Background:

Adult family homes are community-based facilities licensed to care for up to six individuals who need long-term care. These homes provide room, board, laundry, necessary supervision, and assistance with activities of daily living, personal care, and nursing services.

Adult family homes are licensed by the Department of Social and Health Services and must meet facility standards as well as training requirements for resident managers and caregivers. An adult family home may only admit residents whose needs and preferences the home is able to meet through available staff and reasonable accommodations. Each resident must receive identified care and services in a manner and environment that supports, maintains, or improves the resident's quality of life. The services must be provided by appropriate professionals based upon the resident's assessment and negotiated care plan.

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Summary of Substitute Bill:

An adult family home provider may increase the home's bed capacity to seven or eight beds. A provider may apply for a license to operate with seven or eight beds if:

the provider has held the initial adult family home license for at least 24 months;
the Department of Social and Health Services (Department) has not taken an enforcement action against any of the provider's currently licensed homes in the previous 24 months;
the home has been licensed for six residents for at least 12 months;
the provider has completed two full inspections without any enforcement actions, with the latest occurring within three months of the application;
the provider attests that an increase will not adversely affect the health, safety, or quality of life of the home's current residents; and
the provider has paid any required fees.

The fee for an application to increase the bed capacity of an adult family home is set at $453.

The increase in bed capacity is permissible if the provider demonstrates financial solvency and management experience for the home. In addition, the provider must be able to meet safety, health, and operating standards related to the operation of a seven- or eight-bed adult family home, including the mitigation of potential traffic impacts. The Department must also consider comments related to quality of care and quality of life from current residents, as well as their views on adding more residents to the home.

The Department shall conduct an inspection of the home prior to issuing a license to determine if the home is able to meet the needs of eight residents. The Department may reduce the maximum number of beds to six if there has been serious noncompliance with licensing standards.

When changing ownership of a seven- or eight-bed adult family home, the applicant must have operated an adult family home for at least 12 months without any enforcement actions within the 12 months prior to application.

An adult family home that applies for an increase in capacity up to eight beds must notify all residents and their designated guardians about the increase at least 60 days prior to admitting a seventh resident. The notice must be in writing in a manner or language understood by the residents and their designated representatives.

Substitute Bill Compared to Original Bill:

The substitute bill requires that applicants, to expand an adult family home to seven or eight beds, demonstrate the ability to meet the needs of all current and prospective residents and complete two full inspections without any enforcement actions, with the latest inspection occurring within three months of the application. The Department of Social and Health Services (Department) must consider comments related to quality of care and quality of life from current residents of the adult family home, as well as their views on adding more residents to the home. The discretionary authority of the Department to conduct an inspection prior to licensing a seven- or eight-bed home is changed to a mandatory requirement.

The substitute bill allows for the change of ownership of a seven- or eight-bed adult family home if the applicant has operated a home for at least 12 months without any enforcement actions in the 12 months prior to application.

The substitute bill increases the notice to current residents related to an expansion from 30 days to 60 days from the time of application for expanded bed capacity and requires that the notice be in writing in a manner or language understood by the residents and their designated representatives.

The substitute bill authorizes the Department to charge a fee of $453 for an application to increase an adult family home's bed capacity to seven or eight beds.

Staff Summary of Public Testimony:

(In support) The bill intends to expand long-term care resources and maintain quality, individualized care. This bill deals with the reality that, while small homes are ideal, many people are stuck in hospitals and other institutions. There is a challenge in finding enough beds in the community. This bill recognizes the need to expand capacity and does it in a thoughtful way with a high bar for those who are eligible to expand. Only experienced providers would be eligible for the expansion using the same criteria for those applying to own multiple homes. The homes would need to have adequate square footage, the appropriate number of bathrooms, and adequate common space. The bill does not change the requirement to meet the residents' assessed needs.

(Opposed) People with developmental disabilities are shown to do better in smaller settings. People with developmental disabilities use adult family homes and larger adult family homes will not be as beneficial to them. People want an environment that they can make their own. While there needs to be an expansion of care providers, it should be done through higher salaries, rather than allow more people into adult family homes.

(Other) There are concerns about the residents currently living in the home. There should be greater scrutiny to ensure that the adult family home can meet the needs of two additional residents. An inspection should be required after the seventh or eighth resident is admitted to the home to make sure that the home is safe, providing quality care, and meeting the quality of life needs of the residents. There needs to be a process to govern the sale of an eight-bed home to assure that the new owner is qualified. Expanding to eight residents looks like more of a commercial venture than a residential one.

While there is a great need for adult family homes, there is a concern about increasing the number of people in homes that do not have sprinklers. Without sprinklers in homes there is a greater risk to both residents and fire fighters. Adult family homes have vulnerable residents who might not be capable of self-evacuation. There should be a requirement that there be residential sprinklers in adult family homes that have increased their number of residents.

Persons Testifying: (In support) Representative Macri, prime sponsor; and John Ficker, Adult Family Home Council.

(Opposed) Diana Stadden, The Arc of Washington; and Cheryl Monk, Self Advocates in Leadership.

(Other) Bill Moss, Aging and Long Term Support Administration; Patricia Hunter, Washington Long Term Care Ombuds; Robert Bradley, Washington Association of Fire Marshals; and Amy Brackenbury, Washington Association of Building Officials.