Adult foster care in Michigan: what it is, how it is licensed, and how it fits with Home Help

The short answerIn Michigan, an adult foster care home is a licensed home that gives adults room and board, supervision around the clock, protection and help with personal care, for people who need supervision every day but not continuous nursing care. LARA licenses these homes and lets you look each one up. If your parent is on Home Help, it stops while they live in adult foster care. A resident with Medicaid may have a personal care supplement paid to the home instead, authorized by the county Adult Services Worker.

Families usually start looking at adult foster care when care at home is getting harder: a parent who can no longer be left alone at night, or a caregiver who is running out of road. This guide sets out what Michigan's own rules say adult foster care is, how to check a home before you choose one, how it fits with Home Help, and what we could not confirm.

What adult foster care is

Michigan's Adult Foster Care Facility Licensing Act (1979 PA 218) describes an adult foster care facility as a home or facility that provides foster care to adults who are aged, mentally ill, or developmentally or physically disabled, who need supervision on an ongoing basis but do not need continuous nursing care. MDHHS's Adult Services Manual says these homes provide:

• Room and board.
• Supervision, 24 hours a day, 7 days a week.
• Protection.
• Personal care to adults 18 and over who are frail, developmentally disabled, mentally ill, or intellectually or physically disabled.

Under the Act, "personal care" means help with dressing, personal hygiene, grooming, keeping to a medication schedule set by the resident's physician, and the personal and social skills needed to live in the least restrictive setting. "Supervision" includes reminders about medication and appointments, help keeping appointments, and knowing where a resident is.

The Act defines foster care as supervision, personal care and protection, with room and board, given to non-related adults for pay, 24 hours a day, five or more days a week, for two or more weeks in a row. Caring for your own parent in your home is something else, and Michigan has a separate program, Home Help, for care at home.

The four kinds of adult foster care home

The Act sets four types by size:

• Family home: a private residence approved for 3 to 6 adults. The licensee must live there as a member of the household.
• Small group home: approved for 3 to 12 adults. A six-bed home can be a family home or a small group home, depending on whether the licensee lives there.
• Large group home: approved for 13 to 20 adults.
• Congregate facility: more than 20 adults. The Act no longer allows new ones to be licensed; the Adult Services Manual says only nine remain.

Homes for the aged are a different kind of licensed home, also licensed by LARA. LARA publishes a fact sheet comparing the two licenses.

How to check a home before you choose it

The Adult Foster Care Licensing Division of LARA's Bureau of Community and Health Systems licenses these homes. LARA offers:

• An online search of licensed adult foster care homes and homes for the aged.
• Licensing inspection reports and special investigation reports for each home (LARA has a video showing how to find them).
• A list of homes closed or suspended because of disciplinary action.
• An online form to file a complaint about a home.

Before a visit, look the home up, check that its license is current, and read its recent reports. Ask the home how many residents it is licensed for, who is awake at night, and how it handles medications.

How adult foster care fits with Home Help

MDHHS's Adult Services Manual (ASM 101) says Home Help services are for people who are not living in a hospital, nursing facility, licensed foster care home or home for the aged, intermediate care facility, or institution for mental illness. So if your parent gets Home Help today and moves into an adult foster care home, Home Help stops.

The manual (ASM 135) also says the client or the Home Help caregiver must tell the Adult Services Worker within 10 business days of a change such as an adult foster care admission. If your parent moves back home, ask the Adult Services Worker what is needed to restart Home Help.

How Medicaid can help with the cost

When an adult foster care resident has Medicaid, the Adult Services Manual (ASM 060 and 065) describes a personal care supplement: a flat-rate payment from MDHHS to the licensed home. The money goes to the home, not to the family. MDHHS's provider FAQ says only the Adult Services Worker at the county MDHHS office or the resident's Community Mental Health case manager can authorize it. ASM 065 adds that if MI Choice Waiver services are in place, the supplement cannot be approved.

MDHHS's Adult Community Placement page says that if you or your loved ones can no longer live independently and need licensed adult care, you may be eligible for assistance. Your county MDHHS office is the place to ask.

What we could not confirm

We could not confirm the current amount of the personal care supplement, what homes charge for room and board, how room and board is paid when someone is on SSI, or whether a given home has an opening. Please do not rely on us for those. Ask your county MDHHS office, the home itself, or your Area Agency on Aging.

Where Already Caring fits

Already Caring is preparing to work with Michigan Home Help, which pays for care at home. We are not an adult foster care home, we do not place people in homes, and we are not yet an MDHHS-approved agency or taking clients. We cannot tell you which setting is right for your parent. If you are weighing care at home first, our guide to what Home Help pays for explains the tasks the State covers, and our guide to respite care lists places to ask for a break.

If you are worried that someone is being hurt or neglected, at home or in a care home, call 911 in an emergency, or Michigan Adult Protective Services at 1-855-444-3911.

Common questions

What is adult foster care in Michigan?

Under Michigan's Adult Foster Care Facility Licensing Act (1979 PA 218), an adult foster care home gives adults who are aged, mentally ill, or developmentally or physically disabled room and board, supervision, protection and personal care. It is for people who need supervision on an ongoing basis but do not need continuous nursing care.

Who licenses adult foster care homes in Michigan?

The Michigan Department of Licensing and Regulatory Affairs (LARA), through the Adult Foster Care Licensing Division of its Bureau of Community and Health Systems. LARA has an online search for licensed homes and an online complaint form.

How many people live in an adult foster care home?

Michigan's law sets four types: a family home (3 to 6 adults, with the licensee living there as a member of the household), a small group home (3 to 12), a large group home (13 to 20), and a congregate facility (more than 20). New congregate facilities can no longer be licensed.

Can my parent keep Michigan Home Help after moving into adult foster care?

No. MDHHS's Adult Services Manual (ASM 101) says Home Help services go to people who are not living in a hospital, nursing facility, licensed foster care home or home for the aged, and some other facilities. If a Home Help client moves into adult foster care, the client or caregiver must tell the Adult Services Worker within 10 business days.

Does Medicaid pay for adult foster care in Michigan?

For a resident with Medicaid, MDHHS can authorize a personal care supplement, a flat-rate payment made to the licensed home rather than to the family. Only the county Adult Services Worker or a Community Mental Health case manager can authorize it. We could not confirm the current amount, and room and board are a separate cost.

This is general information, not legal, medical or benefits advice. Whether someone qualifies depends on the State's decision for that person. Rules change, so confirm with MDHHS or LARA. Already Caring is a private company and is not part of MDHHS, LARA, Medicaid or the State of Michigan.