The December 2012 Adult Family Home Quality Assurance Panel Report
In 2011, the Washington State Legislature examined problems with the quality of care and oversight of some adult family homes (AFHs). Washington has over 2,800 AFHs, serving approximately 14,000 vulnerable residents and/or residents with disabilities in small residential homes.
In 2011, the Washington State Legislature examined problems with the quality of care and oversight of some adult family homes (AFHs). Washington has over 2,800 AFHs, serving approximately 14,000 vulnerable residents and/or residents with disabilities in small residential homes. The 2011 Legislature passed HB 1277 to address these care quality and oversight issues. The new law increased requirements for AFHs—the homes now had to have a qualified caregiver on-site, as opposed to on-call; owners needed to understand English; and more prior caregiving experience was required of new AFH owners. HB 1277 also augmented the civil fine authority of the Department of Social & Health Services (DSHS), the agency that licenses and inspects AFHs, and directed the agency to increase penalties for AFHs that are consistently deficient. The changes went into effect in January 2012. In addition, through Initiative 1163 and effective January 2012, the basic training requirements for newly licensed AFH owners and newly hired caregivers in AFHs were increased.
In order to examine the issues more fully, HB 1277 also directed DSHS to convene a Quality Assurance panel, selected by DSHS and the State Long-Term Care Ombudsman (LTCO) and chaired by the latter, to review problems with neglect and abuse in AFHs, and the oversight of new providers, de minimus violations, and overall licensing, investigation and enforcement issues regarding AFHs. The Panel was directed to provide a report to the Governor and Legislature by December 1, 2012.
The Long-Term Care Ombudsman (LTCOP) and DSHS assembled a Panel representing AFH associations and providers, resident advocates and families, nursing/hospice, public guardianship, and DSHS oversight and management divisions. The Panel met five times over the past year and discussed a broad array of topics and recommended action steps. These steps are not based upon a rigorous study, but upon the pooled knowledge of an experienced, diverse group of stakeholders working in this field.
A team of ombudsmen also reviewed a random sample of 160 unredacted DSHS licensing and investigation files, and a representative sample of those cases was then considered by the Panel. The case reviews revealed both effective and ineffective enforcement actions. For example, an AFH teetering on the brink of financial crisis and with staff mistreating residents was shut down promptly. On the other hand, an AFH with residents with dementia who were wandering repeatedly out of the home, and a caregiver who could not read residents’ records, was permitted to operate for a year before DSHS required a second caregiver.
Summary of Recommendations
While not every member of the Panel agreed with the every statement in this report, overall, nearly all members of the panel concluded that the quality of care in AFHs would be improved, and abuse and neglect would decline, if some caregivers and AFH owners received better training and mentoring, residents and their families were better informed and selected the right AFH, and DSHS oversight was more vigorous and prompt against poorly performing AFHs. The panel specifically makes the following recommendations.