A board and care home is a small residential home where a few adults get a room, meals, supervision and help with daily tasks. Medicare does not pay for it. Families pay privately, and in some states Medicaid, a VA benefit or long-term care insurance pays toward the care.
The name changes from state to state. You will see adult family home, residential care home, adult foster care home, personal care home and group home, plus "assisted living" for homes that a state licenses under that name. That is why this guide spends time on how to check what a specific home is, who licenses it and what it can legally provide.
What a board and care home is
ASPE uses a working definition of board and care as nonmedical community-based residential settings that house two or more unrelated adults. Services can include meals, medication supervision or reminders, organized activities, transportation and help with daily living such as bathing and dressing. ASPE's study found that more than three-quarters of the homes reported providing medication storage or supervision, and about a quarter reported providing nursing services.
Do not assume small. ASPE says the widespread perception that board and care homes are small, homelike settings is misleading, and its sample ranged from places with 2 beds to those with more than 1,400. So ask for the licensed capacity and the number of current residents in every case.
Who board and care homes are for
ASPE describes residents as typically older, with many having cognitive or functional impairments. MedlinePlus, writing about assisted living, which overlaps with board and care, says residents are usually older adults and can include people with Alzheimer's disease or other dementias, and in some cases younger people with mental illness or developmental disabilities.
A small home can fit someone who wants a household feel, needs help with daily tasks and medicines and does not need round-the-clock nursing. VA describes its community residential care program as for Veterans who do not need hospital or nursing home care but cannot live alone because of medical or psychiatric conditions.
What board and care includes and leaves out
What a home provides depends on its licence. In general you should expect to ask about:
- Room type and whether it is private or shared
- Meals and special diets
- Help with bathing, dressing, toileting and moving around
- Medicine storage and supervision
- Laundry and housekeeping
- Activities, outings and transportation
Do not assume nursing is included. ASPE's study found about a quarter of homes reported providing nursing services, so most did not. If the person needs injections, wound care, catheter care or frequent skilled monitoring, ask whether the home can legally provide it and who does. Home health agencies may be able to visit, as described in home health care.
Board and care vs nearby care options
- Assisted living. ASPE says all types of group residential care are generally referred to as assisted living today. The practical difference is size and style. See assisted living vs nursing home for how that compares with skilled nursing.
- Nursing homes. Federally certified, with 24-hour nursing and CMS ratings. Board and care homes are state-regulated.
- Memory care. Residential care built for dementia. A board and care home might serve people with dementia, but ask what training staff have.
- Home care. Caregivers come to your own home. Board and care is a move into someone else's.
- IDD services. Group homes for adults with intellectual and developmental disabilities follow different programs and funding. ASPE says its board and care study left out homes licensed only for special populations such as people with developmental disabilities.
Who pays for board and care homes
Medicare. Medicare.gov says Medicare does not pay for long-term care, which can be received in an assisted living facility or a nursing home. You pay all costs for services Medicare does not cover. See what Medicare pays for.
Medicaid. Medicaid.gov says states can set up 1915(c) waivers that cover services such as case management, homemaker help, home health aide, personal care, adult day health, habilitation and respite care. States choose how many people a waiver serves. The ASPE compendium says that for Medicaid-eligible residents, state regulatory policy and Medicaid policy determine the types of units available. Federal rules at 42 CFR 441.310 generally bar federal matching funds for room and board. Whether any given home takes Medicaid depends on the home and the state. Check your state on the programs page and read Medicaid.
VA. VA lists medical foster homes (private homes where a trained caregiver provides services to a few people), adult family homes (private homes renting rooms to six or fewer people) and assisted living as community residential options that VA inspects and approves. Eligibility generally needs VA health care enrollment and a VA decision that you need the service. See VA benefits.
Long-term care insurance and private pay. Some policies cover residential care, but the terms vary and some settings may not qualify. Ask the insurer in writing. See long-term care insurance and private pay.
What drives the cost of board and care
We do not quote an average price. The sources we trust do not give a figure that fits your state, and board and care prices differ widely. The things that change a bill:
- The state and the neighborhood
- Private or shared room
- The level of help the resident needs and how it is assessed
- Whether medicines, laundry, supplies and transport are in the base price
- Whether the home takes Medicaid, and whether room and board is charged separately
- Deposits, notice periods and rate increases
Use the care cost comparison and ask for every charge in writing.
How states oversee board and care homes
There is no CMS star rating for board and care homes, and our listings carry none. State rules decide who is licensed. ASPE found each study state had different definitions or criteria for licensing board and care homes, and some states license several categories through different agencies. ASPE also says not all board and care facilities are licensed, and that unlicensed homes may be as numerous as licensed ones by some estimates.
So your first check is a phone call to the state agency that licenses residential care. Ask whether this specific home holds a current licence, what it is licensed to do, and whether there are inspection or complaint records. For local help, the Eldercare Locator (1-800-677-1116) is a public service of the Administration for Community Living. See our care ratings by state and methodology.
If Medicaid home and community-based services pay for the person's care in that home, federal rules for those settings say, among other things, that the setting must be selected by the individual from among options, protect privacy and dignity, and, in provider-owned or controlled residential settings, give the person a lockable entrance door, visitors of their choosing at any time and access to food at any time. Any modification must be based on a specific assessed need and recorded in a person-centered plan.
How to choose a board and care home
- Ask the state whether the home is licensed and what for.
- Ask for the licensed capacity and how many residents live there now.
- Visit at different times of day, and meet the people who provide care.
- Ask about staff on duty overnight, and who covers when the owner is away.
- Read the residency agreement before you decide.
- Ask how the home works with doctors, home health and hospice when needs change.
Questions to ask the home's operator
- What is your licence, and what are you not allowed to do under it?
- Who is on site at night, and what training do they have?
- What happens if my relative needs more care than you can provide?
- How is the fee set, and what increases have there been?
- Do you take Medicaid, and what do residents pay out of their own income?
- Who manages medicines and how are changes made?
- What are the rules for visitors, going out and bringing furniture?
What a visit to the home should tell you
Small homes feel personal, and the quality depends heavily on a few people. On a visit:
- Meet the person who runs the home and the staff who work evenings, nights and weekends, not only the person who gave the tour.
- Ask how many residents live there and how many staff are on at any time.
- Watch how staff speak to residents and whether residents' rooms and common areas look cared for.
- Ask about the last time someone from the state visited, and whether you can see the report.
- Ask who the home calls in an emergency, which hospital it uses and how families are informed.
- Ask what the home does when a resident needs more care than it can give, and how much notice it gives.
Visit again unannounced during a mealtime, if the home allows it. A good home should be comfortable with a second visit.
Red flags when you visit a home
- No clear answer on whether the home is licensed
- Care claims that go beyond the licence, such as complex nursing with no nurse
- A residency agreement you cannot take home
- Restrictions on visitors that are not explained
- Few staff, or staff who change constantly
- Resident rooms that cannot be locked, in a Medicaid-funded setting
- Pressure to pay a large deposit before you have seen the contract
About the homes listed below
Carevo is a directory and connection platform. It does not place residents, check that a home is licensed or vouch for any provider. The lists below come from public data. Check each home yourself, and use get matched if you want help finding options near you.