By David Jones, Volunteer Hotline Attorney
F. Search for a Facility
In this article, I discuss a search by a person other than a prospective resident. The person is generally called a “designated representative” (DR). This is a person who is a legal guardian or has been granted the authority by the prospective resident. That person is generally a relative, but it can be any competent person legitimately interested in the prospective resident’s wellbeing. Usually, the prospective resident is not able to do the search. If so, the prospective resident still should be included in the decision making. Of course, some prospective residents may be able to search on their own. They can also follow these directions.
2. Importance of Licensure
Not all facilities claiming to provide AFC or HA care are licensed. Because of the technicalities of the statutes, some of these facilities do not have to be licensed. Some should be licensed, but are not. For instance, their license may have been revoked, but they reopened or never closed.
In your search, only consider licensed facilities. For licensed facilities, unlike unlicensed facilities, the agency has done preliminary and ongoing investigations to determine compliance with the Statutes and Rules. Such investigations may not be perfect but are better than no official agency that will investigate and hopefully take the necessary actions.
3. Search Before Visiting Facilities
Your search for Adult Foster Care Facilities should start on the website. From the website, you can find the names and license type for all licensed facilities in Michigan. Just click on General Public, search for Adult Foster Care and Homes for the Aged Facilities. A new page will come up. Type the name of a county you are interested in, and click search. If you want to check on a particular facility by name, just type in the name and click search. For each name, click on the name and it will provide much useful information. Be sure to click on and read the Reports Available. These reports will give you much important information, including the name and phone number of the Licensing Consultant, and the history of compliance, and violation.
If you want additional documents, such as corrective action plans, you may file a Freedom of Information Act (FOIA) request to get them. Information on how to file the request is on the website (cited above). Go to Online Services, and click on FOIA.
For each facility you are interested in, call the facility and ask if it has any openings. If so, and you are interested, you need to visit the facility.
4. Visit to the Facility
a. Inspection of Facility
When you go to the facility, you need to not only speak with the admitting person but also to inspect the facility for yourself. Look at the outside and inside of the facility to determine the condition of the building. Walk around the inside. Look at the bedrooms, bathrooms, and public areas. Are they clean? Are there physical barriers (such as stairs) that would make it difficult for the prospective resident to live there? The smell of bad odors. Bad odors may indicate the facility itself is not kept clean, or incontinent residents are not regularly changed. Taste the food to see if it is palatable.
Talk to staff to determine what they are like. Talk to residents in private and ask them about their care. If you can find people visiting residents, talk to the visitors. The visitors may also have a great deal of useful information.
Is this really a place where the prospective resident would be comfortable and well cared for?
b. Discussion with Admitting Staff Member
Attend a scheduled appointment with an admitting staff member at each facility you are interested in. Ask many questions.
If you have not yet checked on the licensure of the facility, ask the staff member. Many facilities in their advertising simply describe themselves as “assisted living” facilities. The term is vague and conceals information about licensure. If the staff member does not give a full answer, be cautious about proceeding. However, you can determine licensure on the website.
You need to determine if the facility is appropriate for the prospective resident. Can the facility meet the prospective resident’s needs? Would the prospective resident be comfortable here? Can the prospective resident afford the costs out of his or her own funds and other available funds?
It is best to compare several facilities for quality, price, accessibility, etc.
Before admission, certain evaluations must be made and documents prepared and signed. Be sure to carefully read all documents before signing them. Also read carefully any handouts given.
For the four relevant types of AFCF, the rules provide a detailed list of the preadmission requirements. I suggest you read the rules before going through admission. The rules for each type are similar to the rules for the other types. The relevant rules for Family Homes are found at MAC R400.1401 and 1407. The relevant rules for Small Group Homes are found a MAC R 400.14102 and 14301. For Large Group Homes, the relevant rules are found at MAC R 400.15101 and 15301. For Congregate Facilities, the relevant rules are found at MAC R 400.2402, 2417, and 2423.
Here I will only discuss three of the relevant requirements in AFCF. A written resident assessment plan must be prepared which identifies the prospective resident’s needs and the services the facility will provide to meet these needs. A written resident care agreement (aka foster care agreement) must be prepared and signed with a number of things in it. In the resident care agreement or elsewhere the fees must be specified. In addition, a written health care appraisal and/or treating doctor’s instructions must be obtained.
For HA, a detailed list of the evaluations and documents required is found in MAC R 325.31901 and 1922. Again I suggest you read these rules. Here I will emphasize two important requirements. A written service plan must be prepared (in cooperation with the resident’s representative) which identifies the prospective resident’s needs and the services the facility will provide to meet these needs. Also, a written resident admission contract must be prepared and signed. The contract has to specify a number of things, including the services to be provided and the fees for the services.
No agency regulates the costs of care in these facilities. The costs may vary considerably from facility to facility. The variance is based on the amount of services provided and other factors not necessarily quality. Generally, HA will charge less the AFCF but provide fewer services. It is best to compare the costs at several facilities.
Mainly these facilities are private pay. If the prospective resident has long-term care insurance, that may pay a significant part of the cost. If the prospective resident has Medicaid, that may pay some of the medical costs. If the prospective resident is eligible for the CHOICE program (administered under Medicaid by the Michigan Department of Health and Human Services) that may pay a significant amount of the costs. Perhaps you can also find other sources to help pay.
H. Contacts and Problems after Placement
Because the facility is excellent at placement, does not mean it will remain excellent. Many changes can occur. A few are listed as follows. The Licensee may have financial problems, leading to a cut back in staff, a decline in the quality and quantity of food, decrease in services, deterioration of the building, etc. Excellent staff may leave and poor staff arrive. A new resident who is disruptive may arrive. Residents may be injured. Therefore it is important to keep in close contact with the resident and to make unannounced visits to the facility periodically.
It is best to read all the rules applying to the type of facility in which the resident is placed. It will help you to understand if the issue you are concerned about is a violation of a rule. Reading all the rules may be tedious, but it is well worth the effort.
If you see a problem, first talk to the Licensee. If you are not satisfied with the Licensee’s response, contact the Licensing Consultant. If you have the Licensing Consultant’s name and phone number, call that number. If not, then call 866-856-0126.
It is best to also file a written complaint. Go to the website and in the upper right-hand corner, click on “Complaints”. A page will come up explaining the process. You can fill out and send online a complaint form. Or you can download a copy of the complaint form, fill it out and mail it to a listed address. The Licensing Consultant must respond to your complaint.
The online page says you must allege violations of the facility’s governing act and rules. If you are able to allege a violation of a specific section of the statute or rule, do so. Otherwise just allege violations in general.
Note that if you are alleging abuse or neglect of an adult, the web page tells you to call 855-444-3911. This is a statewide toll-free number to report neglect or abuse to a child or adult. However, you should also file a written complaint with licensing.
Selection of a licensed residential care facility for placement and dealing with problems after placement is a difficult and time-consuming process. For the resident’s protection, it must be done carefully. Hopefully, this article helps you through that process.
Part 2 of 2: PLACEMENT AND CONTINUED CARE FOR SENIOR RESIDENTS IN LICENSED RESIDENTIAL CARE FACILITIES (Other than Nursing Homes)
By David Jones, Volunteer Hotline Attorney