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Adult Family Homes: Opening an Adult Family Home

The Wisconsin Department of Health Services (DHS) includes the Division of Quality Assurance (DQA). The DQA is responsible for regulating facilities that serve:

  • Frail elderly.
  • People with developmental, mental health, physical, or sensory disabilities.
  • Individuals with substance abuse problems.

DQA is responsible for administering Wis. Admin. Code ch. DHS 88 as required by Wis. Stat. ch. 50. This governs licensure of adult family homes (AFH).

Adult family home means a place where three or four adults who aren't related to the operator reside. They receive care, treatment, or services that are above the level of room and board. It may include up to seven hours per week of nursing care per resident. See Wis. Stat. § 50.01(1)(b).

DQA doesn't refer residents for placement in assisted living facilities. In addition, DQA doesn't provide funding to facilities to care for residents. Residents may be eligible for waiver funding through their local public health departments and/or human services.

For more information on funding for residents in assisted living, please visit:

Attention Milwaukee County applicants: Due to market saturation, managed care contracts for ambulatory only adult family homes may not be offered at this time. Please confirm with your funding source that there is a need for services in your area prior to applying for an adult family home.

Contact a local aging and disability resource center to learn if you are eligible for a publicly funded long-term care program and to find out which programs are available in your area.

  • Community Care Inc call 866-992-6600
  • iCare call 414-223-4847
  • My Choice Wisconsin call 877-489-3814

Established provider: A provider who currently operates the facility type for which an application for licensure or certification is being made.

New provider: A provider who has never held a license or certification for the facility type for which an application for licensure or certification is currently being made.

Attestation prior to initial licensing survey: BAL requires every applicant to complete an applicant compliance statement prior to scheduling an initial licensing survey.

Inactive application: Applications not completed within six months of submission will be closed due to inactivity.

Two revisions: An application isn't complete until all required documentation meeting regulations have been submitted. If the required documents don't meet the licensing/certification regulations, BAL will only send two revision letters per application. After a second unsuccessful revision, no further applications will be accepted from this applicant for the specified location for a period of one year.

Before you apply, please review:

As part of the application process, you'll be required to upload documents, such as:

  • The facility's program statement.
  • A model balance sheet.
  • Operating expenses.

Get your documents ready before you begin. Make sure each document to be uploaded consists of one single file. For example, if you have three separate pages of your program statement, you should combine the three pages into one file to upload.

You are encouraged to complete the online license application process in a single session. However, your information will be saved as you go through the screens. This allows you to stop when needed and return to complete it later. The system will display the status of your application (in process, under review, etc.) when you return. You also will be able to print a copy of your completed application.

This checklist will help you figure out which documents you'll need for your application:

To be eligible to receive Medicaid waiver funding, you also should upload a completed Home and Community-Based Services (HCBS) Compliance Review Request, F-02138.

Create your ID for the Web Access Management System

Web Access Management System (WAMS) allows you to access the state internet applications using the same means of identification. You'll need to create a WAMS account. If you have an existing WAMS account but don't remember your ID or password, use the WAMS account recovery process to reactivate it. Don't create another account.

The email address you use to create your WAMS account will be the email BAL uses to register you in the e-licensure system. Please ensure your account has been activated before moving to the next step. You should receive a confirmation email after you create your account.

Notify BAL of your WAMS account

Please send an email to dhsdqabalregistration@dhs.wisconsin.gov. It should include:

  • Your name.
  • Your WAMS ID.
  • A written request to be registered for the e-licensure system.

This email will notify BAL to register you as a user of the e-licensure system.

Advance to the "License application" section once you get your confirmation email from BAL.

Identify the ambulatory status of the provider in the program statement, service agreement, and floor plan.

