LARA Living Room
Inside stories and real conversations from the Michigan Department of Licensing and Regulatory Affairs. LARA Living Room explores how regulation works, why it matters, and the people making it happen.
LARA Living Room
Protecting Vulnerable Populations: Adult Foster Care
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What does it take to ensure safe, supportive care for vulnerable populations? In this episode, we explore the role of Adult Foster Care and the systems in place to protect residents and uphold quality standards. Learn how LARA’s work helps create environments where individuals are supported, respected, and cared for.
Hello, and welcome back to the LARA Living Room Podcast. I'm your host, Anastasha Osborn, and today we're diving into the topic of adult foster care. For many individuals across Michigan, adult foster care isn't just about receiving help with daily tasks. It's about having a safe place that they can live, being treated with dignity, and of course having the support that they need to live as independently as possible. And when we talk about protecting vulnerable populations, this is exactly the kind of work that we are talking about. So today we're going to unpack what adult foster care really is, who it serves, and the role LARA plays in making sure that the environments are safe, supportive, and held to high standards. So to guide us through this conversation, I'm going to be joined by Larry Horvath, who is the Director of the Bureau of Community and Health Systems, or BCHS. But first, before we jump in, go ahead and fill up your coffee or your drink of choice, grab a seat and get comfortable because you are now in the Lara living room. Larry, thank you so much for being here. Let's start with you telling us a little bit about your role and the work that your team is doing.
Larry HorvathSure. So my role is the Bureau of Director for the Bureau of Community Health Systems. Our role is a regulatory body. We oversee state licensing of adult foster care, but in addition to that, we also see oversee hospitals, nursing homes, surgery centers. So we have a portfolio of programs, agencies, and facilities. In addition, we do have a portfolio of individuals that we oversee as well, such as certified nurse aides and medication aides, as well as American Sign Language and Language Interpreters. Okay. With the NurseAid and Medication Aid program, we also oversee training programs and those trainers inside those training programs.
Anastasha OsbornWonderful. So because today's going to be the focus on adult foster care, can you kind of walk us through if someone were to go into an adult foster care home for the first time, what would they see and experience?
Larry HorvathSure. So one of the things that we always encourage if if a loved one is going to go into an adult foster care, we encourage the family or the guardian to visit the place first and visit that place with the potential resident. To make sure that they're comfortable, to make sure that the other residents are compatible to them. So that is always important. And so we serve a role to make sure that environment is a good environment for this individual. But it's also important that the family take charge and to visit these places, ask good questions, go visit these places during off hours as well.
Anastasha OsbornOkay. So can you tell us how many adult foster care homes are there in Michigan?
Larry HorvathSo there's approximately 3,800 adult foster care homes. And when you think about them, there's varying types of adult foster care homes. Our largest group is our small group homes, which means about one to six residents. And a similar type of home is the family home. The family home is different, and we have about 450 family homes in the state of Michigan that are licensed. And that's where the family actually resides in the home along with the residents. All of our other home types are group homes where you know family members don't reside there, but the individual residents will reside there with staff. So we have about 565 large group homes. That means an adult foster care home is usually anywhere from about four residents up to 20 residents. So in our large group homes, they get up to 20. In our smaller group homes, where it's one to six, that's our largest group with about 2,500 licensees.
Anastasha OsbornWow.
Larry HorvathThese homes in total, the 3,800 homes serve about 32,000 residents daily.
Anastasha OsbornOkay. Yeah, that's a lot.
Larry HorvathYes.
Anastasha OsbornSo, and that kind of makes me then lead to my next question, which is when we are talking about you know vulnerable populations, like who are these individuals that we are speaking about?
Larry HorvathFirst of all, you know, obviously the name implies adult. So we're talking about adults, not children in these homes. Um, you know, in the family home, obviously there can be children because that's the family's residence. Um, but for for the most part, what we're really talking about is is adults, you know, over the age of 18. Uh the individuals usually can uh the home can specialize in an age population, meaning that they're only going to serve seniors. Um the other two populations that adult foster care will primarily provide services to is those that have behavioral or physical needs. So it's an aged population or somebody with behavioral or physical needs.
Anastasha OsbornOkay. Can you elaborate a little bit on what some of those needs might be?
