When most people think about long-term care for older adults or individuals with disabilities, they often picture nursing homes or assisted living facilities. However, a lesser-known but deeply impactful option that offers a more personal and homelike approach is adult foster care (AFC). Often overlooked in discussions about elder care, AFC focuses on individualized support in a small residential setting. With growing attention toward person-centered care models, AFC is gaining recognition as a compassionate and cost-effective solution for individuals who need assistance with activities of daily living (ADLs) but do not require institutional-level care.
AFC refers to a model of long-term care where individuals, usually one to five adults, are placed in a private residence with a licensed caregiver. The caregiver provides support with ADLs, such as bathing, dressing, toileting, medication management, and meal preparation. Unlike larger facilities, the caregiver typically lives in the same home as the residents, creating a familial and supportive environment. This intimate arrangement promotes not only physical assistance but also emotional well-being, fostering companionship and trust between the caregiver and the individuals in their care.
A significant strength of AFC lies in its ability to maintain a sense of dignity and autonomy for residents. Many individuals prefer to remain in a home-like environment where they can participate in daily routines, preserve their independence, and avoid the impersonal nature some associate with larger institutions. The small scale of AFC homes allows caregivers to tailor care plans based on each resident’s needs, habits, and preferences, leading to increased satisfaction and an overall higher quality of life.
While there are many benefits to AFC, there are also some downsides. For an older adult who thrives in larger social groups and more activities, AFCs might not meet their needs. Larger long-term care communities tend to have more variety in their activities, larger facilities, and more amenities.
In addition to its emotional and personal benefits, AFC has proven to be a cost-effective option compared to traditional nursing homes. A study conducted by the U.S. Department of Veterans Affairs evaluated Medical Foster Homes, a federally supported version of AFC, and found that they reduced daily care costs, rates of hospitalization, and mortality compared to community nursing homes. These findings suggest that AFC models not only provide better individualized care but also reduce the strain on healthcare systems by avoiding unnecessary medical interventions.
Another study that evaluated Oregon’s Medicaid-funded AFC program found that some individuals experienced improved physical functioning compared to those in nursing homes. The study concluded that AFC homes were beneficial for residents with milder needs and improved ADLs. These findings underscore the importance of placing individuals in care settings that are best suited to their level of need.
AFC caregivers must meet specific eligibility criteria and play a crucial role in their patients’ lives. State regulations typically require caregivers to be 18 years old or older, pass background checks, and complete training in caregiving, medication management, and emergency response. Because they often live with the individuals they care for, caregivers become a central part of residents’ daily lives. This living arrangement promotes strong emotional bonds. For that reason, providing respite care, access to mental health resources, and continuing education is essential to sustaining the health and well-being of caregivers and maintaining the quality of care in these homes.
Despite its many benefits, AFC is not without its challenges. One of the primary concerns is the lack of standardization across states. Because AFC is regulated at the state level, there is significant variability in how programs are administered, funded, and monitored. This can result in inconsistencies in care quality and difficulty accessing AFC services in certain regions. A report from the American Association of Retired Persons (AARP) Public Policy Institute emphasized the need for states to build better regulatory frameworks, support caregiver training, and ensure adequate funding for AFC programs to succeed.
Another major challenge is funding. While many states use Medicaid waivers to cover services in AFC homes, room and board are not typically included. This can place financial pressure on both residents and caregivers. Without consistent and comprehensive reimbursement policies, many caregivers struggle to maintain their homes and services, particularly in low-income communities. Expanding Medicaid coverage or developing alternative funding streams could greatly increase the accessibility and sustainability of adult foster care programs.
In addition to state support, public awareness of AFC remains limited. Many families are unaware that adult foster care is a viable alternative to institutional care. Therefore, increasing public education about this model can help more families make informed decisions that align with their loved ones’ preferences and needs. In many cases, families choose nursing homes not because they are the best option, but because they are the most well-known.
Looking ahead, adult foster care stands as a promising model for the future of long-term care. As the population ages and demand for elder care rises, the U.S. healthcare system must adapt to provide care that is not only effective and affordable but also dignified and person-centered. Adult foster care meets this demand by blending medical support with a homelike setting, preserving the humanity of care and ensuring that aging and disabled adults receive the respect and comfort they deserve.
Ultimately, adult foster care provides more than just physical assistance; it restores a sense of normalcy, stability, and connection to those who might otherwise be isolated or institutionalized. With improved regulation, caregiver support, and broader public awareness, AFC can continue to grow as a compassionate cornerstone of the long-term care landscape.
Sources:
- Medical foster home is less costly than traditional nursing home care – PubMed
- Effect on physical functioning of care in adult foster homes and nursing homes – PubMed
- Building Adult Foster Care: What States Can Do
- Supporting Family Caregivers in Providing Care – Patient Safety and Quality – NCBI Bookshelf
- Medicaid & Adult Foster Care: State by State Benefits & Eligibility
