AFH Reference Guide

By Lawrence Patterson,2014-05-05 19:29
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AFH Reference Guide



This document contains information intended to help you decide if you want to become

    a licensed adult family home provider.


    To be an adult family home provider you will be expected to care for the most

    vulnerable members of our society, including persons with challenging behaviors,

    physical and developmental disabilities, mental illness and the elderly. If you become

    licensed you will assume a serious responsibility that will have a large impact on you

    and your family member’s lives.

Adult family homes are heavily regulated. If you become licensed you will have to meet

    all of the many licensing requirements. In addition, you will have to provide the care

    and services that your residents need day and night. As an adult family home provider,

    you will quickly find out that it is a rewarding experience but it is very tiring and stressful

    to be working and available to residents day and night. As a result, you may decide that

    you need to hire staff to be awake and available to care for residents at all times.

We know that a number of providers close their adult family homes after only one or two

    years. This is usually because they did not realize how difficult it will be to share their

    home with others or how hard it may be to attract residents and operate a business.

    When a home closes, this negatively impacts residents and their families, as well as

    providers and their families.

Before you decide to apply to become an adult family home provider, you should

    consider why you want to become a licensed provider and how you will maintain your

    adult family home business over time. The self assessment at the end of this guide

    along with the other information may help you decide whether or not you want to go

    forward with the process to apply to become a licensed adult family home provider.

    AFH DEFINITION What is an Adult Family Home (AFH)?

    ? An AFH is a residential home licensed to care for up to six adults not related by

    blood or marriage to the person or persons providing the services.

    ? The AFH provides room and meals, laundry, supervision, assistance with activities

    of daily living and personal care. Some homes provide nursing or other special care.

    ? A licensed AFH is generally at a residential home address.

    ? An adult family home may be in a duplex or similar living arrangements. Each

    unit must have:

    o A separate address; and meet separate requirements such as,

    o Separate staffing;

    o Separate call systems;

    o Separate living quarters;

    o Either a fire wall or floor separating the two units; and

    o No internal door in common.



What is not an Adult Family Home (AFH)?

    ? An apartment in an apartment building or condominium cannot be licensed as

    an AFH.

    LICENSE NEEDED When is a license required?

    ? You have to have an AFH license before you can provide personal care, special

    care, room and meals for two to six adults, unrelated to you, in your home.

When is a license not required?

    ? An AFH license is not required for you to provide care for your own relatives in

    your home.

    ? An AFH license is not required to provide care for one person unrelated to you in

    your home.

    ? An AFH license is not required to take care of a relative such as your mother and

    one other person not related to you in your home.

    ? An AFH license is not required if you are providing only room and meals in

    exchange for rent.


    What are some management responsibilities for operating an adult family home?

    The following is a partial list of some things the provider must do:

    ? Know and comply with all AFH applicable laws and rules;

    ? Meet the assessed care needs and preferences for each resident which may

    include, but is not limited to assistance with:

    o Personal hygiene, dressing, bathing, toileting, body care, walking and

    moving from one spot to another;

    o Providing nutritious meals, offering activities other than television;

    o Providing medication assistance or administration; and

    o Providing supervision to residents with challenging behaviors or at risk of falls.

    ? Be responsible for the care and services provided to residents 24 hours a day

    whether the provider is on site or not;

    ? Screen and hire responsible, dependable and qualified staff members;

    ? Ensure that staffing is adequate to meet all resident needs at all times: 24 hours

    a day, seven days a week;

    ? Provide staff orientation, and ongoing staff support and training; and

    ? Maintain adult family home records such as, individual resident records, staffing

    records, accounting, income tax and payroll records.

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    SKILLS NEEDED What are the skills necessary for operating an adult family home?

    The provider must:

    ? Have the cognitive ability, emotional stability and physical health to meet the

    licensing requirements, and the personal and special needs of vulnerable adults.

    ? Be committed to achieving success in the AFH business;

    ? Be willing to put the needs and interests of residents first over the needs of

    yourself and your family;

    ? Actively advocate in the best interests of their residents;

    ? Be able to speak English well enough to understand and be understood by

    residents, their families, medical professionals, emergency medical responders

    (911), case managers, department staff such as licensors, complaint

    investigators, long-term care ombudsman, pharmacists and other professionals

    about the resident and their care needs ;

    ? Have the ability to read, understand and follow the adult family home laws and

    rules; and

    ? Have the ability to write down in English certain required information related to

    the care and services of each resident.


    What are costs associated with obtaining an adult family home license?

    Starting July 26, 2009, a $900 license and processing fee must be turned in with the

    license application.

     The following costs vary by instructor, by county, location, fees and codes.

