Legislative Analysis
Phone: (517) 373-8080
ADULT FOSTER CARE FACILITIES
http://www.house.mi.gov/hfa
House Bill 4841 as introduced Analysis available at
Sponsor: Rep. Stephanie A. Young http://www.legislature.mi.gov
Committee: Families, Children and Seniors
Revised 9-28-23
SUMMARY:
House Bill 4841 would amend the Adult Foster Care Facility Licensing Act to provide new
requirements and procedures for adult foster care facilities and for the Department of Licensing
and Regulatory Affairs (LARA) in regulating those facilities.
Public information
The bill would require LARA to provide the following information concerning adult foster
care facilities to the public, in compliance with the Freedom of Information Act (FOIA), and
to post it online as part of the adult foster care facility search tool:
• Facility ownership information, including the owner’s name, address, and phone
number.
• Whether the facility is profit or nonprofit.
• The facility’s name, address, and telephone number, and the administrator’s name.
• The staff-to-resident ratio in the facility.
• The total number of beds in the facility.
• A list of services and specialty services provided by the facility.
• The number of current violations of specific rules promulgated under the act for which
the facility has been cited.
• A link to a detailed report of the facility’s violations or a special investigation report
regarding the facility.
• The education requirements of facility staff.
• Certifications required of staff members.
• The number of complaints filed against the facility.
• The number of violations that have been committed three or more times.
License renewals
The act currently requires LARA to investigate the activities and standards of care of an
applicant for license issuance or renewal, including an on-site evaluation of the facility. The
bill would require LARA staff conducting a license renewal inspection to include a registered
nurse licensed or authorized under the Public Health Code, a dietitian, and a social worker
licensed under the Public Health Code.
In addition to existing license renewal requirements, the bill would require LARA to consider
the following when a licensee applies for renewal:
• The licensee’s training plan for direct care staff and direct care staff’s completion of
that training and of mandated continuing education core classes and yearly competency
tests as described below.
• The successful completion of annual training and educational assessments by each of
the direct care staff.
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 • The posting in a conspicuous area of the contact information for all agencies that
investigate complaints regarding an adult foster care facility and contact information
for Adult Protective Services.
• The number of new and repeated violations since the last license renewal.
• Civil penalties and any late fines assessed by LARA unpaid at the time of renewal.
• Any incomplete corrective action plan past the completion date. If there is one, the
license could be renewed for a three-month period, when the corrective action plan
would have to be completed for the license to be renewed (if still incomplete after the
three months, the license would not be renewed).
• Resident satisfaction survey results from residents, residents’ family, or a resident’s
designee.
• Interviews with residents and family councils if applicable.
• Staff satisfaction surveys.
LARA could “waive certain requirements” (unspecified in the bill) for the owner or licensee
of one adult foster care group home or family home if LARA determines that those
requirements would cause the facility financial hardship. (It is unclear whether the ownership
requirement means “only one” or “at least one.”)
The bill would also newly allow LARA to refuse to issue or renew a license if it determines
that the applicant has a relationship with a person whose license was not renewed due to not
meeting the above requirements.
Complaint procedure
The bill would require LARA’s complaint process to include all of the following:
• A clear and concise overview of the complaint process, including how to file a
complaint, the steps in the process, and information on how the complainant will be
kept informed at each step.
• Escalation procedures if the complainant is not satisfied at any step of the process.
• The ability for a complainant to participate and give verbal input for each step of the
process, including the administrative review process.
• A complainant satisfaction survey at the completion or closure of a complaint or
investigation, including the administrative review process.
• The appeals process for a complainant who is not satisfied with the outcome of an
investigation.
Licensee disclosure and complaint process requirements
A licensee would have to identify the facility as an adult foster care facility in all legal and
marketing documents. In addition, before a resident is admitted to an adult foster care facility,
the licensee would have to inform the resident or the resident’s designee of all of the following,
verbally and in a written copy signed by both the licensee and the resident or resident’s
designee:
• The facility’s designation as an adult foster care facility governed by the Adult Foster
Care Facility Licensing Act and its rules.
• The resident’s rights and the right to file a complaint without intimidation, retaliation,
or threat of retaliation.
• The facility’s complaint policy, process, and contact information.
• Website information for the following entities:
o The facility’s internal complaint department.
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 o The local long-term care ombudsman.
o LARA’s Bureau of Community and Health Systems.
o The local law enforcement agency.
• All violations currently pending and cited against the facility.
• The licensee’s medication administration policy and standards.
• The staff-to-resident ratio.
• Information regarding staff training, education, and certification.
Resident would include a vulnerable adult.
Resident designee would mean the person designated by the resident in writing or by
a court order with legal authority to act on the resident’s behalf. (The bill defines the
term resident designee, but uses the term resident’s designee.)
Vulnerable adult would mean one or more of the following:
• An individual 18 years of age or older who, because of age, developmental
disability, mental illness, or physical disability, requires supervision or personal
care or lacks the personal and social skills required to live independently.
• A person 18 years of age or older who is unable to protect himself or herself
from abuse, neglect, or exploitation because of a mental or physical impairment
or advanced age and who is suspected of being abused, neglected, or exploited.1
• A child who is placed in an adult foster care family home or an adult foster care
small group home under the child care licensing act, 1973 PA 116.
Each adult foster care facility would have to establish and maintain a structured and
documented internal complaint policy and process that includes all of the following:
• Designating a staff person who is responsible for receiving complaints and determining
resolution of complaints.
• Investigating and resolving complaints. The facility would have to respond in writing
to a complainant within seven business days after receiving the complaint.
• Maintaining a log of all complaints and resolutions of complaints, which would have
to be made available to LARA when it reviews the facility’s next licensing renewal.
