State Wide Foster Care Work Group

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State Wide Foster Care Work Group

• This presentation was developed thorough the
  collaborative efforts of the following agencies
  DODD, REM, RHC, Dungarvin, Cuyahoga County Board
  of DD, Clearwater COG

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WORK GROUP PURPOSE

• Establish material that can be used to educate
  the identified stake holder groups in this
  effective and efficient residential model of
  care. Identified stake holders include
• APSI, County Boards, Provider Community, ARC,
  Family Advisory, Ohio Self Determination Group,
  DD Council
• Use educational material that is developed to
  provide training and establish a dialogue within
  the stake holder communities

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ADULT FOSTER CARE MODEL OVERVIEW

• Adult Foster Care is a residential model that is
  a viable and affordable option to other 24 hour
  residential supports and has been available as a
  service under the IO waiver since 2008.

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ADULT FOSTER CARE MODEL OVERVIEW

• This service is provided in conjunction with the
  individual residing in the private home of an
  unrelated caregiver. The individual becomes a
  member of the caregiver household and
  participates in family activities, integrating
  into the rhythm of life that naturally occurs as
  part of living in a family home.

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ADULT FOSTER CARE MODEL OVERVIEW

• Individuals with a range of needs can be
  successfully served under this model, enjoying
  family life while being supported to develop new
  skills.

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STATISTICS ABOUT FOSTER CARE SERVICES 2010 DATA
BILLINGS OF FOSTER CARE IO SERVICES - DODD
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FOSTER CARE AS A WAIVER SERVICE
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• Host Home for Adults
• Another Option for People

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WHAT IS A HOST HOME?

• A host home is another descriptor for the adult
  foster care model.
• It suggests that the adult model is different
  from childrens foster, which typically has the
  outcome of family reunification and is considered
  to be a temporary residence.
• What can adult foster/host home provide?

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A HOST HOME CAN PROVIDE

• An environment that encourages the development of
  positive long-term relationships and personal
  growth.
• Activities structure and consistency needed to
  make progress in daily functional skills and in
  accordance with the ISP

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• Transportation and experienced knowledgeable
  supports to medical appointments, therapy
  appointments, activities and planned respite.
• Improved ability to assist individual to
  communicate with others

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• Structure to follow guidelines of supervision.
• Participation with the interdisciplinary team to
  plan and implement the ISP.
• Identification and access to community resources
  and most importantly be active participants in
  the community

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THE HOST HOME CARE SERVICE MODEL

• What are the program characteristics that
  separate AFC from employee based services?
• the individual lives in the home of an
  independently contracted or individual foster
  provider. As with the I/O waiver program there
  are no rules tied to the environment of the home.
  Many providers will develop criteria for the
  home to assure it is a program-qualified foster
  home. Criteria would need established by
  guardians or county board staff for Independent
  Contractors

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• Host Home provider develops knowledge,
  familiarity and commitment to the individual
• Host Homes have low turnover rates, and require
  far fewer people as a whole for ongoing support
  the environment.
• Individuals participate in the daily life of the
  household as full family and community members.

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Best PracticeSupport for Individual and Foster
Family
Best Practice-Supports for the Individual and
Foster
Medical and behavioral care oversight
Foster Family
INDIVIDUAL
Respite
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ADULT FOSTER CARE LICENSED AND UNLICENSED
ENVIRONMENTS

• Licensed Environment and Certified Agency
  Provider
• Certified Agency Provider
• Certified Individual Provider
• Not all Foster Care is the same

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CONSIDERATIONS
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UNIQUE SUPPORT SERVICES

• Does the individual have medical and/or
  behavioral needs that may require
  oversight/access to additional resources?
• How will the provider (independent or agency)
  ensure access to these or other needed community
  resources?

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UNIQUE SUPPORT SERVICES

• The independent provider would be responsible for
  their own incident reporting and management.
• What kind of training and oversight might be
  needed by SSA?

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UNIQUE SUPPORT SERVICES

• What crisis support is available within the
  agency for the provider or for non-agency
  settings, for the independent provider?
• Who oversees the implementation of the ISP and
  coordinates the access to supplemental supports?
  

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Room and Board Nothing defined in rule

• The foster care daily rate does not include room
  and board. How much will the individual
  contribute to the household expenses?
• The individuals contribution to household
  expenses is meant to be a supplement to the
  general costs of the household. It is a partial
  offset of costs for the expenses that the entire
  household shares (cable, telephone, utilities,
  meals, etc.)

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Money Management/Payeeship Nothing defined in
rule

• Who will act as payee for the individuals
  benefits?
• If an independent provider acts as payee, there
  must be a clear understanding that the
  individuals funds need to be managed and
  ledgered separate and apart from household
  expenses.

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COST OF LIVING EXPENSES NOTHING OUTLINED IN RULE

• The ISP should address how decisions will be made
  re. the management of the individuals resources
  beyond room and board. The individuals
  resources will need to cover clothing, recreation
  and other expenses.

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INDIVIDUALS SUPERVISION NEEDS

• By rule, since the agency is the provider of
  record for these foster supports, other household
  members can provide services and supports to the
  individual as long as they have background checks
  and maintain current training requirements as
  well.

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INDIVIDUALS SUPERVISION NEEDS CONT

• An independent foster provider is the only one
  authorized to deliver services in the foster
  home. ISP would need to address whether the
  individual has alone time or can be in the home
  under the supervision of other household members
  (natural supports) if the independent provider
  needs to be away for a brief period of the day.

