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Adult family home program statement template

Adult Family Home (AFH) Program Statement 2026

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The document outlines the requirements for submitting a program statement for certification and renewal of Adult Family Homes (AFH) in accordance with Medicaid Waiver Standards. It includes sections for detailing the home's characteristics, target groups served, accessibility, respite services, community resources, and activities to engage residents. The document emphasizes the need for approval from the AFH Program Manager for any changes and provides contact information for submission.

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Click ‘Get Form’ to open the Adult Family Home (AFH) Program Statement in the editor.
Begin by filling in the 'Name of Adult Family Home' and 'Address/City/State/Zip' fields. Ensure accuracy as this information is crucial for identification.
In the 'Target Groups(s) Served' section, check all applicable boxes that represent the populations your home will serve, such as Developmental Disability or Elderly.
Indicate the number of individuals your home can accommodate and their gender preferences. Specify if it’s a shared room by selecting 'Yes' or 'No'.
For respite services, indicate your intent and provide details about maximum occupancy, bedroom space, and staff availability.
Describe the accessibility features of your home and select the type of home from the options provided.
List nearby resources like grocery stores or parks that may benefit residents. This helps prospective residents understand community integration.
Complete any additional sections regarding activities, services offered, and household members before signing and dating the form.

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Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (24 Votes)
2017	4.4 Satisfied (23 Votes)

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What is the difference between a nursing home and an adult family home?

AFHs offer a smaller, family-oriented setting for personalized care. Nursing Homes: Best for seniors with advanced health conditions requiring medical supervision.

What is the meaning of adult care home?

Adult care homes are single-family homes with shared living spaces, such as living and dining rooms, kitchens, and bathrooms. They may offer fewer services and amenities than larger assisted living communities. Residents may have their own room or share a bedroom and bathroom.

What are adult family care homes?

In AFC, sometimes called adult foster care or adult family homes, residents live full-time in a house or other small residential setting where they receive assistance with activities of daily living, personal care, and help with medications and other health care tasks, in collaboration with health care professionals.

What is an adult family home in Washington state?

Adult family homes provide living for six or fewer residents and are licensed by the state. They are regular neighborhood homes where staff people assume responsibility for the safety and well-being of the residents. A room, meals, laundry, supervision and varying levels of assistance with care are provided.

What is the definition of an adult family home?

Adult Family Homes are private homes where a few residents (6 or less) rent rooms. The homes have shared common spaces and Veterans might share a bedroom and bathroom with another person. There is a trained caregiver on duty 24 hours a day, seven days a week.

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What is an adult family care home?

Adult Family Homes, a subset of assisted living, are small, personalized senior care environments. Unlike larger senior living communities, AFHs are actual residential homes modified to support the needs of seniors.

Adult Family Home (AFH) Program Statement 2026

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How to use or fill out Adult Family Home (AFH) Program Statement with our platform

See more Adult Family Home (AFH) Program Statement versions

Complete this form in 5 minutes or less

Got questions?

What is the difference between a nursing home and an adult family home?

What is the meaning of adult care home?

What are adult family care homes?

What is an adult family home in Washington state?

What is the definition of an adult family home?

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What is an adult family care home?

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