Jill Schramm/MDN Gathered around the table at the Enney Adult Foster Home are the Enneys and their residents. From left are Don Wald, Matt Enney, David Lelm, Rose Enney and Jim Kemmit.

From the comfort of his living room chair, Don Wald is right at home listening to music or singing one of his favorite songs. He and other residents of the Enney Adult Foster Home feel at home because they are at home.

Matt and Rose Enney of rural Minot are among only seven private adult foster home providers in North Dakota who offer the alternative to nursing homes or assisted living. As the only adult foster home provider in Minot, Rose Enney said she would like more people to take an interest in offering the service.

“We need more foster homes,” she said. “There really is a need, and there’s so many people out there that have no place to go. And, they don’t even realize there is such a place like this.”

Nancy Maier, director of Adult and Aging Services in the North Dakota Department of Health & Human Services, said North Dakota offers two types of licenses for foster home care for older adults or adults with physical disabilities. Licensing is required if a private home houses more than one person or more than two related people, such as a married couple. Depending on space in the home, a provider can be licensed for up to four residents.

A second, relatively new type of licensing exists for agency adult foster home, in which an organization either rents or owns a home in a residential setting. Up to four people can share that living environment and receive services covered under Medicaid.

In addition to the seven adult foster homes operated by private individuals, there are eight homes operated by agencies, Maier said. Those homes are scattered in communities across the state, she said.

“It used to be a model that was more popular. There used to be over 100 homes, but that has been many years ago. But I think that the awareness that this is an option isn’t out there and so, that could be one of the reasons why we have so few,” she said.

She added the availability of home and community-based services, and the public dollars to sometimes help pay for them, also has influenced more elderly residents to stay in their own homes longer.

“There’s a lot of different ways to receive care but there are definitely people who, I think, would like to live in an individual situation like a family home and just have that camaraderie, or reduce their isolation by allowing them to live with others,” Maier said.

She said the state wants to get the word out that private homes are an option in the care spectrum and that the Department of Health & Human Services can help prospective providers get started.

The Enneys didn’t originally plan to operate an adult foster home.

“We just kind of grew into it,” Rose Enney said.

Enney, a registered nurse, had worked at a rehabilitation center for 10 years, switching to part time after moving her father into her home to take over his care. She later took in another family member as well. Under a Medicaid program that paid her to care for family, she left her job to provide care full time.

She was somewhat familiar with adult fostering because her mother-in-law once operated a home. It seemed a natural progression to follow that same path.

Following facility inspections and background checks, Enney Adult Foster Home received its initial one-year license last year. Continued licenses are valid for two years.

Matt Enney worked 30 years for the U.S. Postal Service before leaving to assist his wife with the foster home.

Because adult foster homes cannot hire employees, relying only on respite help when needed, providers get to know their residents well.

“We will notice more subtle changes in them than would be caught in a nursing home or even a big assisted living,” Rose Enney said. “We’re expected to care for them like family and do it ourselves, which is really nice. Again, they get the more personal touch.”

To open an adult foster home, a person needs no medical training but must demonstrate certain competency standards to become licensed. Providers also can determine the level of care they are willing and able to give, which guides their selection of clients. They can choose to accept private pay, public funded or long-term care insurance.

The Enneys have adopted the use of equipment aids, such as nighttime activity alert monitors, to be able to take clients with various challenges and independence skills. While transporting clients to medical appointments isn’t a requirement of licensing, Rose Enney said she finds doing so aids in her ability to meet their care needs.

Matt Enney has been building a deck that will surround the house and give clients an opportunity to more safely walk around outdoors.

Rose Enney said residents are free to spend their time doing whatever activities they enjoy, just as anyone would in their own home. If they want to sit and listen to music, work on puzzles or run errands with the Enneys, they have the freedom to do so. Enney said one previous resident enjoyed writing letters and folding laundry so those activities were made available to her.

For clients who are more introverted and like a quiet environment, an adult foster home is a good choice, she said.

“Of course, it’s not always this quiet because we have people coming and going, family and friends coming over,” Rose Enney said.

Because their home is their residents’ home, they welcome their residents’ families to stop for regular visits or to celebrate holidays. The Enneys once opened their home to a resident’s celebration with about 28 family members present.

“We were all gathered around singing Christmas carols, and it’s fun,” Rose Enney said.

Resident David Lelm, who recently moved in after his previous foster home closed, said he particularly likes the personal touch and the modern home environment he experiences in living with the Enneys.

“I like it more here,” he said.

The Enneys said opening an adult foster home has been not only a good business decision for them but a fulfilling job choice. They are convinced there are others who also would find operating a foster home to be a good fit.

“It’s not that hard, really, to start,” Rose Enney said. “I’d be more than happy to help anybody get started.”