>> Sreenivasan: THERE ARE ABOUT

12 MILLION AMERICANS WHO DEPEND

ON SOME FORM OF LONG TERM CARE.

THAT CAN RANGE FROM NURSING

HOMES TO ASSISTED LIVING.

AS BABY BOOMERS AGE, THE DEMAND

FOR LONG-TERM CARE IN THE U.S.

IS EXPECTED TO OUTPACE SUPPLY

AND FUNDING WITHIN A DECADE.

THERE IS NO ONE WAY TO MEET THAT

NEED, AND STATES ARE LOOKING AT

A PATCHWORK OF SOLUTIONS.

ONE APPROACH IS ADULT FOSTER

CARE.

SPECIAL CORRESPONDENT JOANNE

ELGART JENNINGS REPORTS FROM

OREGON.

ADULT FOSTER CARES HAVE BEEN

AROUND THERE FOR MORE THAN 40

YEARS IN THE STATE.

THIS STORY IS PART OF OUR

ONGOING SERIES ABOUT POVERTY AND

OPPORTUNITY IN AMERICA: "CHASING

THE DREAM."

>> Reporter: 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.

>> HI MOTHER.

>> HI.

>> HOW ARE YOU DOING?

>> I'M DOING WELL.

>> MOTHER WAS A VERY ACTIVE

PERSON.

SHE WAS ONE OF THOSE KIND OF

PEOPLE JUST GO, GO, GO, GO, GO,

GO, GO.

>> Reporter: BUT AT 99-YEARS-

OLD, MARJORIE LARRENCE IS NOW

PARTLY BLIND.

AND AFTER SUFFERING MANY FALLS,

SHE CAN'T WALK ANYMORE.

>> HOW'S YOUR LEG DOING?

>> IT'S DOING WELL.

>> NO PAIN TODAY?

>> NO.

>> Reporter: 13 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.

>> 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.

>> THERE YOU GO.

>> Reporter: THAT'S BECAUSE

MARJORIE LARRENCE IS LIVING WITH

A FAMILY.

IN THIS CASE, IT'S CARMEL

DURANO'S FAMILY, IN CARMEL

DURANO'S HOME.

>> WHAT WE DO FOR YOU EVERY DAY.

>> Reporter: 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?

>> 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.

>> Reporter: 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.

>> HOW ARE YOU FEELING TODAY?

>> Reporter: FOR THOSE WHO

REQUIRE IN HOME MEDICAL CARE, A

NURSE OR DOCTOR IS CALLED IN.

MEDICAID, MEDICARE, OR PRIVATE

INSURANCE MOST 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.

CARMEL DURANO HAD JUST EMIGRATED

FROM THE PHILIPPINES WHEN SHE

FIRST OPENED HER HOME TO ELDERLY

RESIDENTS 27 YEARS AGO.

>> 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.

>> Reporter: 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.

>> 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.

>> Reporter: 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.

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.

>> 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.

>> Reporter: AND WHY IS THAT

IMPORTANT?

>> 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.

>> Reporter: IN OREGON, ADULT

FOSTER CARE IS REGULATED BY THE

STATE'S DEPARTMENT OF HUMAN

SERVICES OR D.H.S., 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.

>> 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.

>> Reporter: NOT DOING A GOOD

JOB CAN INCLUDE NEGLECT, OR EVEN

ABUSE OF ELDERLY CLIENTS.

ACCORDING TO OREGON'S D.H.S.,

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.

>> HI, HOW ARE YOU?

>> Reporter: 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.

>> 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.

>> Reporter: NEXT, BATISTE-BALL

LOOKS FOR ANY POTENTIAL SAFETY

HAZARDS.

>> I'M JUST GLANCING FOR

EXTENSION CORDS OR NON SURGE

PROTECTED MULTI-PLUG ADAPTORS.

OKAY, YOU LOOK GOOD.

MAKE SURE YOUR TOILET FLUSHES.

YOU HAVE VENTILATION.

>> Reporter: AND FINALLY, SHE

INTERVIEWS RESIDENTS TO SEE IF

THEY HAVE ANY COMPLAINTS.

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.

>> I'M NOT HERE BECAUSE I CHOSE

TO BE HERE.

I'M HERE BECAUSE I WAS PUT HERE.

>> 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.

>> OH NO.

NOTHING LIKE THAT.

>> AND THAT YOU'RE GETTING ALL

YOUR NEEDS MET AND YOU'RE

GETTING FOOD.

YEAH.

YEAH, GOOD.

NO COMPLAINTS AT THIS POINT.

>> Reporter: SOMETIMES, OF

COURSE, THERE ARE ACCUSATIONS OR

INSTANCES OF NEGLECT OR ABUSE.

>> THERE IS TIMES WHEN THERE ARE

REALLY UNSAFE PRACTICES

HAPPENING IN THE HOME AND WE

HAVE TO RESPOND ACCORDINGLY.

>> Reporter: 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."

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.

>> 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.

>> Reporter: IN HER DEFENSE,

DURANO SAID IT WAS THE FIRST

SUCH ACCUSATION IN HER 27 YEARS

OF RUNNING HER FACILITY.

>> NO INSTANCE HAPPENED BEFORE,

YOU KNOW, WE NEVER HAD AN

INCIDENT LIKE THIS BEFORE.

>> Reporter: SHE SAYS MOST

RESIDENTS USE A CALL BUTTON WHEN

THEY NEED HELP.

>> IT'S A LOUD NOISE.

IT WILL MAKE YOU JUMP OUT OF

YOUR BED AND GET DISORIENTED.

IT'S VERY LOUD.

>> Reporter: 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.

>> 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.

>> Reporter: DURANO SAYS THE

INCIDENT WAS A WAKEUP CALL FOR

HER AND THAT HER MOTHER IS NO

LONGER PROVIDING CARE.

>> IT WAS JUST A TEACHING MOMENT

THAT MAYBE WE NEED TO REASSESS

EVERYTHING.

>> Reporter: 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, "ATTENDED TO

QUICKLY."

HE ADDED THAT SHE ALWAYS FEELS

CARED FOR.