Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

Abstract

BACKGROUND. In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS. In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS. On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS. Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC.

Assisted Living Literature Through May 2004: Taking Stock

“…But the small scale of foster care suits rural areas. Some evidence has suggested that people with dementia do well in these small, familiar settings, and they sometimes relocate to foster care from AL as their dementia worsens (Kane, Kane, Illston, Nyman, & Finch, 1991;Nyman, Finch, Kane, Kane, & Illston, 1997;Stark, Kane, Kane, & Finch, 1995).…”

Long-Term Care in the United States: Policy Themes and Promising Practices

“…Community residential care gives residents more privacy and autonomy than that afforded by nursing homes while maintaining the economies of scale that are more efficient than providing services in individual homes (R. A. Kane, Kane, Ilston, Nyman, & Finch, 1991). Community residential care generally serves a population that is less impaired than those living in nursing homes but more impaired than those still living in their own homes (Hedrick et al, 2003).…”

“…Most adult foster care providers are not health care or social service professionals (Nyman, Finch, Kane, Kane, & Illston, 1997), but they can access additional health and supportive services provided by home care agencies (R. A. Kane et al, 1991). As with assisted living facilities, many adult foster home residents are private pay and have a higher level of physical and cognitive functioning than individuals living in a nursing home (R. A.…”

“…As with assisted living facilities, many adult foster home residents are private pay and have a higher level of physical and cognitive functioning than individuals living in a nursing home (R. A. Kane et al, 1991). As with most promising practices in long-term care, there is little empirical evidence of the benefits of community residential care compared to nursing facilities.…”

Can Medicaid Long-term Care Expenditures for the Elderly Be Reduced?

“…Recognizing that there are certain economies of scale in residential settings that are lacking in traditional home care where services must be provided to one person at a time, Oregon has developed nonmedicalized residential alternatives to nursing homes (Kane, Kane, Illston, Nyman, & Finch, 1991). By aggressively expanding assisted living and adult foster care, the state hopes to promote residential settings that are more homelike, provide greater personal autonomy, and cost less.…”