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In Oregon, adult foster care offers support for the elderly

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In a bid to meet the demand for long-term care in the U.S., which is expected to grow in the coming years, some states are turning to adult foster care to offer aging adults physical assistance and emotional support. NewsHour Weekend Special Correspondent Joanne Elgart Jennings reports from Oregon, where adult foster care has existed for more than 40 years, as part of an ongoing series of reports called “Chasing the Dream,” which reports on poverty and opportunity in America.

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  • JOANNE ELGART JENNINGS:

    When Steve Larrence wants to visit his elderly mother, it's a short walk to her care facility. It looks like most of the other homes in this suburban Portland neighborhood.

  • STEVE LARRANCE:

    Hi mother.

  • MARJORIE LARRANCE:

    Hi.

  • STEVE LARRANCE:

    How are you doing?

  • MARJORIE LARRANCE:

    I'm doing well.

  • STEVE LARRANCE:

    Mother was a very active person. She was one of those kind of people just go, go, go, go, go, go, go.

  • JOANNE ELGART JENNINGS:

    But at ninety-nine-years-old, Marjorie Larrence is now partly blind. And after suffering many falls, she can't walk anymore.

  • STEVE LARRANCE:

    How's your leg doing?

  • MARJORIE LARRANCE:

    It's doing well.

  • STEVE LARRANCE:

    No pain today?

  • MARJORIE LARRANCE:

    No.

  • JOANNE ELGART JENNINGS:

    Thirteen years ago, when Larrence realized his mother could no longer live on her own, he didn't want to put her in a large nursing home.

  • STEVE LARRANCE:

    I wanted adult foster care because I'd seen the advantages of the individual care you get here and having your own room. You don't feel like you're in an institution, you feel like you're living with a family.

  • JOANNE ELGART JENNINGS:

    That's because Marjorie Larrence is living with a family. In this case, it's Carmel Durano's family, in Carmel Durano's home.

  • JOANNE ELGART JENNINGS:

    I think a lot of people hear the word foster care, they think of kids being taken from their families and placed in homes. What does it mean in this context?

  • CARMEL DURANO:

    The residents are placed in your home or they choose your home to live like a normal, you know, it's like a normal home. I think you foster a home-like atmosphere for them, compared to living in assisted living or a nursing home.

  • JOANNE ELGART JENNINGS:

    Five elderly residents live in this adult foster home. That's the maximum allowed under Oregon law. As with traditional nursing homes, residents here receive 24-hour care and can access a range of services from prepared meals to assistance with hygiene to physical and emotional support. For those who require in home medical care, a nurse or doctor is called in. Medicaid, Medicare, or private insurance often covers the expense. The cost of adult foster care ranges from about $3,500 to $5,000 a month. Again, those on Medicaid are covered. In any case, it's about half the average cost of a bed in a nursing home in Oregon.

  • JOANNE ELGART JENNINGS:

    Carmel Durano had just emigrated from the Phillipines when she first opened her home to elderly residents twenty-seven years ago.

  • CARMEL DURANO:

    In the Philippines, our grandparents are always around us. It seems like the grandchildren's lives can center around the grandparents who were expected to love them and respect them.

  • JOANNE ELGART JENNINGS:

    It was a natural fit for Durano. She was able to raise her children and run a business caring for elderly people, all under the same roof.

  • CARMEL DURANO:

    I had three small boys then and I figured, you know, instead of working outside I can do the elderlies and my own family at the same time.

  • JOANNE ELGART JENNINGS:

    Durano's sister, who runs another adult care home in the neighborhood frequently visits. And their 78-year-old-mother lives here too. Durano's kids have since graduated college. But she will allow employees to bring their children to work on occasion.

  • JOANNE ELGART JENNINGS:

    Paula Carder, a researcher at Portland State University's Institute on Aging, has been studying Oregon's adult foster care system for three years. She's impressed with the quality of care that's delivered at a cost lower than other elder care settings.

  • PAULA CARDER:

    The folks who live in adult foster homes in many ways look more like people living in what we call memory care units.They're caring for people who have similar kinds of needs in terms of assistance with eating, assistance with using the bathroom, mobility, and staying in the residences until they die.

  • JOANNE ELGART JENNINGS:

    And why is that important?

  • PAULA CARDER:

    That's important to me because sometimes people worry that adult care homes can't provide a high level of care to people with multiple chronic illnesses and disability and dementia and the evidence shows that they can, and they do, and they charge much less.

  • JOANNE ELGART JENNINGS:

    In Oregon, adult foster care is regulated by the state's Department of Human Services or DHS, the same agency that regulates other elder care facilities like assisted living. Licensees must meet several requirements including living on site or providing a qualified resident manager, passing a background check, having a home that meets structural and safety requirements, completing a training course, passing an exam, and being recertified each year. Carder says regulation is key to adult foster care as it is with all elderly care.

