title: Mom and pop versus the big boys: adult family homes as providers of Medicaid-funded residential care.
abstract: This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities.
authors.affiliation: Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington 98101, USA. susan.hedrick@va.gov
authors.forename: Susan C
authors.initials: SC
authors.lastname: Hedrick
authors.forename: Jean H
authors.initials: JH
authors.lastname: Sullivan
authors.forename: Anne E B
authors.initials: AE
authors.lastname: Sales
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
mesh_terms: D004777:Environment; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D010067:Ownership; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011640:Public Policy; D012112:Residential Facilities / Q000458:organization & administration*; D014481:United States