Standards for public agencies

2020 Edition

Adult Foster Care (PA-AFC) 2: Personnel

Personnel have the competency and support needed to provide services and meet the needs of persons served.
2020 Edition

Currently viewing: ADULT FOSTER CARE (PA-AFC)



 Adult Foster Care (PA-AFC) programs support community-based living arrangements for adults in need of long term-services and supports, matching them with in-home caregivers.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures or other documentation relevant to continuity of care and case assignment
  • Table of contents of training curricula
  • Documentation tracking staff completion of required trainings and/or competencies
  • Sample job descriptions from across relevant job categories
  • Training curricula
  • Caseload size requirements set by policy, regulation, or contract, when applicable
  • Documentation of current caseload size per worker
  • Interviews may include:
    1. Program director
    2. Relevant personnel
  • Review personnel files


PA-AFC 2.01

Care managers are qualified by: 
  1. a bachelor’s degree in a human service field and experience in direct services;
  2. an associate’s degree in a human service field and two years’ experience in direct services; or
  3. five years experience in direct services.


PA-AFC 2.02

Supervisors or program managers are qualified by: 
  1. an advanced degree in social work or a comparable human service field and a minimum of two years’ experience in direct services;
  2. a bachelor’s degree in a human service field and five years’ experience in direct services; and/or
  3. licensure as a registered nurse and a minimum of two years’ experience in direct services.

Fundamental Practice

PA-AFC 2.03

There is adequate nursing staff, including licensed registered nurses, to meet the needs of the service population.


What constitutes adequate nursing differs from state to state based on the ability to delegate nursing tasks. For states that don’t allow delegation of duties, there will be a higher need for nursing staff. Nursing staff do not necessarily live within the home, but are able to meet with the family with the needed frequency.
NA Responsibilities related to nursing staff are provided by another service provider or agency as documented in policy and/or through contract.


PA-AFC 2.04

Direct service staff are trained on, or demonstrate competency in the following: 
  1. special needs related to working with the identified service population;
  2. signs of abuse or neglect;
  3. advance directives;
  4. coordinating services as part of a team;
  5. disaster relief resources, planning, and procedures.
Examples: In regards to element (a), examples of special needs may include, but are not limited to, individuals with disabilities, Alzheimer’s disease, behavioural health conditions, cognitive impairment, and older adults. These populations are susceptible to suicidal ideation which is often missed due to what is considered to be atypical presentation, therefore training related to people with special needs should include how to recognize symptoms of depression


PA-AFC 2.05

A supervisor or care manager is available to provide support 24/7.


PA-AFC 2.06

The agency minimizes the number of workers assigned to the individual over the course of their contact with the agency by:
  1. assigning a worker at intake or early in the contact; and
  2. avoiding the arbitrary or indiscriminate reassignment of direct service personnel.

Fundamental Practice

PA-AFC 2.07

Case load sizes are sufficiently small to support the achievement of client outcomes and allow for: 
  1. a flexible response when problems arise in a placement;
  2. a schedule of regular contact, including in-person visits; and
  3. responsiveness to the differing needs of individuals and caregivers.
Examples: Examples of factors that may be considered when determining employee workloads include, but are not limited to:
  1. the qualifications, competencies, and experience of the worker, including the level of supervision needed;
  2. the work and time required to accomplish assigned tasks and job responsibilities; and
  3. service volume, accounting for assessed level of needs of persons served.