An Introductory Guide to Family Care Homes

By Jessica Saks

Residential Assisted Living, also known in North Carolina as Family Care Homes (FCHs), is a growing trend with some estimates citing tens of thousands of such homes through the US.  This model of boutique-style assisted living and memory care can be a wonderful alternative for those who need  assistance with activities of daily living – such as dressing, bathing, eating, and medication management – but do not want to reside in a large institution. In fact, research has shown that residents in more intimate settings such as those offered by FCHs experience better outcomes including greater levels of personal dignity and lower rates of depression and anxiety. Nonetheless, not all Family Care Homes are created equal. The purpose of this guide is to help families determine if this model of care is appropriate for their loved one and ask the right questions when choosing among assisted living alternatives.

What is a Family Care Home?

Simply put, a Family Care Home is assisted living in a residential setting usually located in an unmarked house that completely blends into the neighborhood in which it is located. Per state law, up to six (6) residents may reside together in a home where they receive round-the-clock care from professional staff like certified nursing assistants, medication aides, and registered nurses; are fed home-cooked meals; and participate in activities tailored to their preferences and abilities. Residents may reside in private or semi-private (shared) rooms, and some homes are even designed with private en-suite bathrooms. Daily housekeeping and laundry services are provided, and many homes will coordinate physician appointments. FCHs are regulated by the Department of Health and Human Services and receive the same scrutiny as large facilities.

What are the Benefits of Family Care Homes?

Family Care Homes offer numerous benefits as compared with typical assisted living institutions.

• Easier transition to residential setting. Particularly for those with dementia, transitioning into a home environment can significantly lower the anxiety that a move often brings about. A familial setting – where residents enjoy meals together around a dining room table as opposed to in a large cafeteria – continues to bring comfort as residents become accustomed to their new home.
• Semi-private care. Due to high caregiver to resident ratios of 1:6 – and, in some homes, 2:6 – the quality of care that a resident receives is unmatched by a large facility where ratios can be as high as 1 caregiver for every 20 residents.
• Predictability of cost. Many FCH offer their services for a fixed monthly price, which makes financial planning easier for families and caretakers. In many larger facilities charges are based on levels of care – as the amount of care needed increases, so does the price. Given how rapidly health needs can change, some families may find themselves in a financial situation they hadn’t anticipated.

What Should You Look for in a Family Care Home?

Here are just a few considerations to research and inquire about when evaluating a FCH.

• Quality of accommodations varies. FCHs range in quality like any large facility. Higher-end FCHs offer beautiful furnishings, in-home salons with weekly hairdressing services, chef-prepared meals, satellite TV, fully furnished private rooms with en-suite bathrooms and private exits to outdoor spaces. Most importantly, the best homes will have significant built-in safety features –look for a fire alarm and sprinkler system, plenty of grab bars and railings, secure outdoor spaces, slip resistant surfaces, adequate lighting, call buttons, and completely level floors throughout the home.  If you notice while touring that family members come often and stay for long visits, there’s a good chance the residents feel comfortable too.
• Not all homes accommodate non-ambulatory residents. If you want your loved one to age in place, make sure that the FCH is licensed for non-ambulatory residents. If your loved one requires or may someday require a wheelchair or becomes heavily cognitively impaired, he or she may be forced to move if the FCH is not licensed for non-ambulatory residents.
• Quality of staff is of utmost importance. Be sure to inquire about staff turnover – well-compensated and well-treated staff don’t often leave a great workplace. When there’s high turnover, that should raise red flags. If your loved one has dementia, make sure the FCH specializes in memory care, which requires specific staffing levels and experience. Ask about the clinical team – is there a physician and/or nurse who visit the residents in the home and, if so, how frequently? Finally, make sure the staff has heart. Many facilities will hire staff that treat their work purely as a job. The best caregivers exhibit patience and a positive, upbeat attitude; they take the time to meaningfully engage with each resident (rather than caring only for their physical needs) and are genuinely happy to come to work every day.

Family Care Homes offer a unique, intimate setting and a very high level of care at competitive rates. While there are certainly many considerations when evaluating assisted living or memory care options for a loved one, FCHs offer many benefits that cannot be overlooked.