Adult Family Care and Foster Care for Dementia in Vermont

What Adult Family Care Looks Like in Vermont

An adult family care home is a private residence where a trained caregiver provides 24-hour supervision, meals, personal care, and companionship to a small number of adults — typically one to three residents. Unlike large assisted living communities or nursing homes, the setting is a regular home in a regular neighborhood. For someone with dementia, the smaller scale, consistent caregivers, and home-like environment can reduce the agitation and confusion that often accompany transitions to institutional settings.

Vermont's Choices for Care (CFC) Medicaid waiver explicitly includes adult family care homes as an approved setting for Home and Community-Based Services (HCBS). This means a parent who qualifies for CFC at the High or Highest Need level can receive Medicaid-funded care in an adult family care home rather than a nursing facility or assisted living community.

How Coverage Works

When Medicaid covers adult family care through the Choices for Care waiver, it funds the clinical and personal care services — similar to the Enhanced Residential Care (ERC) model used in larger facilities. The family care provider receives a daily rate from Medicaid to cover caregiving services, while room and board costs are handled separately.

The resident contributes their monthly income toward care costs (minus a Personal Needs Allowance of $79.93 per month). If the resident has a spouse living in the community, the standard spousal impoverishment protections apply — the Community Spouse Resource Allowance of up to $162,660 and the Minimum Monthly Maintenance Needs Allowance of $2,707.

For families who can't afford $8,595+ per month for assisted living or $15,528 for a private nursing home room, adult family care with Medicaid coverage can be the most affordable full-time care option.

Finding and Evaluating Adult Family Care Providers

Adult family care providers in Vermont operate under the oversight of DAIL and the Area Agencies on Aging. To find approved providers:

1. Contact your regional AAA (HelpLine: 1-800-642-5119) and ask for a list of certified adult family care providers in your area
2. Request background information — providers must meet training requirements and pass background checks
3. Visit the home — evaluate the physical environment, meet the caregiver, and ask about their experience with dementia

Questions to ask during a visit:

• How many residents do you currently serve? Smaller ratios mean more individualized attention.
• What's your experience with dementia specifically? Memory care behaviors (wandering, agitation, sundowning) require different skills than physical disability care.
• What does a typical day look like? Structure and routine help reduce anxiety for people with dementia.
• What happens when you need time off? Backup caregiver arrangements matter for continuity.
• Is the home secured against wandering? Door alarms, locks, and fenced outdoor areas are essential for someone with exit-seeking behavior.
• Do you accept Choices for Care Medicaid? Not all providers participate in the Medicaid program.

When Adult Family Care Fits — and When It Doesn't

Adult family care tends to work best for people with mild to moderate dementia who benefit from a calm, predictable environment with consistent caregivers. The home setting avoids the overstimulation of large facilities, and the caregiver-to-resident ratio is typically much higher than in institutional settings.

It may not be the right fit if your parent:

• Has advanced dementia with severe behavioral symptoms requiring specialized SCU-level intervention
• Needs skilled nursing care (wound management, IV medications, ventilator support) beyond what a family caregiver can provide
• Has a history of physical aggression that could endanger the caregiver or other residents

If your parent's needs are currently moderate but likely to progress, ask about the provider's approach to transitions. Some family care providers can accommodate increasing needs up to a point; others have clear limitations on the level of care they can provide. Knowing that threshold upfront prevents a crisis-driven transfer later.

The Vermont Dementia & Memory Care Guide covers adult family care alongside every other care setting option, including how to compare costs and coverage across nursing homes, assisted living, ERC, and home-based care.

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