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What Needs to be Licensed
An operation needs to be licensed under Act 218 as an adult foster care (AFC) facility if it provides personal care, supervision and protection in addition to room and board to 3 to 20 unrelated persons who are aged, mentally ill, developmentally disabled, or physically disabled, for 24 hours a day, 5 or more days a week, for 2 or more consecutive weeks for compensation. Note that an AFC license is not required when a home has a capacity of 4 or less residents/clients and that home only serves community mental health (CMH) residents/clients and the CMH monitors those residents/clients.
An operation needs to be licensed under Act 368 as a home for the aged (HFA) if it provides room and board and supervised personal care to 21 or more unrelated people who are 55 years of age or older; or if operated as a distinct part of a licensed nursing home, can be provided to fewer than 21 residents.
AFC and HFA are statutorily defined in MCL 400.703(4), 400.704(6) and 333.20106(3) respectively.
Elements that Constitute AFC and HFA:
The elements of AFC and HFA are drawn from their statutory and administrative rule definitions.
Personal care means personal assistance with dressing, personal hygiene, grooming, maintenance of a medication schedule, or the development of those personal and social skills required to live in the least restrictive environment.
Supervision means guidance of a resident in the activities of daily living, including reminding a resident of important activities and appointments and to take medication, and being aware of a resident's general whereabouts even if the resident may travel independently in the community.
Protection means actions taken to insure the health, safety, and well-being of a resident, including protection from physical harm, humiliation, intimidation, and social, moral, financial, and personal exploitation.
Supervised personal care means guidance (cuing, prompting, reminding) or assistance with eating, toileting, bathing, grooming, dressing, transferring, mobility, medication management, reminding resident of important activities to be carried out, assisting a resident to keep appointments, supporting a resident 's personal and social needs, and being aware of a resident's general whereabouts even if the resident is capable of independent travel about the community.
Room and board means the provision of housing and meals. Under this definition, a "room" could be a bedroom, an apartment, a suite, etc. Board means any involvement in the purchase or preparation of meals.
Personal care, supervised personal care, supervision, and protection are all defined in rule and statute: MCL 400.706(1)(4), 400.707(7) and 325.1901 (2)(16)(20)(22)(23).
How BCHS Determines What Must Be Licensed:
An investigation to determine if an operation requires licensure focuses on whether or not the above elements of AFC or HFA are being offered or provided.
Is housing being offered or provided?
Are meals (food/board) being offered or provided?
Is personal care being offered or provided?
Are supervision and/or protection being offered or provided?