AFH Ownership Transfer Rules Relaxed (slightly)

A revised rule recently signed (Bill 1677) will relax time restrictions that are currently in effect for transferring a currently licensed AFH to another currently licensed provider. The change should become effective after August 6, 2013.

The application for the license transfer must be relative to the change in ownership of existing adult family homes that is currently licensed and IF the department has taken no enforcement actions against the applicant's currently licensed adult family homes during the twelve months prior to application.

Basically, it might just help you go a little faster if you want to buy or sell to another currently licensed provider. It's not new, but simply relaxes the 24 months time restriction previously in place for such transfers of ownership license.

For the fine print, read RCW 70.128.065.

Washington State Raises Adult Family Home Licensing Fees - Again.

She's done it again; Governor Christine Gregoire's budget raised licensing fees for adult family home providers from $175 to $220 per bed, per year beginning July 2013. 

And beginning July 2014, it will go up again to $291 per bed, per year. That's a 26% increase from last year, and by 2014 this will amount to 66%. Just 3 years ago, licensing fees were $100 per year, per home - not per bed.  Total increase to date: 1220%.

Now let's keep in mind that DSHS has also CUT daily reimbursement rates by 4% in 2009 and we've seen no increase since.

And like everyone else, we've seen significant increases in cost of living thru-out Washington state, especially relative to food, water usage, gas, electricity and other utilities, and significant liability insurance increases.

Let's do some basic math.

The average reimbursement rate from the Medicaid program to an adult family home provider in Washington State breaks down to about $3.75 per hour (average daily Medicaid reimbursement rate being about $90 per day).

Now let's multiply this by 6 residents - the state limit per care home - that comes to $22.50 per hour.

Let me ask you this: if you were a nursing assistant with the expensive training required, how much would you want to be paid per hour to help care for 6 residents?
- Pick a number;
- Now let's subtract your pay from the $22.50, what's left?
- Now add: mortgage, utilities, food, insurance, payroll taxes, drive them to the doctor, run 24/7/365, etc. etc.
- Oh, pay the provider...
You get the idea.

Interestingly, DSHS does look at care provider's ability to have sound financial footing, but there are no clear guidelines as to what that is, at least nothing concrete that a care provider can refer to.

So here are my predictions for the next 24 months.

As more and more Medicaid-serving adult family home providers struggle to make ends meet on a shoe-string budget, more DSHS inspectors enforcing rules (rather than providing technical assistance), we'll be seeing:

1. more citations for AFH providers who serve Medicaid clients
2. more frustrated and struggling providers leaving the profession 
3. more families struggling to find care providers willing to accept Medicaid residents
4. a renewed increase in the use of nursing home for the poor Medicaid recipients
5. a more select audience who can afford the better quality care - albeit more expensive - alternative that AFHs offer.

So what are we learning? 

1. The flavor of the decade hasn't changed; more cuts to social programs and for those who need it most, increased costs for small business owners. The excuse hasn't changed either, somehow "not enough money."
2. Adult family homes are an essential part of our long term care system, and the preferred consumer setting for the frail elderly who need assistance. It's a home, and many provide top-notch care through the end of life. But it can't be done without money. Fund the program as it needs to be, or go back to the extensive use of nursing homes and leave the AFH option as the high-end alternative for those who can afford it.
3. If your age dictates it, consider long-term care insurance! The bulk of long-term care is provided and received in licensed residential care settings, NOT assisted living.
4. Plan ahead. If you or your parent is running low on funds, take some steps as early as possible to figure out where you/she may receive care if needed.

New Adult Family Home Locator Service

Until now, finding adult family homes typically involved using third party referral agents. Although convenient in some cases, it turns out that using senior placement services is not always in consumers' best interest. That's because these services only refer seniors to facilities that are contracted to pay referral fees, and that reduces options for seniors.

To help seniors and consumers find senior care on their own, Adult Family Homes Central created a website that helps consumers in Washington State learn about care options, find adult family homes, and share information freely.

The service is FREE to use and doesn't charge referral fees to adult care home facilities - or consumers. Consumers do need a FREE account to use the service (name and email only).

To learn more visit Adult Family Homes Central website.

Senior Referral Agencies Slammed by FTC

A recent article by a senior housing industry blogger discussed a Washington Post article where the FTC cracked down on CarePatrol and ABCSP.

These elder care referral agencies claimed to have done extensive research on long-term care facilities and offered recommendations to consumers based on their alleged legwork. Their claims included uncovering citations or violations the facilities may have received.

Both charge substantial referral fees to the facilities, the FTC said. These charges are often 100% of a monthly care fee. CarePatrol and ABCSP agreed to settle charges from the FTC that they misled consumers on how much work they actually do in monitoring the care facilities.

Nearly all placement and referral agencies advertise that their "senior care consultants" offer consumer placements in care facilities based on extensive research, and often claim that among other things, their "Certified Advisers" look beyond the appearances to monitor each community's care history and state violations so they can "recommend the safest options for your loved one."

The blogger believes that for the most part referral agencies are a drain on the senior housing industry and that consumers rarely have a clear understanding of the financial relationship between the referral or placement agency and the communities they recommend.

To back his point of view, he highlights several key points about how referral and placement agencies work:

1. Recommended facilities are only those that are on the referral agency's contracted list and exclude all other communities, even if they would really fit the senior's best interest.
2. The higher the monthly fee a facility charges the resident, the higher the commission is. Commissions are typically 100% of the monthly care fee. So there is a powerful incentive to bring prospective residents to communities that are at the top end of their budget, even though there may be other more appropriate or less expensive communities.
3. If a prospective resident receives Medicaid assistance, the agency will not help because it cannot collect a placement fee. Since referral fees collected are often in the $3000 to $6000 range, a model based on charging consumers for placement services is not financially attractive.
4. It is extremely difficult for any referral agency to monitor care facilities closely, let alone for agencies that are internet-based. It is simply not feasible or cost-effective.

In 2011 Washington State implemented the "elder and vulnerable adult referral agency act." The act makes an attempt at protecting consumers, however, it is in its infancy and fails to address key concerns, some of which are discussed in this article.

We strongly advise consumers to do their own due diligence when choosing a care facility, just as they would when choosing any important service.

Consider engaging the services of a Geriatric Care Manager; as client-paid advisers, you're assured of an unbiased approach to finding communities and care services that will benefit you most. Make sure the geriatric care manager doesn't sub-contract the placement service.

You can also visit AdultFamilyHomesCentral to find a FREE database listing of all adult family homes in Washington State. The site also offers free articles to help you understand and guide you thru your care options.

Welcome to 'Seattle Adult Family Homes' Blog Entry

Hello there, my name is Joseph Spada, I am the owner of this blog.  

In 1982, at the tender age of 18, I  got a job at the University Hospital in Geneva Switzerland,  thanks to my father who worked there.  Simply put, I fell in love with seniors and have been involved in taking care of them in one way or another ever since! 

I started operating Spada Homes, Inc. a small 6 bed adult family home in Seattle, WA in 1990, and started a second one in 1995. I am still operating these two adult family homes where we provide the finest personal care to a few lucky seniors :-) 

You can learn more about these adult family homes here, at spadahomes.com.

I started this blog to address current trends and changes in the industry and the operation of adult family homes that are not being tackled at other on-line venues. My goal is to provide relevant content as time permits.  You will be able to offer feedback to these blogs, and I believe the comments may often be more valuable than the original blog post.  

If you think there are things I should be talking about, or are interested in contributing as a guest blog please contact me.