Ambulatory AFH settings serve residents who are able to walk independently. They:

  • May not admit or retain a resident who isn't able to walk or walks with help of a cane, crutches, or walker.
  • Aren't required to meet Wis. Admin. Code. § DHS 88.05(2)(a)1-3.
  • If an existing ambulatory AFH wants to retain a resident who temporarily walks only with difficulty, cannot walk at all, or can only walk with the help of crutches, cane, or walker, the provider may submit a waiver request to the appropriate BAL assisted living regional director. The waiver request should note the temporary ambulation status of the resident. It also should show that the setting complies with the applicable codes in Wis. Admin. Code. § DHS 88.05(2)(a)-(d).

Ambulatory with conditions AFH settings serve residents who are able to walk only with difficulty, walk only with the help of crutches, a cane, or walker, or aren't able to easily negotiate stairs without help. These settings may not serve residents who use wheelchairs or who aren't able to walk at all.

  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2) "Residents shall be able to easily enter and exit the home, to easily get to their sleeping rooms, a bathroom, the kitchen and all common living areas in the home, and to easily move about in the home."
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(a)1 Exits ramped to grade with a hard surfaced pathway with handrails.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(b) Grab bars.
  • The setting must assess for Wis. Admin. Code. § DHS 88.05(2)(c) Levered handles.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(d) "Any resident who is unable to easily negotiate stairs without assistance shall have his or her bedroom, toilet and bathing facilities and all common living areas on the first floor." If the resident has a change in ambulation status, the licensee must comply with the following:
    • If the resident is no longer able to easily negotiate stairs without help, the resident will be moved to the first floor. If a first-floor room is not available, the AFH may not retain the resident.
  • If the resident is no longer able to walk at all, and if the AFH meets all requirements for a non-ambulatory designation:
    • The licensee may submit a waiver request to the appropriate BAL assisted living regional director if the resident's non-ambulatory status is temporary.
    • The licensee may submit a request to the appropriate BAL regional office to change the ambulation designation on the AFH license if the resident's non-ambulatory status is permanent.
  • The program statement and admission agreement must include information on the potential for discharge if a resident has a change in ambulation status and the setting is unable to obtain a waiver or change the licensure status.

Non-ambulatory with conditions AFH settings serve residents in a single story or multi-story home who aren't able to walk at all and/or are able to walk only with difficulty or only with the help of crutches, a cane, or walker, and/or who independently walk. These settings meet the regulatory structural requirements to admit at least one or more non-ambulatory resident, but not all bedrooms meet the regulatory requirements for a non-ambulatory license.

  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2) "Residents shall be able to easily enter and exit the home, to easily get to their sleeping rooms, a bathroom, the kitchen and all common living areas in the home, and to easily move about in the home."
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(a)1-3:
    • Exits ramped to grade with a hard surfaced pathway with handrails.
    • All exit and common use doors and non-ambulatory resident bedroom doors have a 32-inch clear opening.
    • Sufficient turn radius in bathroom(s) used by non-ambulatory resident(s).
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(b) Grab bars.
  • The setting must assess for Wis. Admin. Code. § DHS 88.05(2)(c) Levered handles.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(d) "Any resident who is unable to easily negotiate stairs without assistance shall have his or her bedroom, toilet and bathing facilities and all common living areas on the first floor." If the resident has a change in ambulation status, the licensee must comply with the following:
    • If the resident is no longer able to easily negotiate stairs without help, the resident will be moved to the first floor. If a first-floor room is not available, the AFH may not retain the resident.
    • If the resident is not able to walk at all, the resident will be moved to a first-floor room that meets the requirements for a non-ambulatory resident. If a non-ambulatory first-floor room is not available, the AFH may not retain the resident.
  • The program statement and admission agreement must include information on the potential for discharge if a resident has a change in ambulation status and an appropriate first-floor room is unavailable. The program statement also must clearly state how many bedrooms are designated for non-ambulatory residents.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(3)(h)5:
    • 80 square feet per ambulatory resident in single occupancy bedroom.
    • 60 square feet per ambulatory resident in double occupancy bedroom.
    • 100 square feet per resident requiring the use of a wheelchair.

Non-ambulatory AFH settings serve residents in a single-story home who are not able to walk at all and/or are able to walk only with difficulty or only with the help of crutches, a cane, or walker, and/or who independently walk.

