CONTENT INDEX
PURPOSE OF THE TUTORIAL
The purpose of this tutorial is to answer questions and provide information to assist you in making an informed decision about applying for an adult foster care (AFC) license.
This will also provide you with information intended to assist you in identifying the type of license application to request and the category of AFC facility to apply for.
This tutorial will not:
- Determine your appropriateness to be a licensee.
- Provide you with training or competency to be an AFC licensee or administrator.
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BUSINESS CONSIDERATIONS
The purpose of this section is to discuss the business aspect of becoming a licensee.
The Licensee is the person, persons in a partnership, the corporation or the limited liability company (LLC) who the adult foster care license is issued to. It is best to check with your business consultant first before submitting an application.
The Effect of Licensing On You:
- Developing and operating a business today requires a level of sophistication
- Perhaps consult with someone already licensed
- Determine type of ownership
- Proprietorship/partnership/corporation/limited liability company
- Determine level of insurance (auto/home) and liability insurances to buy
- Determine how to market and finance
- Determine food service supplier - vendor/local grocery
- Determine if you want employees bonded
- Determine if you are ready to give up your privacy - finances, family members, business relationships, psychiatric/medical/criminal history will be investigated, all areas of the home will be inspected
- Determine if your are ready to face many conflicting demands and pressures:
- you must satisfy your customers
- you must comply with the regulation of at least one government agency, maybe more
- you must meet the expectations of employees
- you must make a good impression on the public
Although not a licensing requirement, it is recommended that you develop a business plan to include:
- Marketing strategies
- Financial plan
- Determine / get acquainted with potential placement sources: community mental health system, Department of Human Services, veteran's hospital, etc.
The following web site may be helpful: http://www.michiganbusiness.org/start-up/business-assistance/
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PURPOSE AND DEFINITION OF ADULT FOSTER CARE
The purpose of this section is to provide the purpose and definition of adult foster care and how adult foster care differs from other types of residential programs.
Definition of Adult Foster Care
- Adult foster care is a specific type of assisted living, as outlined in PA 218 and the administrative rules.
- Adult foster care facility means a governmental or nongovernmental establishment that provides foster care to adults.
- Foster care means the provision of supervision, personal care, and protection in addition to room and board, for 24 hours a day, 5 or more days a week, and for 2 or more consecutive weeks for compensation.
- Supervision means guidance of a resident in the activities of daily living, including all of the following:
(a) Reminding a resident to maintain his or her medication schedule, as directed by the resident's physician.
(b) Reminding a resident of important activities to be carried out.
(c) Assisting a resident in keeping appointments.
(d) Being aware of a resident's general whereabouts even though the resident may travel independently about the community.
- Personal care means personal assistance provided by a licensee or an agent or employee of a licensee to a resident who requires assistance with dressing, personal hygiene, grooming, maintenance of a medication schedule as directed and supervised by the resident's physician, or the development of those personal and social skills required to live in the least restrictive environment.
- Protection means the continual responsibility of the licensee to take reasonable action 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 while on the premises, while under the supervision of the licensee or an agent or employee of the licensee, or when the resident's assessment plan states that the resident needs continuous supervision.
Purpose of Adult Foster Care
- To provide needed care for aged, developmentally disabled, mentally ill and physically handicapped persons.
- To assure privacy, and protection from moral, social and financial exploitation.
- To treat people with dignity while meeting personal needs and assuring safety.
What Adult Foster Care is Not
- A nursing home
- A home for the aged
- A hospital
- A psychiatric hospital
- A county infirmary
- A child caring institution
- A substance use disorder program
- A private residence with the capacity to receive at least 1 but not more than 4 adults who all receive benefits from a community mental health services program and the community mental health services program monitors the services being delivered in the residential setting.
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POPULATIONS SERVED IN ADULT FOSTER CARE FACILITIES
This section will provide an overview of a variety of adult foster care populations served and their referral and funding sources.
A licensee is required to have a minimum of 1 year of experience working with each population identified as their adult foster care customer on the application, program statement and admission policy. [NOTE: This requirement does not apply to applicants or licensees of adult foster care family homes. See TYPE OF ADULT FOSTER CARE FACILITIES below.] In addition, it is recommended that you research how you will receive placement referrals as well as the sources and amount of funding provided for each population served. This will assist in determining administrative costs and budget planning for the monthly operation of the adult foster care program.