Staffing requirements
An adult foster care facility would have to meet all of the following staffing requirements:
• The facility administrator would have to be competent in the following areas:
o Knowledge of the physical, emotional, and mental health needs of the facility’s
residents being housed and cared for.
o Knowledge of residents’ rights.
o Development of training and education courses for direct care staff in order for
them to understand the physical, emotional, mental, and social needs of the
residents they are hired to serve.
• The facility would have to maintain a licensed practical nurse on duty on the premises
24 hours per day, five days per week.
• The facility would have to maintain a staff member on duty on the premises 24 hours
per day, seven days per week who holds a valid certification in cardiopulmonary
1
For the definitions of “abuse,” “neglect,” and “exploitation” that pertain to this provision, see MCL 400.11:
https://www.legislature.mi.gov/documents/mcl/pdf/mcl-400-11.pdf
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 resuscitation issued by the American Heart Association, American Red Cross, or a
similar nationally recognized association.
• The facility would have to maintain a social worker who is licensed, registered, or
otherwise authorized under the Public Health Code, with a minimum availability for
one hour per week for each resident.
Licensed practical nurse would mean an individual who is licensed or otherwise
authorized to engage in the practice of nursing as a licensed practical nurse under part
172 of the Public Health Code.
Except for a registered nurse, only a staff member who has successfully completed a diabetic
continuing education course approved by LARA could administer an insulin injection.
Resident rights
In addition to rights, benefits, and privileges guaranteed under law, a resident would have the
rights described below unless otherwise restricted by law:
• A resident or resident’s designee would have the right to request meals be delivered to
the resident’s room. A resident could not be forced to accept or eat a meal in a dining
room.
• A resident or resident’s designee would have to be given 60 days’ notice before a new
rule or update to a rule takes effect.
• A resident could not be deprived of their rights under this act. A waiver of a resident’s
rights would be void and unenforceable. A resident’s rights could not be used as a
reward or sanction.
• An adult foster care facility would have to ensure that a resident’s physical, emotional,
and mental health needs are met and that the resident is protected from neglect and
abuse, including physical abuse, mental abuse, verbal abuse, and sexual abuse.
• An adult foster care facility must ensure that a resident’s rights are protected.
• An adult foster care facility would have to ensure that a resident is treated with dignity
and respect.
Neglect would mean failure to provide goods and services to a resident that are
necessary to avoid physical harm, pain, mental anguish, mental stress, or emotional
distress.
Abuse would mean willfully inflicting injury, unreasonable confinement, intimidation,
or punishment with resulting physical harm, pain, or mental anguish, and would
include mental abuse, physical abuse, sexual abuse, and verbal abuse.
Physical abuse would mean a willful act directed at a resident that is likely to result in
injury or pain, including such things as slapping, pinching, kicking, shoving, corporal
punishment, rough handling during caregiving or when moving a resident, isolating a
resident from visitors or other residents, and abandonment.
Mental abuse would mean a willful act directed at a resident that is likely to result in
mental distress or mental anguish, including such things as humiliation, harassment,
threat of punishment, or threat of deprivation.
Verbal abuse would mean using oral, written, or gestured language that willfully
includes disparaging or derogatory terms to residents or their families, or that is used
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 or uttered within hearing distance of residents or their families, regardless of their age,
ability to comprehend, or disability.
Sexual abuse would mean sexually oriented behavior directed at a resident by a staff
member, sexually oriented behavior between residents that is not fully and freely
consented to by both residents involved or when either or both are incapable of
consenting to the behavior, or any sexually oriented behavior by a visitor directed at a
resident incapable of consenting to the behavior.
A resident or resident’s designee would have to be provided with a written copy of their rights
and of the complaint process. The documents would have to be signed by both the resident or
resident’s designee and an individual representing the adult foster care facility.
A licensee would have to conspicuously post the following in an area of the adult foster care
facility accessible to residents, employees, and visitors:
• The resident’s rights.
• The adult foster care facility’s internal complaint process
• The contact information and website information for the following:
o The facility’s internal complaint department.
o The local long-term care ombudsman.
o LARA’s Bureau of Community and Health Systems.
o The local law enforcement agency.
A licensee would have to accept and respond to an oral or written complaint from any source
regarding an alleged violation of a resident’s rights, quality of care, or any other matter, without
retaliation or threat of retaliation.
A licensee would have to conspicuously post on the premises contact information for all
agencies that investigate complaints regarding an adult foster care facility and contact
information for Adult Protective Services.
The bill would not affect any right of a resident to damages under any other law.
Continuing education
In addition to in-service training or on-the-job training, a direct care staff member who is not
a certified nurse assistant would have to be educated to understand the physical and emotional
needs of the population the staff member is hired to serve by completing the following
continuing education core classes within 90 days after the date of hire:
• Empathy and simulation of the aging process, which would have to provide staff
members with the experience of sensory challenges related to aging and the emotional
challenges that come with the loss of independence, home, and relationships with
family and friends.
• Dignity and sensitivity, which would have to include basic techniques for effectively
and compassionately communicating with the elderly, including those experiencing
hearing loss, dementia, or other issues that impair communication for the population
being served, and how to handle and defuse difficult situations in a respectful manner.
• Death and dying, which would have to provide basic understanding of end-of-life
issues and the impact on the resident, including appropriate behavior and
communication with the resident and resident’s family.
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 • Resident rights, which would have to instruct staff members on all rights granted to the
resident.
• Basic medication training for staff assisting with self-administration, which would
have to be provided by a registered nurse to an unlicensed direct care worker employed
by the adult foster care facility who will be assisting in self-administration of
medication. The course would have to include appropriate medication handling.
• Understanding dementia, which would have to instruct the staff member on the
fundamentals of dementia, including how to recognize signs of dementia, effects on
the resident, effective communication, and proper