Alabama’s adult foster care program sees growth in interest amid promotional campaign

A advertising push for Alabama’s adult foster care program appears to be working.

The Alabama Department of Human Resources (DHR) has seen a significant increase in calls from potential providers since the department ramped up efforts to grow its adult foster care program.

Billie Robinson, program supervisor for DHR Adult Protective Services, said that in the last four months, she fielded over 100 calls from people interested in becoming an adult foster care provider.

The department received four calls in April; 13 calls in May, and 29 calls in June. In July, the department received nearly 60 calls, a 150% average increase each month since April.

“We have seen a huge increase in the number of calls that we’re getting, and then that information was filtered to the counties so they can go ahead and reach out to that potential provider,” Robinson said in an interview Wednesday.

Adult foster care programs offer 24-hour assistance to older and/or disabled persons who are unable to live alone in their own house or apartment.

These adults wouldn’t benefit from a nursing home or an assisted living facility because they don’t require the level of care provided by those institutions. The programs place them in settings with a small number of residents, where they get individual attention and have their basic needs met.

The program, being less expensive than nursing homes or assisted living communities, could help the state save money, particularly as the need for senior services continues to grow. The percent of Alabamians aged 65 or older rose from about 14% in 2010 to nearly 18% in 2020.

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In March, the department had 54 applications from prospective adult foster care providers and 21 potential providers. The department now has 75 pending applications with 61 potential providers.

She said that while there has not been much change to the number of licenses yet, the department is seeing “a lot of movement.”

Since starting a promotional campaign for the adult foster care program, the department has put up 106 billboards, at least one in each county, in areas that are considered high traffic.

“We wanted to make sure that people see them and would start contacting him from the billboards because we weren’t sure how it was going to work,” Robinson said.

Alabama had an adult foster care program in the late 1970s, but the modern program grew out of a one-time American Rescue Plan Act grant from the Administration for Community Living, which the department is still utilizing the funds to promote the program.

DHR previously used the ARPA funding to recruit adult foster homes starting in April 2021. The department started the project by providing “refresher” training to each county DHR office so that staff were familiar with adult foster home recruitment and licensing. DHR also created recruitment materials such as flyers, banners, brochures, and tablecloths.

The state is the only one in the nation that does not offer some sort of waiver to pay for the program. With so few providers in the state currently, it’s unclear how providing a waiver would shape the program.

While care at a nursing home may cost twice as much as foster care, nursing home residents need specialized medical care that can’t be provided outside of a medical facility.

John Matson, spokesperson for the Alabama Nursing Home Association, said in a phone interview Wednesday that nursing home care includes 24/7 nursing care, where medical treatment is administered. There are other services included as well, such as room and board, including meals, social and individual activities, as well as accommodating different religious beliefs.

“If someone needs nursing home care, there should be a nursing home available to them. But not every person needs a nursing home level of care,” Matson said.

There are over 600 vulnerable adults in Alabama who the state deems “out-of-home placements,” but each application is independently investigated. DHR looks at whether an adult is at high risk of abuse and whether circumstances would require their removal from a home. Some may benefit more from living in a nursing home or assisted living facility.

“Adults in foster homes can basically provide almost all of their care, but they may need a little assistance, with maybe their food, their meal prep, something like that,” Robinson said. “Someone that would go into a nursing home and have medical issues where they can’t provide for themselves so they would need institutionalized care.”

A comprehensive range of residential, community, and in-home services are typically necessary to balance long-term care systems and reduce Medicaid use of nursing home care. While most beneficiaries who receive services outside of a nursing home live in their own home, residential settings provide a supportive, home-like environment for vulnerable adults who lack caregivers, need on-demand support, or require oversight or supervision.

Alabama requires licensed providers to be at least 19 years old, able to read, and have a driver’s license and access to a car. Some providers may care for up to three adults if they have the capacity and choose to do so.