Populations Served in Adult Foster Care
- Developmentally disabled residents may exhibit extremely challenging behaviors, may be medically fragile, and require highly skilled staff. Common referral sources include local mental health agencies and the ARC of Michigan. Residential services are often funded by the resident's Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Consumers of the public mental health system who require a specialized residential program and those receiving SSI may receive additional public funding and support.
- Mentally ill residents may exhibit extremely challenging behaviors and require highly skilled staff. Common referral sources include local mental health agencies and the Alliance for the Mentally Ill.
- Aged residents may need adult foster care services because of the physical frailties of age. Common referral sources include local Offices on Aging and the Department of Human Services' Office of Adult Services.
- Aged residents may need adult foster care services as a result of Alzheimer's Disease or other causes of dementia. There are additional statutory requirements for a written description of services, staff training and environmental design features of adult foster care facilities that represent to the public that they provide services to persons with Alzheimer's Disease or related conditions.
- Residents who have sustained closed head injuries need special rehabilitation program services to be eligible for receipt of funding by most auto or workers compensation insurers.
- Physically handicapped residents include those with cerebral palsy and spinal cord injuries. Sources of referrals for placement include the Easter Seals Society and the United Cerebral Palsy Association as well as private insurers.
- The Bureau of Children and Adult Licensing (BCAL) does maintain a "searchable" database of all currently licensed adult foster care facilities on its website that is available to the public for use in identifying and exploring placement possibilities.
- The Bureau of Community and Health Systems DOES NOT make referrals or recommendations for placement or have any involvement in payment for adult foster care.
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TYPE OF ADULT FOSTER CARE FACILITIES
The licensing statute, PA 218, and the administrative rules provide for four different types of adult foster care (AFC) homes. This section will identify these different types of AFC homes. It will also provide basic information regarding the requirements for each type of home to allow you to make an informed decision as to the type of home to identify on the application.
TYPES OF HOMES
Adult Foster Care Family Home (AF)
- May be licensed for 3-6 residents depending on available space.
- Licensee must live in the home; a responsible person who can provide emergency care for up to 72 hours must be identified.
- Licensee must be an individual(s).
- Adult members of the household are required to obtain a medical clearance and authorize a criminal history check.
- There are no zoning restrictions.
Adult Foster Care Group Homes
(This is general information that applies to all categories of group homes.)
- Licensee not required to live in the home.
- Licensee can be an individual, partnership, a corporation, a Limited Liability Company (LLC) or other business entity.
- If a corporation or LLC, a licensee designee must be identified to represent the corporation in licensing matters.
- An administrator must be appointed for the home.
- A licensee or licensee designee can also be the administrator.
- An administrator is the individual responsible for the daily operations of the home/facility.
- Licensee/licensee designee, administrator and direct care staff must meet specific training qualifications.
- Licensee/licensee designee and administrator must have a high school diploma or GED.
- Licensee/licensee designee and administrator must have at least 1-year experience working with the population proposed to be served by the AFC facility.
- Licensee/licensee designee and administrator must obtain a medical clearance and authorize a criminal history check.
Small Group Home 3-6 (AS)
- May be licensed for 3-6 residents depending on available space, as well as the number of occupants of the home and the number of toilets in the home.
- There are no zoning restrictions.
- Requires an interconnected smoke detection system installed according to the manufacturer's specifications and the NFPA 101, Life Safety Code of 1988, powered by the building's electrical system.
Small Group Home 7-12 (AM) *Sometimes referred to as a Medium Group Home
- May be licensed for 7-12 residents depending on available space, as well as the number of occupants of the homes and the number of toilets in the home.
- Approval from the local zoning authority is required.
- Bureau of Fire Services (BFS) rules apply and are enforced by the BFS.
- Newly licensed homes require a sprinkler system; existing homes that undergo a change of ownership/licensee do not require a sprinkler system if the new license application is made within 60 days of the previous license expiration and the license category is not changed.
- Local health departments complete inspections of group homes with private water supply and/or sewage disposal systems.
Large Group Home (AL)
- May be licensed for 13-20 residents depending on available space.
- Approval from the local zone authority is required.
