Adult Foster Care (AFC): Helping Seniors Stay at Home

Aging brings challenges that can make living alone unsafe. Families often struggle to balance caregiving duties with work, finances, and their loved one’s dignity. For many seniors, the choice seems limited to either staying home without enough support or moving into a nursing facility. Adult Foster Care (AFC) offers another way—a MassHealth-funded program that enables seniors to remain in their own homes or family settings while receiving daily care.

In Boston and across Massachusetts, AFC has become a lifeline for thousands of families. This article explains what AFC is, how it works, and why it matters for seniors who want to age with dignity at home.

Relate page: https://clareseniorcare.com/afc-gafc/

What is Adult Foster Care (AFC)?

Adult Foster Care (AFC) is a MassHealth program designed for adults and seniors who cannot safely live alone because of medical or cognitive conditions. Instead of moving to a nursing home, the senior lives at home with a trained caregiver—this may be a relative, friend, or non-relative who shares the home.

The caregiver provides:

Help with Activities of Daily Living (ADLs) such as bathing, dressing, eating, toileting, and walking
Medication reminders and health monitoring
Meal preparation and homemaking
Companionship and supervision, especially for those with memory issues
Coordination with nurses and case managers from an AFC provider agency

Unlike nursing facilities, AFC allows the senior to remain in a familiar, home-like environment while still receiving professional oversight from nurses and case managers.

Who Qualifies for AFC in Massachusetts?

Eligibility for AFC is determined by MassHealth regulations and clinical assessments. Seniors (and adults 16+) may qualify if they:

Are enrolled in MassHealth Standard or CommonHealth
Have a medical or mental health condition requiring daily assistance with at least one ADL
Live with a caregiver who can provide 24/7 support
Have a physician’s order and a completed MassHealth clinical assessment

Importantly, AFC participants cannot receive duplicative services such as certain home health aide or PCA hours.

AFC Levels of Care: Level I vs. Level II

MassHealth recognizes two levels of care:

AFC Level I:
- Requires hands-on help or cueing with 1–2 ADLs
- Caregiver provides supervision and daily assistance
- Nurse or case manager visits alternate monthly
AFC Level II:
- Requires hands-on help with at least 3 ADLs, or 2 ADLs plus a behavioral condition (e.g., wandering, aggression, resisting care)
- Higher level of caregiver involvement and supervision
- Monthly visits from both nurse and case manager

These levels ensure that care intensity matches the senior’s needs, while caregivers receive a non-taxable stipend from MassHealth to support their work.

Benefits of Adult Foster Care for Seniors

Stay at Home, Not a Facility
Seniors overwhelmingly prefer to age in place. AFC makes this possible by providing the necessary daily care and supervision at home.
Personalized Care
Unlike large facilities, care is tailored to the individual’s needs, cultural background, and daily routines.
Cost-Effective
By preventing emergency room visits and nursing home placements, AFC saves both families and the state significant healthcare costs.
Professional Oversight
Care is not just provided by the caregiver; it’s supported by regular visits from registered nurses and case managers who monitor health, update care plans, and ensure compliance.
Culturally Inclusive
Agencies like Clare Senior Care in Boston provide AFC services in multiple languages, making the program more accessible to diverse communities.

Benefits for Caregivers

Caregivers are the backbone of AFC. To recognize their work, MassHealth provides a monthly stipend—which is tax-free under IRS Notice 2014-7.

Caregivers also receive:

Training on ADLs, safety, and dementia care
Support from nursing staff and case managers
Access to respite programs and caregiver resources
The emotional reward of keeping a loved one at home

How AFC Helps Seniors Avoid Nursing Homes

One of the biggest fears among seniors is losing independence and being forced into institutional care. AFC addresses this by:

Offering round-the-clock support in a home environment
Providing safety supervision for seniors with memory impairments (e.g., preventing unsafe clothing choices or falls in the bathroom)
Ensuring continuity of care with personalized care plans, updated regularly by nurses and case managers

By reducing loneliness, falls, and hospitalizations, AFC helps seniors live longer, healthier, and happier lives at home.

The AFC Enrollment Process

Enrolling in AFC typically involves five steps:

Intake & Eligibility Check
Review MassHealth coverage, confirm ADL needs, collect identification.
Nursing Intake & Assessment
A nurse performs a full assessment of health status, mobility, and ADL support needs.
Physician’s Order & Prior Authorization
The doctor signs off on the need for AFC, and MassHealth approves services.
Caregiver Training & Approval
Caregiver completes required training and background checks.
Start of Services
Monthly visits from nurses and case managers begin, and caregivers start receiving stipends.

AFC vs. Group Adult Foster Care (GAFC)

It’s common to hear AFC and GAFC mentioned together, but they differ:

AFC: Senior lives in a private home with a caregiver.
GAFC: Senior lives in GAFC-approved housing (such as assisted living or subsidized senior housing) with staff support.

Both programs are MassHealth-funded and aim to prevent unnecessary nursing home placement.

Why AFC Matters for Families in Boston and Massachusetts

Boston’s diverse senior population faces rising healthcare costs and limited long-term care options. AFC stands out because it:

Keeps seniors in familiar neighborhoods close to family and cultural communities
Reduces pressure on the state’s nursing facilities
Offers financial relief for family caregivers
Strengthens the caregiving workforce with training and stipends

For families in Massachusetts, AFC is not just a program—it’s a pathway to preserving dignity, safety, and independence at home.

Final Thoughts

Adult Foster Care (AFC) provides a compassionate, cost-effective alternative to nursing homes. Backed by MassHealth, it supports seniors with daily needs, empowers caregivers with training and stipends, and ensures professional oversight through nurse and case manager visits.

In Boston and across Massachusetts, AFC is helping thousands of families answer the question: How can we keep our loved ones safe at home? The answer is clear—with AFC, home is possible.

👉 Ready to learn more? Book a consultation with Clare Senior Care or contact us today to check your eligibility and start the enrollment process.