    ? 48 hour AFH Administrator training. This is the most expensive training cost. You may

    want to contact a number of instructors to find the one that best meets your needs;

    ? First Aid and CPR training for applicants and all caregivers;

    ? Tuberculosis (TB) tests for applicants and staff;

    ? Fundamentals of Caregiver training;

    ? Specialty training if you plan to take residents with dementia, developmental

    disabilities, or mental illness;

    ? Building inspection; and

    ? Structural changes to your home that may be needed to meet state or local

    building codes.


    What is required before I can apply to be an adult family home provider?

    ? You must attend a prospective provider orientation class before applying for an AFH

    license, unless you are currently licensed, or have been licensed within the past year.

    ? You may sign up for orientation class on-line at:

    and click on AFH On-line Orientation Class Registration, or call 1-866-556-5779

    August 2009 Page 3 of 8




    What are some of the application requirements that I must meet to be licensed as an

    adult family home provider?

    ? $900 fee must be turned in with the license application;

    ? For a change of ownership (CHOW) for a currently licensed AFH, submit a

    written letter from the current licensee saying that they are willing to give up their

    license when and if your license is approved;

    ? Copy of your AFH Orientation Certificate taken within the last 12 months;

    ? Copy of Washington State Business License Number showing the Unified

    Business Identifier or UBI;

    ? Copy of document issued by the Internal Revenue Service (IRS) verifying the

    Employer Identification Number or EIN (Federal Tax ID Number); ? Copies of documents showing that the applicant provider, entity representative,

    and resident manager meet the minimum qualifications for licensure including:

    educational requirements, (CPR) certificate, first-aid card, TB screening test, and

    caregiver training;

    ? Meet the minimum education requirements that include a High School Diploma or

    GED, or any English translated government document listed in WAC 388-76-10130; ? Completed Caregiver Attestation Form verifying 320 hours of successful direct

    Caregiver experience obtained after the age of 18 to vulnerable adults in a

    licensed or contracted setting;

    ? Certification for completing 48 hour Administrator training before applying for an

    AFH license;

    ? Copies of specialty training documents if you intend to care for residents with

    dementia, developmental disabilities, or mental illness;

    ? Completed Background Inquiry Authorization Forms for all providers, resident

    care managers, and all members of the household that are eleven years of age

    or older and others who will have unsupervised access to your residents; ? Copy of the completed AFH Building Inspection indicating “Passed” with the adult

    family home floor plan and printed directions to the AFH;

    ? A copy of your AFH admission agreement for private pay and Medicaid eligible


    ? A copy of the disaster plan; including the applicant’s or entity representative’s

    name and the name of the proposed adult family home on the admission

    agreement and disaster plan;

    ? A copy of your nurse delegation certificate if you plan to perform delegated

    nursing tasks;

    ? Be 21 years of age or older and be able to understand and speak English or

    have a person on staff available at the home who is able to understand and

    speak English; and

    ? A completed application and checklist if your application is not complete it will

    not be processed.

August 2009 Page 4 of 8



    EDUCATION ALTERNATIVES If I do not meet the minimum education requirements, are there other alternatives?

    See WAC 388-76-10130. There are no exceptions to these requirements.

    ? Successful completion of government-approved public or private school

    education in a foreign country that includes an annual average of one thousand

    hours of instruction over twelve years or no less than twelve thousand hours of

    instruction (This is equivalent to grades 1-12 in the US);

    ? Graduation from a foreign college, foreign university, or United States community

    college with a two-year diploma;

    ? Admission to, or completion of coursework at a foreign or United States

    university or college for which credit was granted;

    ? Graduation from a foreign or United States college or university, including award

    of a Bachelor’s degree;

    ? Admission to, or completion of postgraduate coursework at, a United States

    college or university for which credits were awarded; or

    ? Successful passage of the United States board examination for registered nursing,

    or any professional medical occupation for which college or university preparation

    was required. This does not include a certified nursing assistant (CNA).

Will foreign language educational documents need to be translated into English?

    ? Yes, foreign language educational documents submitted with the AFH application

    must be translated into English by an approved language translation service that

    certifies the translation as correct.

    WRITTEN VERIFICATION What is an attestation?

    ? An attestation is a legal and formal written statement. If you sign an attestation related

    to an application you are saying and confirming that what you are signing is true.

    CAREGIVING ATTESTATION Who can provide the 320 hour care giving notarized attestation or verification for you?

    Only the following people may provide attestation or verification for you if they have

    observed you providing direct care:

    ? Supervisor;

    ? Employer;

    ? Co-worker;

    ? Client or resident if they are able to read, understand and sign the form in the

    presence of a notary, and be interviewed by telephone; or

    ? The resident’s spouse or family member.

Who cannot provide the 320 hour care giving attestation for you?

    ? Anyone related to you by blood or marriage

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? A Home and Community Services case manager or a Division of Developmental

    Disability case manager

    What is included and verified as true in the notarized “attestation” of caregiver experience?