- Bureau of Fire Services (BFS) rules apply and are enforced by the BFS.
- A sprinkler system is required for all large group homes.
- Local health departments complete inspections of group homes with private water supply and/or sewage disposal systems.
Special Certification
- Additional certification may be obtained for all facility types.
- Consumers of the public mental health system receive a specialized residential program in the AFC facility.
- Requires more services, more training and additional documentation.
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PURCHASING AN EXISTING ADULT FOSTER CARE FACILITY
This section will inform inquirers about the provisions of Act 218 related to the procedures for purchasing an existing adult foster care facility.
ADULT FOSTER CARE LICENSING ACT
PA 218 OF 1979, AS AMENDED
Section 13 (8) - An applicant or licensee proposing a sale of an adult foster care facility or home to another owner shall provide the department with advance notice of the proposed sale in writing. The applicant or licensee and other parties to the sale shall arrange to meet with specified department representatives and shall obtain before the sale a determination of the items of noncompliance with applicable law and rules that shall be corrected. The department shall notify the respective parties of the items of noncompliance before the change of ownership, shall indicate that the items of noncompliance shall be corrected as a condition of issuance of a license to the new owner, and shall notify the prospective purchaser of all licensure requirements.
To Assist You in Exploring This Option, You Should Know that:
- A license is issued to a specific person or corporation or legal business entity at a specific location and the licensee remains responsible for the AFC until the license is closed by the Department.
- Although a licensee has a property right to a license that has been issued, the license is the property of the Department.
- Licensing regulations do not permit the "transfer" of a license to a new licensee nor can it be purchased or inherited.
- A prospective new owner can be appointed licensee designee or administrator of the current license (by the current licensee) while the new owner's application is pending - current licensee still responsible for all that occurs.
- After an application and application fee for a license have been received by BCAL, but before finalizing the purchase of an existing adult foster care facility, an inspection of the facility should be arranged with the licensing consultant, the current owner and the prospective owner to identify any areas of noncompliance that need correction before a new license can be issued.
- Some licenses were issued under former fire safety rules and the new licensee will be subject to current, more extensive fire safety requirements.
- A sealed architectural building plan will need to be submitted to and approved by the Bureau of Fire Services.
- When considering the purchase of an existing facility, be aware that it may have been issued a license using different administrative rules than will now apply.
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QUALIFICATIONS FOR LICENSEES AND ADMINISTRATORS
The licensee and administrator (for group homes) are required to have specific qualifications. This section will provide an overview of those qualifications. In addition, this same outline format can be used to model the administrator's job description that is required as part of the licensee's written personnel policies.
The Licensee/Licensee Designee is Required to:
- Submit a completed license record clearance request to the Department in order to conduct a criminal history background check.
The Administrator is Required to:
The Licensee and Administrator are Required to:
- Submit a completed licensing medical clearance request form to the Department in order to conduct a medical review of physical, psychological, and tuberculosis test results.
The Group Home Licensee and Administrator are Required to:
- Be 18 years or older, possess a high school diploma or equivalent; have at least 1 year experience working with the resident population; be capable of completing required reports and following written and oral instructions; be suitable to meet the physical, emotional, intellectual, and social needs of each resident; and be capable of handling emergency situations.
- Be competent in the following areas:
-
Nutrition
- Knowledge of the needs of the population served
- Financial and administrative management
- Reporting requirements
- First aid
- Cardiopulmonary resuscitation
- Personal care, supervision, and protection
- Resident rights
- Safety and fire prevention
- Prevention and containment of communicable diseases
- Administration of medication
(Documentation regarding competency in these areas is required and will be reviewed by the Department).
- Have 16 hours of approved training annually.
Some sources of available training are available on our website: /lara/bureau-list/bchs/adult/training/afc-training-attestation-submission-process-for-licensees-and-administrators
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QUALIFICATIONS FOR STAFF
This section will provide an overview of the qualifications for all direct care staff and contract employees who provide direct services to residents. There are additional qualifications for cooks in group homes.
The Licensee is required to:
- Conduct a background check mandated by statute using the Michigan Workforce Background Check website and determine the good moral character of employees.
- Review a physician signed statement of health and tuberculosis test results and conduct annual employee/volunteer health review.
