# COMAR Title 07 — Department of Human Services

## Subtitle 02 — Social Services Administration

### Chapter 17 — Adult Foster Care

**Authority:** Human Services Article, §§4-205 and 4-207, Annotated Code of Maryland(Agency Note: Federal Regulatory Reference, 45 CFR Part 229)

**Administrative History:** Effective date: August 8, 1980 (7:16 Md. R. 1594)

**Administrative History:** Recodified from COMAR 07.02.17 to 07.06.16

**Administrative History:** Regulation .02 repealed and new Regulation .02 adopted effective October 15, 2001 (28:20 Md. R. 1780)

**Administrative History:** Regulation .03 amended effective October 15, 2001 (28:20 Md. R. 1780)

**Administrative History:** Regulation .05 amended effective October 15, 2001 (28:20 Md. R. 1780)

**Administrative History:** Chapter recodified from COMAR 07.06.16 to COMAR 07.02.17, effective June, 2009

**Administrative History:** Regulation .03A amended effective April 10, 2017 (44:7 Md. R. 353)

**Administrative History:** Regulation .04 amended effective April 10, 2017 (44:7 Md. R. 353)

**Administrative History:** Regulation .06 amended effective April 10, 2017 (44:7 Md. R. 353)

**Administrative History:** Regulation .07E amended effective April 10, 2017 (44:7 Md. R. 353)

**Administrative History:** Regulation .08B amended effective April 10, 2017 (44:7 Md. R. 353)

#### Regulation .01 Purpose.

*COMAR 07.02.17.01*

These regulations establish standards for adult foster care and procedures for enforcement of those standards. They apply to all adult foster care programs offered by local departments of social services. Adult Foster Care Programs are optional to the local departments.

#### Regulation .02 Definitions.

*COMAR 07.02.17.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Adult Foster Care” means a program that provides a family setting in the community for an aged adult or an adult with disabilities who requires:

    (a) Protective oversight;

    (b) Assistance with the activities of daily living; and

    (c) Room and board.

  (2) “Local department” means the department of social services in a county or Baltimore City or the Montgomery County Department of Health and Human Services.

  (3) “Protective oversight” means a service of the Adult Foster Care provider which includes the following:

    (a) Daily awareness of a foster adult's functioning and whereabouts;

    (b) Crisis intervention;

    (c) Supervision of medication, nutrition, and money management;

    (d) Coordination of medical care services delivered in and out of the foster home; and

    (e) 24-hour responsibility for the foster adult's welfare while in the foster home.

#### Regulation .03 Eligibility for Adult Foster Care.

*COMAR 07.02.17.03*

A. The foster adult shall:

  (1) Be 18 years old or older;

  (2) Be an individual with a disability;

  (3) Be able to benefit from the service;

  (4) Have a need for the support and interaction of family living; and

  (5) Provide a medical and behavioral health history to allow proper care and supervision.

B. The local department may establish financial eligibility based on the foster adult's income or age or other factors if required by the terms of any source of funding for the local department's program.

#### Regulation .04 Local Department Responsibilities to the Foster Adult.

*COMAR 07.02.17.04*

A. Application Process. The local department shall:

  (1) Accept applications from the adult, a relative, or a guardian or other representative;

  (2) Determine the eligibility of applicants;

  (3) Assess the applicant's needs and capacities;

  (4) Decide with the applicant whether the service is appropriate;

  (5) Refer the applicant to a suitable resource if the decision is that foster care is not appropriate; and

  (6) Develop a service plan for each eligible applicant.

B. The Service Plan. The service plan shall specify:

  (1) A suitable placement approval as meeting all requirements of these regulations;

  (2) Any necessary assistance with making the placement;

  (3) Any supportive services needed during the placement; and

  (4) The way in which the provider will be paid.

C. Local Department Continuing Responsibility. The local department shall:

  (1) Maintain continuing contact with the foster adult and caregiver;

  (2) Encourage relatives of the foster adult to participate in the planning and placement;

  (3) Intervene if a crisis arises;

  (4) Review the foster adult's case at least every 6 months and modify the service plan as necessary;

  (5) Maintain a file of eligible applicants needing placement; and

  (6) Maintain a file of available approved adult foster homes.

