Multnomah County Adult Care Homes: Significant efforts made to ensure vital services can continue safely during the pandemic with areas for improvement noted

Adult Care Homes (ACHs) are licensed, single family residences that offer care for up to five adult residents in a homelike setting. The homes are in residential neighborhoods. Each home has one operator who may employ additional caregivers. All homes are licensed annually and monitored quarterly via unannounced home visits by Multnomah County’s Aging and Disability Services’ Adult Care Home Program (ACH Program). The ACH Program enforces the Multnomah County Administrative Rules that govern the licensing and operations of the approximately 620 licensed adult care homes in Multnomah County, Oregon.

Included in the ACH Program’s responsibilities is ensuring that residents are cared for in a homelike atmosphere that is safe and secure and to enforce the county administrative rules in order to protect the health, safety, and welfare of ACH residents.

ACH operators have the overall responsibility for the provision of residential care and must meet the standards outlined in the administrative rules.  Some homes have a resident manager; this is a person approved by the ACH Program and employed by the home operator, who lives in the home, is responsible for daily operations of the home and care given to residents on a 24-hour basis, and must comply with the ACH Program rules.  Many homes also have caregivers.  A caregiver is any person employed by the operator to provide residential care and services to residents.  For some homes, an operator and caregiver may be the same person, and some homes may support a relative as the resident in the care home setting.

Adult care homes, like other congregate care living facilities, are vulnerable to COVID-19 spread as many of the residents are older, and many have underlying health conditions, placing them at higher risk for severe consequences from COVID-19.

To help us gain an understanding of the ACH Program’s processes in place to monitor ACHs during the pandemic, we interviewed ACH Program management and staff.  We also reviewed supporting documentation of their monitoring efforts. We found that the program had pivoted quickly to remote working conditions for the ACH Program licensers and support staff.  At the time of our audit, the ACH Program performed monitoring activities remotely through email, telephone, and video conferencing.  However, to help ensure homes addressed health and safety concerns, the ACH Program still performed some in-person activities during this time.  Overall, the ACH Program management and staff indicated they felt the shift to working remotely was done safely and in a way that supported them and the ACH residents. 

Why We Conducted an Adult Care Home Survey

We conducted a survey of the ACHs to help substantiate the ACH Program’s efforts and assess ACH compliance with federal, state, and local guidelines and recommendations related to the pandemic.

Our findings are intended to provide community members, county management, and the Board of County Commissioners with information to help understand efforts made to ensure vital services, such as adult care homes, can continue safely during the pandemic. 

Results of the Adult Care Homes Survey

In September 2020, the Auditor’s Office conducted a survey of all ACH operators, resident managers, and caregivers the ACH Program monitors and for which the ACH Program had a valid email address as of August 19, 2020. We collected responses for several weeks and ensured respondents’ anonymity by not collecting identifying information.

Thank you participants

We asked respondents to identify their role with the ACH (operator, resident manager, and/or caregiver).  The response rate was highest among operators (34%) and resident managers (32%), with caregivers providing a lower response rate (8%).  A respondent could select more than one option since some persons may fill more than one role in a home.

We analyzed results by provider type (e.g., caregiver only vs operator/resident manager/combination) and by number of residents in a home (e.g., one resident vs more than one resident) and found little to no significant variation in results, in most cases.  Most results are presented based on all responses provided unless specifically identified. Please see the appendix for a copy of the survey.

We provided an opportunity for comments, which were wide-ranging

We ended the survey with an optional comment box for respondents to share any additional concerns or comments about their experience during the pandemic. About 20%, or 73 of the people who took the survey, chose to comment.  We categorized each comment as positive, neutral, and/or negative. Overall, respondents who provided comments were more likely to leave neutral (38) or negative (30) comments than positive ones (5). Negative comments were a combination of specific issues and/or responding more generally to the pandemic situation itself.

We have incorporated some selected comments in the report to highlight findings and provide insights into respondents’ perceptions. In some cases, comments helped explain why people answered the way they did. We edited responses for clarity and to remove identifying references.

Read the Adult Care Home Survey results:  Adult Care Homes Employee Survey Report (336.67 KB)