction is strong with this type of care, whether it’s offered through the expanding VA Medical Foster Homes Program or other adult foster care arrangements nationwide. Survey responses and other feedback from recipients, caregivers and family members have been highly positive, Cooper and Richards both say.
Getting Started
If you’re interested in adult foster home care, part of the challenge is knowing where to start. Your local referral agency can help guide you.
Adult care homes aren’t covered by Medicare, but certain aspects of care might fall under Medicaid. Long-term care insurance may provide coverage, depending on the policy. In general, adult foster care costs significantly less than nursing home care or assisted living.
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Medical Foster Homes for Helping Veterans and Other Ailing Adults originally appeared on usnews.com
