Felicia Barza, born and raised in Romania, in her Lake Oswego adult foster care home with resident Donald Dickey (top), and Marie Reitan (below) who is turning 101 in July. “This job is 24 hours a day, seven days a week ... It’s a good living, but I’m not going to be a millionaire,” says Barza.
Felicia Barza is sitting at a table in the Lake Oswego foster home she has operated since 2002.
“In Romania, you take care of your mother, your grandmother, your great-grandmother,” the 62-year-old says. “My great- grandmother died in my arms when I was 7. I was so proud.”
The former director of an auto parts warehouse in Transylvania, Barza landed in Anaheim in 1993, where her daughter had emigrated a few years earlier. “Then somebody told me about foster homes in Portland,” she recalls. “I thought the best thing was to be a caregiver because then I [spoke no] English.”
Adult foster care is a relatively small and unknown entity in the long-term adult care industry. There are few statistics indicating the size and demographics of the Oregon market. In 2008, foster homes served about 4,000 of the state’s 27,000 long-term-care Medicaid clients, a sector valued at about $1.1 billion. Another 5,000 foster-care residents pay out of pocket, and many homes serve both Medicaid and private-pay clients.
Unlike nursing homes, adult family dwellings are real houses in residential neighborhoods, often modified with additional rooms, baths and safety features. Although most foster-care providers are not medical professionals, each home is assigned a nurse who delegates tasks such as dispensing medication. In Oregon, the state regulates the industry, with the exception of Multnomah County, where the county wields jurisdiction. Regulators issue licenses to foster-care operators based on the level of care they have the training and experience to provide.
At her establishment, Felicia’s Adult Care Home, Barza attends to five seniors who need help in almost all aspects of daily living: eating, toileting, bathing and behavior management. With the help of a live-in assistant — a Romanian man who grew up in a Transylvanian monastery — Barza also cleans house, does laundry and cooks three meals daily, including native specialties such as chicken paprikash.
Then there is the constant stream of people — case managers, social workers and family members — going in and out her door.
“This job is 24 hours a day, seven days a week,” says Barza. “It’s a good living, but I’m not going to be a millionaire.”
In an era of skyrocketing health care costs, relative affordability is one of the foster-care industry’s key selling points. Nursing homes cost about $7,500 a month; foster care, by contrast, runs about $3,500 to $5,000. Medicaid reimbursement rates reflect a similar divide. The state pays about $6,500 per month for nursing home care and $1,800 for foster care. The cost differential is a source of aggravation for foster-care operators, who believe Medicaid compensation for their services should be higher. But the lower reimbursement rates also mean Oregon saves hundred of millions of dollars by placing Medicaid clients in foster homes instead of nursing facilities.
This year, there are 2,755 Medicaid residents in adult foster care. That saves the state about $158 million, according to an analysis by the Oregon Department of Aging and Disability Services.
But the inherent challenges of caring for the elderly day and night can also lead to complications and complaints. In 2009, there were 700 complaints registered against adult foster homes, including rule violations and allegations of abuse; 27% of those allegations were substantiated. In nursing home and assisted- living facilities, by comparison, about 33% of the total allegations were substantiated.
To understand how Romanians came to dominate the public and private foster-care markets, start with the community’s unique set of assets. The first-generation Romanian refugees who immigrated to Portland seeking religious freedom were well educated, with doctors, engineers and business people among the ranks. Their language is also of Latin origin; unlike Laotian and Ethiopian refugees, Romanians didn’t have to learn a new alphabet.
Lidia Pap, with daughter Ellise Pap, age 4, in the family’s adult foster care home in Wilsonville. Pap is a second-generation care provider whose facility is on a blueberry farm.
Other transferable skills have helped the Romanians succeed. Raised in a communist country noted for its economic and political hardships, the Romanian émigrés share a history of depending on family and friends. Those shared values have translated into a useful strategy for building a family-based, community care industry.
Fashionable in black boots and jeans, 36-year-old Lidia Pap is a good example of the Romanian foster-care network as well as second-generation provider trends. She learned the business growing up in her parents’ adult foster home and now owns her own residence, Just Like Home, on a blueberry farm in Wilsonville, one of a growing number of luxury foster homes springing up in the suburbs.