    ? The proposed licensee or resident manager has successfully provided 320 hours

    of direct care and has caregiver experience. ? The dates of employment and any volunteer work experience as a caregiver that

    occurred after age 18 in a licensed or contracted setting.

    ? The individual verifies that they were in a position to personally observe, over

    time, the applicant’s actual care giving. ? The accurate address and telephone contact information for the individual

    completing the form so the attester can be interviewed by the department about

    the applicant’s care giving experience.


    What are some of the standards that my home must meet when the licensor makes the

    initial inspection visit?

    ? You must be able to show or verify the following for your home. The home:

    o Meets current building code requirements for a single family dwelling (no

    apartments or condominiums are permitted as an AFH);

    o Is clean, sanitary, and free of hazards inside and out;

    o Has secure handrails at all stairs or steps in or out of the home;

    o Has the required approved 2A:10B-C (5#) rated fire extinguishers on each

    floor of the home;

    o Has working smoke detectors, on each floor, in hallways and in each

    resident bedroom and in close proximity to the caregiver’s bedroom;

    o Has windows that open easily and have intact screens on windows that

    can be easily removed in an emergency;

    o Has curtains or blinds on windows to afford the residents’ privacy;

    o Has first aid supplies with a first aid manual;

    o Has emergency water and food supplies for 3-7 days;

    o Has all firearms stored in secure/locked storage areas;

    o Has a place to lock up medications;

    o Has cleaning supplies and other toxic substances out of the reach of residents;

    o Has water, well water and private septic systems that are adequate in size

    and approved (when applicable);

    o Has a written and workable disaster plan; and

    o Has record keeping processes developed that meet WAC 388-76-10315


    ? Bedroom requirements:

    o There must be no more than two residents per room;

    o A single room must have a minimum of 80 square feet not including

    closet space and door swings;

    o A double room must have a minimum of 120 square feet not including

    closet space and door swings;

    o Doors and bedroom closet must be openable from the inside and outside;

    August 2009 Page 6 of 8



    o There must be adequate lighting in the room; and

    o Must have adequate storage space in each bedroom to meet the needs of

    the residents.

    ? Bathroom requirements:

    o Residents must be able to get to toilets and bath/shower facilities easily;

    o One toilet for every five people in the house;

    o The tub and shower must have grab bars and non-skid surfaces;

    o The hot water temperature at fixtures accessible to residents must not

    exceed 120 degrees F.


    The following assessment was primarily developed by a group of adult family home

    providers with many years experience in running adult family homes. It is the intent of

    the assessment to give you as clear a picture as possible of the considerable demands

    of running an adult family home.

    Answer yes, no, or sometimes, to the following questions that best describes

    your response to each statement.

    1. I am patient with other people’s mistakes.

    2. I can be alert and calm and awake in the middle of the night, even after a long day.

    3. I can take verbal abuse and still forgive. I do not hold a grudge.

    4. I am comfortable asking others for help.

    5. I can place the needs of others ahead of my own wants.

    6. I am comfortable taking care of residents of the opposite and same sex.

    7. I have experience and am comfortable taking care of people who are elderly,

    who have mental illness or developmental disabilities who are not related to me. 8. I deal with emergencies without panic.

    9. When planning schedules, I can be thoughtful of the needs of staff, residents,

    and resident’s families.

    10. I am aware and prepared to give up most of my privacy because I will be

    sharing my home with residents.

    11. Confrontation with staff and resident’s families do not intimidate me.

    12. I follow established procedures and do not cut corners.

    13. I can keep abreast of the regulations and laws that govern adult family homes.

    14. I am tolerant of other cultures and points of view.

    15. I respect other’s rights, privileges, and privacy and strive never to control or

    manipulate others.

    16. I save money for a crisis and routinely plan ahead.

    17. The financial risks of owning a business or incurring debt do not frighten me.

    18. I promptly pay my bills.

    19. I speak English clearly and am easily understood.

    20. I am in excellent health have a lot of energy.

    21. I am organized and efficient.

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    22. I am able to follow the instructions of others, doctors, and nurses who give me

    care directions for residents in my home.

    23. I can cope well when cherished residents may pass on. I am able to comfort

    the dying and relatives of those who are dying.

    24. I am prepared financially and emotionally for the length of time it may take to

    get licensed.

    25. I am able to take and act on constructive criticism regarding areas of my work

    needing improvement

If you answered yes to 18 or more of 25 questions, you may understand the nature of

    the adult family home business.

Before making the decision to become licensed as an adult family home, talk to other

    adult family home providers and ask to spend time in their homes. Ask lots of questions

    before committing to opening up your own adult family home.


    For additional information about requirements to operate a licensed adult family home

    you may visit the website

    August 2009 Page 8 of 8

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