  • When DHS determines the application is complete, an initial licensing visit will be scheduled. DHS has 70 days to approve or deny a license. This 70 days for processing begins after a complete license application packet is received and DHS completes the initial licensing survey.
  • Applications not completed within six months of submission will be closed due to inactivity.
  • Once the application is deemed complete, the BAL central licensing unit will send an Adult Family Home (AFH) Applicant Compliance Statement, F-02108 to the applicant. When the applicant is ready for an initial licensing survey, they can return the completed compliance statement to central licensing. Then an assisted living surveyor will be assigned.
  • The assisted living surveyor will review the items listed on the Adult Family Home (AFH) Initial Survey Checklist, F-02634A (Word) during the initial licensing survey and tour of the facility.
  • Once you receive your confirmation email from BAL registering your WAMS ID, you are ready to apply for your AFH online.

Caregiver background checks must be completed at least every four years.

DHS will complete caregiver background checks on the following persons. This will be done before initial licensure and every four years after that.

  1. Non-government entities
    • The owner of the entity, whether or not the person has regular, direct contact with clients. If the owner is a corporation or other type of business that doesn't have a single owner, then the organization may designate one principal officer to legally represent the organization to fulfill the background check requirement. For new applicants, the individual who signs the application fulfills this requirement.
    • Principal officers, corporation, or board members of the business organization who have regular, direct contact with clients.
    • Nonclient residents (over age 10) of the entity who have regular, direct contact with clients.
  2. Government and tribal entities
    • An individual, for example, the entity administrator designated by the government agency or tribe who operates the entity, whether or not the person has regular, direct contact with clients.
    • Non-client residents (over age 10) of the entity who have regular, direct contact with clients.

New applicants for licensure must submit a Background Information Disclosure form and a Background Information Disclosure Appendix form, for each individual as described above, following the caregiver background check requirements.

The entity must complete a caregiver background check on all caregivers. A caregiver is a person who is all of the following:

  • Employed by or under contract with an entity.
  • Has regular, direct contact with the entity's clients or the personal property of the clients and is under the entity's control.

Direct contact is defined as face-to-face physical proximity to a client that affords the opportunity to commit abuse or neglect or misappropriation of a client's property.

A completed caregiver background check consists of:

  • A completed Background Information Disclosure.
  • Response from the entity's inquiry to the Department of Justice.
  • Letter from DHS with information on any government findings of misconduct or credential limitations.

Copies of background checks for anyone covered under this rule must be available for review upon DHS request.

A licensing fee of $171 is charged every two years. Initial application fees and/or license/certification continuation fees are non-refundable.

If you have questions, contact the licensing associates:

Initial licensing videos

BAL offers informational videos for prospective providers. The videos share what you need to know when starting a community-based residential facility (CBRF) or AFH.

The videos will help you learn:

  • How to submit a licensure application.
  • Things to consider in choosing a building.
  • Policies and procedures: why they are important and how to use them.
  • Key elements of AFH and community-based residential facility operations, including program statement and more.

If you plan to start an AFH or community-based residential facility, you may find our informational videos helpful. However, watching the videos isn't required for a license.

Licensing video presentations

How to join a live licensing question and answer session

If you have questions after the webinar, we can answer them during our Live Q&A Sessions. These are held online via Zoom. There is no registration or cost to attend the webinar. Please watch the webinar before attending the Live Q&A Sessions.

Join the live webinar by selecting this link near the start time for that webinar:

Join Zoom Meeting

Or dial: +1-669-254-5252, webinar ID: 160 597 0525

2024 Live Q&A sessions

  • April 9, 2024
    • 10-10:30 a.m. (CBRFs)
    • 10:45-11:15 a.m. (AFHs)
  • August 13, 2024
    • 10-10:30 a.m. (CBRFs)
    • 10:45-11:15 a.m. (AFHs)
  • November 5, 2024
    • 10-10:30 a.m. (CBRFs)
    • 10:45-11:15 a.m. (AFHs)

Additional information

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Glossary

 
Last revised July 29, 2024