Larry HorvathYep, so some of obviously on an aged population, they're going to need more assistance with daily living activities, such as, you know, bathing, taking their medications, um, making sure that you know there's a supervision in the home.
Anastasha OsbornYeah.
Larry HorvathWith the behavioral or physical needs, they could be wheel built, wheelchair-bound, not ambulatory. Um, they could have behavioral problems, they could be autistic, they could have uh traumatic brain injuries of this nature, and and so uh they have uh additional needs um, you know, from the behavioral side or the physical side.
Anastasha OsbornI see. Okay. So what is something then about this type of work that people may not realize unless they've been up close to it, like you have?
Larry HorvathYeah, one of the things is that you know, when you think about a home like this that's prof providing some behavioral and physical needs, these are not health facilities. So by law, they're naturally not required to have uh a licensed health care professional. Okay. Many of our larger homes do have uh professionals there, um, such as nurses that might assist or on call. But for the most part, really what they're doing is assisting with daily activity that you would do in your own home with your own loved ones. You know, you will do medication passes with your loved one in your own home. So this is kind of a similar environment, but it also gets them out into the community in smaller group settings, not an institutional setting, hopefully more like a home-like environment.
Anastasha OsbornYeah, and I do actually remember um I was actually able to go on um a visit once um with someone from your team. So it was very eye-opening to be able to see that these are homes, that they aren't, you know, hospitals or like you mentioned, facilities. They're actually very homey. Um, and I like that it sets up that environment for them so that they don't feel like they are stuck in a hospital setting, so to speak.
Larry HorvathSo they'll have a kitchen like you and I will have a kitchen, they'll have a living room, they'll have their own bedrooms, and you know, so it is a home-like environment as much as possible.
Anastasha OsbornAbsolutely. So let's talk a little bit about um what does a supportive and safe adult foster care environment actually look like for these residents? I know you've kind of touched on a little bit, but I want you to kind of speak a little bit more to that.
Larry HorvathYep. One of the things that by being licensed in the state of Michigan, one of the requirements is your staff have to be trained. You know, from minimal training to, you know, like CPR to make sure that they can respond in emergency situations. Um, trainings on de-escalation and how to do interventions without restraints. Um so the so we do require a lot of training of our adult foster care staff in these facilities. Um, they have to have 24-7 supervision. So that way, even though many of the residents will leave for the day to go to, you know, maybe activities or a job, um, there still is somebody always in the home just in case somebody returns. You know, they're not feeling well today, they they're returning from their job or their um their activity center. Um, so we always uh require constant supervision in these homes. And then the other thing that we do is we look at physical safe environment to make sure that you know these homes are barrier-free for people that are in wheelchairs, uh, to make sure that, you know, um certain chemicals and cleaning supplies are locked up and secured to make it a safe environment for the residents.
Anastasha OsbornAnd just for our listeners for clarification, can you clarify? So when we're talking about the adult foster care and what your team is overseeing, are you guys overseeing just the licensing of the residents or also, and or also the licenses of the individuals who are working in these homes?
Larry HorvathYep, so we're really overseeing the licensing of the home itself and the staff included in that home. But per se, we don't r require that you know somebody has to be certified or registered or licensed. Um but obviously if they are a practitioner, we'll make sure that they are currently licensed and able to practice in the state of Michigan. But we are making sure that they're capable of doing the tests. You know, you just can't become a staff member and walk into a home tomorrow and actually start working there. You the provider has to provide that training to the staff before they enter these environments. We're also looking, you know, like house managers, how how have they worked with uh uh vulnerable populations before and things of that nature.
Anastasha OsbornOkay. Now we kind of talk about the the safety protocols that we're putting in place, but what happens if something isn't right in a facility and how does that get identified and then addressed?
Larry HorvathSure. So the first thing we do is anytime somebody wants to start an adult foster care home, they have to come to the state to get a what we'll call a license application. Part of that initial process is we will announce our visit, we'll go out to the home. You know, obviously there's they're not caring for residents right now, so we'll announce our visit, we'll go out to the home, make sure that the home is physically ready to take in residents, make sure that the staff have been trained and make sure that they have supplies, you know, obviously clean linen for the residents and supplies and and food. Um, we also make sure that they, you know, have three meals a day and things of that nature. So that's what we call is our pre-inspection.