- Assure direct care staff are 18 years of age or older; possess documentation of experience, performance, and training in food preparation; be capable of completing required reports and following written and oral instructions; are suitable to meet the physical and emotional, intellectual, and social needs of each resident; and are capable of handling emergency situations.
- Assure competency in the following areas:
- Reporting requirements
- Cardiopulmonary resuscitation
- Personal care, supervision and protection
- Resident rights
- Safety and fire prevention
- Prevention and containment of communicable disease
- Administration of medication
- Food preparation
- First aid
Group Homes for 7 - 20 are required to:
- Employee at least 1 person who is qualified by training, experience and performance to be responsible for food preparation.
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APPROVAL OF FACILITY BUILDING PLANS
This section will provide an overview of the requirements for the approval of facility building plans by Bureau of Fire Services.
- Building plan reviews are required for facilities of 7 or more.
- Plan reviews are required for new construction, conversions, remodeling, alterations, and changes in ownership. Conversion means an existing building not currently licensed as a home for the aged is being converted to use as a home for the aged.
- Sealed architectural plans and shop drawings are submitted to the Department of Licensing and Regulatory Affairs (LARA), Bureau of Fire Services (BFS) for approval. See link to Fire Safety Inspections.
- Construction or remodeling should not begin until plan review approval is received.
Information about the BFS plan review process may be reviewed at: www.michigan.gov/lara.
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APPLICATION PROCESS
This section will provide an overview of the application process.
- A proposed facility for 7 or more should first obtain written local zoning approval. The application process cannot proceed without this approval.
- The license applicant submits complete application and application fee.
- When application is received in Lansing, we request environmental health and sanitation inspections and fire safety inspections, as needed (no charge to the applicant), and conduct criminal history background checks.
- Licensing staff cannot conduct an initial onsite inspection without receipt of a completed application and fee.
Determining Compliance
- Full compliance with licensing rules is required before an original license can be issued.
- Residents may not be admitted to a home/facility prior to the license being issued.
- We will provide you with written documentation of our findings from all inspections we conduct.
- Initial Inspection - Completed by the licensing consultant after an application and fee is received with proof of ownership or land control (lease) and permission to inspect from the property owner.
- A written report of the physical plant modifications necessary for licensure is provided to the applicant.
- The report may include a listing of qualification materials required for the applicant and/or administrator.
- For group homes, the report may include identification of missing required policy & procedure documents.
- Environmental health and sanitation inspections - Completed by the licensing consultant for all family and group homes with public water supply and/or sewage disposal systems. The local health authority completes inspections for private water supply and/or sewage disposal systems for family and group homes.
- Fire Safety Inspections - Completed by the licensing consultant for homes serving 6 or fewer persons. The Bureau of Fire Services (BFS) has fire safety enforcement authority of homes for 7 or more persons.
- Included items:
- Fire extinguishers
- Smoke detectors (family homes)
- Furnace / hot water heater separation
- Evacuation plans
- Wall & ceiling finish - paneling generally not allowed
- Smoke detection systems (group homes)
- Exterior door locks (group homes)
- Door width (group homes)
- Sprinkler systems (homes for 7 or more)
- Architectural plans with fire safety systems included (homes for 7 or more)
- Follow-up or Final Inspections - Completed by the licensing consultant.
Prior to a recommendation for licensure, all of the following must be completed:
- Required policies & procedures
- Qualifying information on the applicant and/or administrator
- All noncompliance with physical plant requirements must be resolved
- The home must be fully equipped and ready to accept residents.
- Full fire safety approval.
- Full environmental health approval.
Physical Plant requirements that you should be aware of for the various types of homes:
- All Homes must have:
- Required bedroom, dining room, & living square footage space available
- Acceptable wall finishes (generally no paneling)
- Handrails at stairs, tubs or showers, & around decks & porches
- Furnace & hot water heater separation
- Smoke detectors.
- Additionally, all small group homes (6 or less) must have:
- Smoke detection systems
- Full bathrooms on each floor with resident bedroom
- Non-locking-against-egress locks
- Minimum requirements for door widths.
- Additionally, all group homes (7 or more) must have:
- Sprinkler systems & architectural plan reviews and onsite inspection approvals by BFS
- Written approval to operate an AFC from the local zoning authority.
