Aging Well

Family Care Homes: A Good Option

For residents who need a lot of individual attention, a Family Care Home -- with a ratio of one caregiver for each three residents -- might be a good option.

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Kelley's Family Care Home
Liisa Ogburn

While the cost of residential care is out of reach for many, conditions arise when it can become impossible to meet all of one’s spouse’s or parent’s needs at home. Even some Assisted Care, Memory and Skilled Nursing communities, who feel their resident’s needs outweigh their staff’s ability to meet them, will sometimes require a family to bring in 24/7 private care – at a cost of up to $15,000/month – or leave the community. What is one supposed to do?

One solution I’ve found myself recommending for cases like these are Family Care Homes. Family Care Homes are privately-owned homes, usually nondescript, single-story homes in quiet neighborhoods, which can house three to six residents in a mix of private and shared rooms. Unlike Assisted Living, Memory Care and Skilled Nursing facilities, which tend to have a ratio of one caregiver per six, eight or even twelve residents, family care homes guarantee a one caregiver to three resident ratio.

Are Family Care Homes supervised and regulated, many ask. Yes. Social Services and Medical Care Commissions oversee the licensing process, while the NC Division of Health Service Regulation enforces compliance. Social Services and the Ombudsman Program visit homes regularly and report violations. There are over 1400 family care homes in NC. To see those in Wake County, visit here.

All, to the best of my knowledge, are private pay. The cost depends on the resident’s level of care need, staffing, and the location and amenities of each house. Just as an Assisted Living or Memory Care community sends out a nurse to assess the applicant’s needs before accepting them or setting their incoming monthly cost, so, too, do Family Care Homes. However, unlike most Assisted Living and Memory Communities, which often provide a base rate and then a menu of additional costs after the assessment (for care, medication and incontinence management), Family Care Homes tend to provide a single set, all-inclusive monthly charge.

The costs in this area tend to start at around $5,000/month and go up to as high as $9,000/month, for someone who is non-ambulatory and requires a lot of hands-on care. Only a handful Family Care Homes are equipped with the required sprinkler system to accommodate non-ambulatory residents.

The majority of homes, though not all, serve people with memory issues. When touring, it is extremely important to look carefully at the mix of current residents, as your spouse or parent may fit in well, or may not. Some homes are for higher functioning residents with more physical than cognitive needs. Others are becoming known as a good option for hospice care during the last months of life.What is most important is the care. What are the signs of good care to look for? Ask what system they use to record the care they provide each day. Is there a menu of home-cooked meals displayed? Do they provide the required 15 hours of planned activities each week? What do family members of current or past residents say about the care? What happens in the event of a medical need? Do they have an on-call nurse or physician who will make a house call (provided there is time)—in order to avoid a trip to the Emergency Room unless necessary? These are some of the questions you will want to ask. Check to see what their rating is here. Once you have narrowed your list down, check here to see if they have had any violations, and if so, what happened, when and has it been sufficiently addressed.
I’ve been especially impressed with some of the homes run tightly by former nurses, who stop in often, have a team with some longevity and live close by -- should there be an issue. Two which I've been impressed by are Kelley's Family Care and Renaissance Family Care.

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