Standards for public agencies

2020 Edition

Adult Foster Care (PA-AFC) 7: Caregiver Training and Support

Caregivers receive training and support to strengthen their capacity to care for individuals and support their needs.
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
  • Table of contents of training curricula for caregivers
  • Procedures for responding to emergencies
  • Procedures for developing respite plans
  • Training curricula
  • Training attendance records
  • Materials that specify pre- and in-service training requirements
  • Materials provided to caregivers describing their rights
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Caregivers
  • Review caregiver records

Fundamental Practice

PA-AFC 7.01

Caregivers receive pre-service training that addresses: 
  1. specific duties of caregivers;
  2. identification and reporting of abuse and neglect;
  3. documentation and reporting requirements;
  4. reimbursement of services;
  5. creating a safe environment, responsive to the individual’s trauma and mitigating trauma-related stress responses;
  6. preventing allegations of maltreatment and procedures when allegations are made;
  7. complaint procedures;
  8. community resources, including public transportation; and
  9. circumstances that will result in the revocation of a caregiver’s license, certification, or approval.
Examples: Regarding element (e), an environment that mitigates trauma takes an individualized approach. For example, if an individual’s trauma triggers stress responses to loud, sudden noises then ensuring the individual is in a room not directly off areas of high traffic (such as the living room or kitchen) can help mitigate those responses.

Fundamental Practice

PA-AFC 7.02

Caregivers are trained or certified, as appropriate, in: 
  1. basic first aid and CPR;
  2. medication administration, as appropriate;
  3. safe lifts;
  4. the agency's policies on restrictive interventions and behavior support and management; 
  5. medical or rehabilitative interventions; and 
  6. operation of medical equipment when required for an individual’s care.


Medication administration training pertains only to the medicines that are relevant for the service recipients in that household and includes dosage, frequency, side effects, and likelihood and signs of abuse, as well as any other relevant information. If another service provider is responsible for overseeing the individual’s medications, then the agency has procedures in place for ensuring the caregivers receive this information.

PA-AFC 7.03

Caregivers develop or use the agency's procedures for responding to emergencies, including accidents, serious illness, fire, and natural and human-caused disaster.


This includes appointing alternative caregivers, if need be.

PA-AFC 7.04

The agency offers or refers caregivers to: 
  1. psychoeducation;
  2. emotional support;
  3. community services;
  4. self-help referrals; and
  5. care coordination resources, as needed.

PA-AFC 7.05

The care manager works with the caregiver to develop respite plans, which includes identifying backup caregivers, for planned breaks or to tend to unplanned emergencies.