General Information
- Application packet contains instructions on how to complete and where to forward applications.
- License issuance:
No license can be issued until full compliance is achieved.
- At the time of original license issuance, you will receive an Original Licensing Study Report and a letter informing you that a license has been issued. A license to "post" will be mailed to you shortly thereafter.
- A license is issued to a particular person/entity at a specific location for a certain number of residents (capacity) .
- A temporary license is issued for the first 6 months. It provides the opportunity to demonstrate compliance with quality of care requirements.
- A regular license is issued for 2 years when a facility is in substantial compliance with regulatory requirements.
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ONGOING LICENSE PROCEDURES
The purpose of this section is to provide a brief overview of expectations and events after issuance of an original license.
Compliance
- Full compliance with licensing rules is required before an original license will be issued.
- Residents may not be admitted to a home/facility prior to the license being issued.
Maintaining a License
- Ongoing compliance is expected.
- Interim inspections may be conducted between renewal inspections. These may focus on selected areas based on the previous renewal inspection.
- Inspections may be unannounced: Cooperation with inspections is required.
- Following renewal application, renewal inspections will be conducted every 2 years: These are full inspections.
- Fire safety inspections are conducted annually for group homes of 7 or more.
- Environmental health and sanitation inspections of private water and sewer systems for family and group homes are conducted every two years.
- Written confirmation of the findings of an on-site inspection is provided to the licensee/licensee designee.
Complaints
- Complaint investigations are conducted by the licensing consultant when an allegation of a violation of the Act or a rule is made against a home/facility.
- Investigations may be conducted jointly with Department of Health and Human Services' Adult Protective Services, Department of Community Health's Office of Recipient Rights, and/or law enforcement officials.
- The licensing consultant conducts the investigation, including an exit interview with the licensee/licensee designee.
- Licensee/licensee designee is given an opportunity to demonstrate compliance and is provided an exit conference.
- Licensing consultant prepares a written Special Investigation Report that is sent to the licensee/licensee designee.
Special Investigation Report can conclude that:
- No Act or rule violations occurred
- Violations occurred that were isolated incidents of noncompliance that did not result in or have the potential for more than minimal harm to residents that were corrected or can be easily and quickly corrected without a corrective action plan from the licensee/licensee designee.
- Violations occurred and a corrective action plan from the licensee/licensee designee is required
- Violations occurred that result in a recommendation for disciplinary action against the license
- Examples of disciplinary action include revocation of a license, refusal to renew a license, and summary suspension of a license.
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HELPFUL SOURCES OF INFORMATION
The purpose of this section is to identify other sources of information that may be of assistance to you in exploring your interest in applying for an adult foster care license.
Professional Organizations
Michigan Assisted Living Association
15441 Middlebelt Road
Livonia, MI 48154
800-487-0118
LeadingAge Michigan
201 North Washington Square, Suite 920
Lansing, MI 48933
517-323-3687
Health Care Association of Michigan (HCAM)
7413 Westshire Drive
Lansing, MI 48917
517-627-1561
Consumer Organizations/Resources
Michigan Alliance for the Mentally Ill
921 N. Washington
Lansing, MI 48906
800-331-4264, 517-485-4049
The Arc Michigan
1325 South Washington Ave.
Lansing, MI 48910
800-292-7851, 517-487-5426
Alzheimer's Disease and Related Disorders Association
Greater Michigan Chapter
800-337-3827
Michigan Office of Services to the Aging and Area Offices on Aging
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LICENSE APPLICATION DECISION AID
The purpose of this section is to assist you in requesting or downloading the correct license application for the type of adult foster care facility you wish to operate. It will also assist you in submitting the correct type of license application.
- Will you live with the adult foster care residents in the licensed home as your personal residence? If not, you may only apply for an adult foster care group home license.
- Will the license be issued to an individual(s) or partnership? If so, request/submit an Individual license application.
- Will the license be issued to a corporation, limited liability company (LLC), government agency or organization? If so, request/submit a Corporate license application.
Before submitting a license application, you should:
- Determine the specific property where the adult foster care facility will be operated.
- Insure that the property has the required square footage and rooms to accommodate the number of residents you plan to accept.
- Receive local zoning approval if you will be applying for an adult foster care group home license with a capacity for 7 or more residents.
View the license application packet.