  • PAULA CARDER:

    And it sets up an expectation and professionalization of the operators when you license and regulate it. It gives consumers and their families, you know, a peace of mind to know that it's being overseen. It allows the state to provide technical assistance and if needed, sanctions against adult foster care operators who are not doing a good job.

  • JOANNE ELGART JENNINGS:

    Not doing a good job can include neglect, or even abuse of elderly clients. According to Oregon's DHS, every year there are about 1,000 cases of elder abuse in all long-term settings. And the agency says the rate of abuse hovers at about 3% for all care facilities including adult foster homes. Inspectors normally drop in unannounced at least once a year.

  • KENDAHL BATISTE-BALL:

    Hi. How are you?

  • JOANNE ELGART JENNINGS:

    This particular inspection at another adult foster home was announced in advance so we could get permission to film. Inspector Kendahl Batiste-Ball starts with a review of paperwork, and an audit of medications.

  • KENDAHL BATISTE-BALL:

    The medication audit usually comes first because we really want to make sure that meds are safe and being administered as prescribed, that there's doctor's orders in place, and that all the medications are in hand.

  • JOANNE ELGART JENNINGS:

    Next, Batiste-Ball looks for any potential safety hazards.

  • KENDAHL BATISTE-BALL:

    I'm just glancing for extension cords or non surge protected multi-plug adaptors. Looks good. Make sure your toilet flushes. You have ventilation.

  • JOANNE ELGART JENNINGS:

    And finally, she interviews residents to see if they have any complaints.

  • JOANNE ELGART JENNINGS:

    Pat, who just gave us her first name, can't remember how many years she's lived here, but she says it's been a few.

  • PAT:

    I'm not here because I chose to be here. I'm here because I was put here.

  • KENDAHL BATISTE-BALL:

    I am sorry that's your situation, but for what it is, this isn't a bad situation. I just want to make sure you're not being abused.

  • PAT:

    Oh no. Nothing like that.

  • KENDAHL BATISTE-BALL:

    And that you're getting all your needs met and you're getting food. Yeah. yeah, good. No complaints at this point.

  • JOANNE ELGART JENNINGS:

    Sometimes, of course, there are accusations or instances of neglect or abuse.

  • KENDAHL BATISTE-BALL:

    There is times when there are really unsafe practices happening in the home and we have to respond accordingly.

  • JOANNE ELGART JENNINGS:

    If an inspector were to come across one, she would refer it to a State or County Investigator, depending on where it occurred. By chance, several weeks after we visited Carmel Durano's adult foster home, one of her residents alleged being left lying on the floor after a fall and filed a complaint. Following a three-month-long investigation, Oregon's Department of Human Services determined that Durano's facility "failed to follow the resident's care plan, which is considered neglect of care and constitutes abuse."

  • JOANNE ELGART JENNINGS:

    Fred Steele is Oregon's Ombudsman for Long Term Care. His job is to be a watchdog and independent advocate for all elder care residents, regardless of facility.

  • FRED STEELE:

    Proper care planning is a fairly simple thing for residents and that something simple as recognizing the assistance that that resident needed and that assistance just simply not being provided and what I read as almost an indifference by that caregiver that was supposed to be available.

  • JOANNE ELGART JENNINGS:

    In her defense, Durano said it was the first such accusation in her 27 years of running her facility.

  • CARMEL DURANO:

    No instance happened before, you know, we never had an incident like this before.

  • JOANNE ELGART JENNINGS:

    She says most residents use a call button when they need help.

  • CARMEL DURANO:

    It's a loud noise. It will make you jump out of your bed and get disoriented. It's very loud.

  • JOANNE ELGART JENNINGS:

    The day of the incident, Durano left her mother who had been working with her for 27 years in charge of the residents while she went out. Her mother says she didn't hear a call button or cries for help.

  • CARMEL DURANO:

    During the investigation they told us that she can't be left alone anymore because she's older. She's 78 already, but she was a home health caregiver.

  • JOANNE ELGART JENNINGS:

    Durano says the incident was a wakeup call for her and that her mother is no longer providing care.

  • CARMEL DURANO:

    It was just a teaching moment that maybe we need to reassess everything.

  • JOANNE ELGART JENNINGS:

    Under new leadership, Oregon's Department of Human Services has beefed up enforcement over the past five years. Adult foster homes with repeated licensing violations have been forced to close at a higher rate than previously and at a higher rate than other care facilities. As for Steve Larrance, when his mom Marjorie turns 100 in September, she'll have spent 14 years in Carmel Durano's care. I asked him if he was concerned about the abuse charge. Larrance said he still has full faith. He said there were many times his mother needed urgent assistance in the middle of the night and she was, quote, "attended to quickly." He added that she always feels cared for.

Editor’s Note: Chasing the Dream: Poverty and Opportunity in America is a multi-platform public media initiative that provides a deeper understanding of the impact of poverty on American society. Major funding for this initiative is provided by The JPB Foundation. Additional funding is provided by Ford Foundation.

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