#### Regulation .05 Requirements for Adult Foster Care Providers.

*COMAR 07.02.17.05*

The adult foster care provider shall:

A. Have adequate income and financial stability to provide a reasonable standard of living for the foster family;

B. Have the skills, knowledge, and ability to provide adequate care for foster adults;

C. Cooperate with the local department in the enforcement of these regulations and any other program requirements;

D. Communicate as needed with the local department, relatives, and community resources concerning the foster adult's condition;

E. Have the maturity, patience, and warmth to respond to the foster adult's emotional needs;

F. Be 21 years old or older;

G. Provide for required supervision and care when the caregiver is absent from the home; and

H. Provide three satisfactory non-relative character references.

#### Regulation .06 Local Department Responsibility to the Provider.

*COMAR 07.02.17.06*

The local department shall:

A. Review applications from those desiring to be considered as adult foster care providers.

B. Review and approve or disapprove all applications within 90 days, after the local department has received all required documentation. If it is determined that there will be a delay in the approval or disapproval of the application, the local department shall advise the applicant, in writing, within 5 working days of the reason for the delay.

C. Conduct a home study if a foster adult is already in the home when an application to be a provider is made. Due consideration is given to the importance of maintaining the home for the adult involved. If the home cannot be approved, the local department shall notify both the foster adult and the caregiver and offer them assistance to meet the standards or inform them of the possible alternatives and of the consequences of continuing in an unapproved home.

D. Conduct an annual review of the foster care home and advise the caregiver in writing of continued approval or disapproval.

E. Offer consultation and supportive services to caregivers.

#### Regulation .07 Standards for Adult Foster Home Approval and Reapproval.

*COMAR 07.02.17.07*

The local department shall require:

A. A written approval from the local health department of the water supply (well) and waste disposal. A home using a municipal water and sewer system may be exempt from this requirement.

B. Documentation that the home meets the requirement, if any, of the local fire marshal.

C. A clean, well maintained and structurally sound home. The local department may consult with a local building inspector if there is question about possible structural defects.

D. Sleeping and living quarters for foster adults which have:

  (1) Appropriate modified access for foster adults whose special physical needs require it (in most cases, foster adults require a first floor and, preferably, a ground level room);

  (2) Adequate opportunity for privacy in sleeping and living quarters for each foster adult;

  (3) Grab rails and other special equipment in accordance with individual needs;

  (4) Storage for clothing and personal possessions, and, if possible, some of the foster adult's own furniture;

  (5) Adequate protection and supervision;

  (6) Accessibility to family living spaces, which the foster adults are expected to share as a part of the family's life style; and

  (7) Adequate household supplies.

E. A limit of four foster adults at a time. The local department shall assess the needs of each foster adult as well as the capacities of the provider and the home before making a placement.

F. That the foster home meet requirements and be approved by the local department before taking an adult in the home.

#### Regulation .08 Enforcement.

*COMAR 07.02.17.08*

A. Upon discovery of a violation of these regulations, the local department shall give the home written notice of the nature of the violation and shall set a time period, not to exceed 90 days, within which the violation is to be corrected.

B. At the end of the period, if the home has failed to correct the violation, the local department shall send to all the foster adults in the home a notice that contains:

  (1) A written description of the violation;

  (2) An offer to aid in relocation to an approved home or other living arrangement;

  (3) A warning that in 60 days the local department will notify the Social Security Administration of the violation and that the Social Security Administration may reduce the amount of the SSI benefits of any foster adult still in the home.

C. If, after the expiration of the 60-day period for relocation of the adults, the violation remains uncorrected, the local department shall notify the Social Security Administration of the violation and of the date the relocation period ended.

D. The local department may not assist in the placement of a foster adult in any home not in full compliance with the standards for Adult Foster Homes approval.

#### Regulation .09 Appeal.

*COMAR 07.02.17.09*

A. Appeals for a fair hearing and the conduct of the hearing are according to the fair hearing regulations in COMAR 07.01.04.

B. The local department shall give written and oral notification of the right and methods of requesting and obtaining a fair hearing to each applicant for, and to each recipient of, adult foster care services at application and whenever the local department notifies the applicant or recipient of any pending action that may deny, suspend, reduce, or terminate this service.