Adult Family Care
Individuals with a variety of different medical diagnoses can need help with activities of daily living that make them unable to live alone. They may still want and be able to live independently with the help of a live-in caregiver.
The Adult Family Care (AFC) Program (also known as Adult Foster Care Program) is an option for people age 16 and older who due to medical, physical, cognitive or psychiatric problems cannot live alone. In the Adult Family Care Program, an individual lives with a caregiver who receives a daily stipend for the assistance s/he provides with activities such as bathing and dressing, laundry and grocery shopping. The caregiver can be any family member (except a spouse, your parent if you are a minor, or other legally responsible relative), or someone that either you or Springwell recruits.
MassHealth programs can be confusing, with complicated eligibility criteria. Springwell’s expertise is in understanding and helping you sort out the questions and the paperwork involved in applying for this program. Springwell has a dedicated AFC Care Advisor and a registered nurse to provide support, education, and case management to the individual receiving care, monitor the care provided and provide training to the caregiver. Our staff understand the needs of care recipients, the requirements for caregivers, and the regulations of the program.
- 16 years of age or older, and
- Enrolled in MassHealth Standard or CommonHealth, and
- Have a chronic disabling condition or disability, and
- Require daily assistance, cueing, or supervision, with at least one activity such as eating, dressing, bathing, transferring, ambulation, and toileting, and
- Written authorization from a physician
- The caregiver is required to submit to a background check and have his or her physician complete a referral for enrollment in the program.
Eligibility details, Care Provider and Care Provider Home requirements, a Program support outline, and Reimbursement details for the Adult Family Care Program are provided here for your information. A dedicated Springwell AFC Care Advisor can also help you sort through these details.read more
A Springwell RN and Social Worker meet with individuals interested in receiving services through the AFC Program for a complete assessment of their needs. Eligibility is determined for Level 1 or Level 2 service within the AFC Program. If the individual is eligible a Comprehensive Care Plan is created.
Eligibility (Level I) :
Adult Family Care services are provided to MassHealth members who meet the clinical criteria for AFC:
- At least 16 years of age or older;
- A physician must write an order for AFC;
- The member must have a medical or mental condition that requires daily physical assistance or cueing and supervision during the task in order for the member to successfully complete at least one ADL;
- A member must be clinically approved for AFC services by MassHealth.
Eligibility (Level II):
In addition to Level I AFC services, the MassHealth agency pays for AFC at Level II if a member requires:
- Physical assistance with three ADLs (bathing, dressing, toileting, transferring, ambulating and eating); or
- Physical assistance with two ADLs and management of behaviors that require caregiver intervention: i.e. wandering, verbally abusive behavioral symptoms, socially inappropriate or disruptive behavioral symptoms and resisting care.
Care Provider Requirements
A Springwell Social Worker will meet with potential Care Providers at his/her home to discuss the AFC Program and to assess whether the Care Provider meets the following requirements:
- Be a responsible person who is at least 18 years of age;
- Not abuse alcohol or drugs;
- Be able to devote appropriate time necessary to provide needed personal care to the member to ensure the individual’s safety and well-being at all times;
- Have a physical and tuberculosis test within prior 12 months
- Meet all other requirements of the AFC regulations.
Certain relatives of a MassHealth member may serve as that member’s AFC Care Provider in a qualified setting. Excluded relatives are: a spouse, parent of a minor member, including adoptive parent, or any legally responsible relative of the member.
Care Provider Home Requirements
During the visit to the Care Provider Springwell’s AFC Social Worker will conduct an assessment of the home to ensure it meets all requirements including:
- A private residence located in Massachusetts; not subject to state licensure as another type of facility (e.g. group home);
- Physically accessible to meet specific needs of its residents;
- In good repair; compliant with local health, fire, occupancy and state building codes for residential dwellings; equipped with appropriate safety equipment; and
- Occupied by no more than three AFC-enrolled individuals, no more than two of whom require Level II AFC services, regardless of type and payment source.
Matching AFC Individuals w/ Care Providers
Springwell AFC staff will carefully match individuals with Care Providers according to availability. While an individual interested in the AFC Program may have a specific Care Provider to appoint, many do not. If someone does not have an available Care Provider, introductory visits are made and if requested, a trial weekend stay is provided. Once both the AFC-enrolled individual and Care Provider agree with a match the Springwell AFC staff assists with facilitating the individual move into the Care Provider’s home.
The Springwell AFC RN and Social Worker are in regular contact with the individual and Care Provider, visiting the home a minimum of one time per month. The staff provides on-going training to ensure that the needs of the AFC consumer are being met.
- The individual pays only room and board to the Care Provider (approx. $420 per month).
- Springwell pays the Care Provider $23.00 per day for caring for an individual who is enrolled in Level 1 and $49.05 per day for caring for an individual who is enrolled in Level 2.
- All other services (including Adult Day Health, LifeLine and medical transport) are paid for by MassHealth (Medicaid) directly.
Rosie and Tanya have participated in the Adult Family Care Program and it has changed their lives.