Anastasha OsbornOkay.
Larry HorvathOnce we determine that the provider is ready and ready to take residents, we will go ahead and grant them a license and then they will start to take residents in. Um there on in, all of our inspections and investigations are unannounced. Um, and so we do routine inspections about every two years at these homes. Um, and that's where we look at the comprehensiveness of our regulations when we go into these homes. In addition, if we get a complaint and that allegation from the complaint could be a violation of state law, then we will go in and do an unannounced complaint investigation. And obviously, if we if the allegation is, you know, on third shift, if the allegations on the weekends, we'll try to go at the time in which the allegation might be occurring, that they say there's no staff in the evenings, there's no staff on the weekends. So we'll try to verify that.
Anastasha OsbornOkay.
Larry HorvathUm, but the complaint investigation is unannounced, and it's more focused. What were the allegations? You know, was it you know on dietary, was it on supervision, uh things of that nature? The other thing that we're gonna look at in these um inspections and and investigations is we're gonna first of all look for observations. We're gonna you know tour the uh facility. We're gonna do interviews with not only the staff but the residents and any family members that might be there. We'll interview the complaint, and if somebody files a complaint and they give us their name and number, we'll interview them to get more specific information. Um and then you know, then the last thing we will want to do is is really through all of these types of activities, we'll identify if there's any deficient practices and notify the the licensee. Here's the deficient practices, here's what you need to correct.
Anastasha OsbornIs it uncommon um if you go in specifically for um a complaint that you might find something else while you're there?
Larry HorvathYeah, so our complaints will focus uh primarily on the allegations that were made to us, but it does not prevent us that if we came into the facility and we're really focusing on dietary because that's the allegation. But we start to notice that there's a lack of supervision. Right. We will expand our investigations beyond the specific allegation.
Anastasha OsbornYeah, that makes sense. So if you could clear one misconception about adult foster care, what would it be?
Larry HorvathI think one misconception is that these are health facilities. And I think that's why it's so important for the family to do their research prior to putting their loved one in a facility. You know, what type of services do they offer? Do they offer the level of services that they that their loved ones need? Um, you know, are you comfortable with the physical setting? Um, are you comfortable with the staff? Are you comfortable with the other residents? Are they compatible? So I think I think a lot of the misconception is that the state is going to control everything and the state is going to make everything right. And I always encourage families, you have more control than we have. Because if you're not happy, you can move your loved one to another. You know, and I would also say that, you know, because this is such a vulnerable population, we work with the county medical health agency. Um, a lot of times, most of these residents, their their um stays are paid by the CMHs. And we also work with the Department of Health and Human Services, Adult Protective Services. So all three of these agencies really work together to try to make sure that we have a safe environment for those residents.
Anastasha OsbornYeah, and you mentioned one acronym that I wanted you to elaborate on. You said CMH. Can you explain what that is for our listeners?
Larry HorvathYeah, so that's the community mental health agency. So many people that are receiving behavioral care, um, a lot of times the county CMH will actually be paying for that care. So they will be the one uh working with the family or the guardians to identify the appropriate home, put them in that placement. They will also be monitoring. So not only does the provider write up a care plan, but if you're if you're receiving the benefit from the county, the county is also involved in that writing of the care plan. So you have two, you know, you have two independent folks trying to make sure that the care plan is appropriate. But the other thing, even though you have the provider working and you have the county working there, the family's also important. Be involved in your family, your loved one's care plan. Uh you have that right to be involved and to make sure that it is everybody's unique. And so we always try to make sure that the care plan is specific to that individual.
Anastasha OsbornYeah, absolutely. Well, thank you, Larry, for being here today. You know, this conversation I felt was such an important reminder that, you know, behind all of these policies and inspections and regulations, you know, there are real people and they are people who deserve to feel safe and supported and cared for. And honestly, that's what a lot of the work that we do here at Lara is about. So, um, again, thank you so much for being here. And to everyone who's listening, we hope that this gave you a better understanding of adult foster care and the role that it plays in protecting some of Michigan's most vulnerable residents. And as always, thank you for spending a little time with us here in the Lara Living Room, from our living room to yours. We'll see you next time.