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INDIVIDUALS SUPERVISION NEEDS CONT

• An independent foster provider cannot subcontract
  with another individual to provide services
  inside or outside of the home. .
• The independent foster provider has undergone a
  background check to get certified. The other
  adults in the household are not required by rule
  to have a background check or have any training
  or first aid certification.

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INDIVIDUALS SUPERVISION
NEEDS CONT

• RESPITE
• For individual providers, a certified
  homemaker/personal care provider must be arranged
  to deliver substitute coverage and the service is
  billed as homemaker/personal care. Individual
  providers shall work with the individual's SSA to
  arrange for substitute coverage. 51232-13-06
  (F)(2)(b)

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INDIVIDUALS SUPERVISION
NEEDS CONT

• For agency providers, arrangements can be made
  for a substitute adult foster care provider to
  deliver substitute coverage and they can still
  bill the service as adult foster care.
  51232-13-06(F)(2)(c)

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HOME REQUIREMENTS

• For Agency or Independent Providers that are not
  using licensed locations the following items are
  NOT required by rule. All of these items can be
  requested and are required in licensed
  environments.
• Safety Inspections such as
• Fire inspection
• Smoke detectors
• Fire extinguishers
• Two clear emergency exits

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HOME REQUIREMENTS

• Private well inspection
• Adequate heating and ventilation
• carbon monoxide detectors
• Hot water tank kept at safe temperature
• Separate bedroom measuring at least 80 square ft

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MYTHS
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MYTHS ADULT FOSTER CARE (HOST HOMES)

• A Host Home cannot support a person with high
  medical needs
• Retired medical personnel often apply to become
  Host homes
• Host homes offer consistency in health care and
  extensive knowledge of the individuals medical
  care one person attends all medical visits,
  completes follow up care, administer medications.

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MYTHS ADULT FOSTER CARE (HOST HOMES)

• Host homes arent stable
• 75 of people placed in Host Homes experience
  two or less placements in their history. (REM
  statistics)
• Many Host home placements last throughout an
  individuals life, and carry on to host family
  members when the Host provider retires.

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MYTHS ADULT FOSTER CARE (HOST HOMES)

• Host homes are short term
• Can be set up to teach skills short term until
  the person is ready to move on
• Typically result in long term placements where
  they become a part of the family, spending time
  with extended family and growing in their social
  supports

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MYTHS ADULT FOSTER CARE (HOST HOMES)

• When Host provider quits, there is no more
  placement
• Teams plan for the time when a Host provider will
  be ready to retire, or can no longer handle the
  placement.
• Back-up home is used more often as the time
  approaches so the individual gets to know the new
  family.

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MYTHS ADULT FOSTER CARE (HOST HOMES)

• Often adult children of the Host Home provider
  are ready to move into the role of caregiver and
  take over as Host Home provider,
• In regards to services from an agency, staff
  continue to be a part of the individuals life
  and increase involvement and contact during
  transitions

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MYTHS Adult Foster Care (HOST HOMES)

• Host Homes cant handle people with behavioral
  needs
• Many of the antecedents for behaviors are reduced
  or eliminated when an individual moves into a
  Host home.
• No one takes their things without asking
• There are less people to compete with

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MYTHS ADULT FOSTER CARE (HOST HOMES)

• They feel safe and secure when staff turnover is
  eliminated
• The environment is calmer and quieter

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CASE STUDIES
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Providing Stability

• Jeff struggled to understand what boundaries were
  and had to be supervised at every social event.
  This was due to unstable environments that Jeff
  had lived in his entire life. He had endured
  abuse in his childhood and he did not understand
  social and personal boundaries. This led to Jeff
  having a sheltered life. He was not able to take
  special trips with his friends and he had minimal
  social interactions.
• Jeff desperately needed a stable environment in
  which he could grow and realize his potential. It
  was then that he met Ben and Rhonda, his Foster
  Providers. With this stable home environment,
  Jeff was able to recognize his self worth and his
  Foster Providers were able to teach him what
  boundaries were. Ben and Rhonda were also able to
  help Jeff understand who he really was a
  handsome, young man.

Now that Jeff is in a stable and loving
environment, he has really started to live his
life. He now goes on overnight trips with friends
and has found different interests. Jeff learned
about the Ohio State Buckeyes and has grown to
love football. He has also been enjoying golf and
country concerts. Jeff has gone through quite a
transformation and is enjoying his new life.
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Achieving Independence
Michael, Mike, came to Foster Care in 2003 to
live with a family in our adult foster program.
While living with the family, Mike gained the
confidence and skills that he felt he could live
out on his own. In February of 2008 Mike moved
into his own apartment. He was supported by
staff who would assist him in maintaining his
apartment, budgeting his finances, attending
medical appointments, and shopping but this was
only a couple of hours each week. Through the
course of the time that Mike lived on his own, he
started to see how much he really missed a
family atmosphere. He was also having a
difficult time with his health and he felt he
needed more guidance and the daily support of
someone encouraging him to make healthier
choices. In December of 2009, Mike made the
decision to move back in with a family in our
foster care program. Debbie and Randy Jarvis
have become an important part of Mikes life.
Mike sees that Debbie and Randy are genuinely
concerned about his health and well being.
They encourage him daily in making healthy and
thought-out choices, as well as continued support
of remaining independent. Mike stated he has
finally found that father figure hes been
looking for, in Randy. The interests he and the
Jarvis family share has also helped make the
transition of moving back into foster care
easier. Even though Mike has only lived with the
Jarvis for a couple of months, theres been much
improvement in his health and he has gained back
his self confidence. He truly feels he is a part
of the Jarvis family.