Adult Foster Care Homes: A Smaller, Home-Like Option
Not everyone thrives in a large assisted living facility. Adult foster care homes—also called residential care homes, board and care homes, or adult family homes—offer care in a regular house with just a handful of other residents. For some families, this smaller, more personal option is exactly what they're looking for.
Different Names, Same Concept
These homes go by different names depending on where you live: adult foster care (Michigan), residential care facility for the elderly/RCFE (California), adult family home (Washington), or board and care home. They all provide similar services in a home setting.
What Is Adult Foster Care?
Adult foster care homes are regular houses in residential neighborhoods that have been licensed to provide care for a small number of adults. Typically, they house 4-6 residents, though some states allow up to 10.
Basic Structure
- Setting: A regular home in a neighborhood
- Residents: Usually 4-6 people
- Operator: Often a family or small business
- Staff: Caregivers available 24/7
- Rooms: Private or semi-private bedrooms
- Meals: Home-cooked, family-style dining
Services Typically Provided
- Help with activities of daily living (bathing, dressing, toileting)
- Medication management and reminders
- Three meals a day plus snacks
- Laundry and housekeeping
- Social interaction and activities
- Transportation to appointments
- 24-hour supervision
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Recommended Care Transition Resources
- Get It Together: Organize Your Records Prepare documents for care home evaluation
- The 36-Hour Day Understanding care needs and options
- Fireproof Document Safe Keep care contracts and documents secure
- Portable Document Scanner Digitize medical records for care providers
Adult Foster Care vs. Assisted Living
Size and Environment
| Adult Foster Care | Assisted Living |
| 4-6 residents typical | 20-200+ residents |
| Regular home in neighborhood | Purpose-built facility |
| Shared common spaces | Individual apartments |
| Family-style atmosphere | Institutional feel (varies) |
Staffing and Care
| Adult Foster Care | Assisted Living |
| Very high staff-to-resident ratio | Lower staff-to-resident ratio |
| Same caregivers daily | Rotating staff |
| Owner often lives on-site | Management on-site during business hours |
| Personalized attention | More standardized care |
Pros and Cons
✓ Advantages
- Personal attention: With few residents, staff know each person well
- Home-like setting: Less institutional than large facilities
- Consistent caregivers: Same faces every day builds relationships
- Often less expensive: Typically costs less than assisted living
- Flexible routines: More adaptable to individual preferences
- Family atmosphere: Meals together, shared living spaces
- Good for dementia: Small, calm environment is less confusing
- Neighborhood setting: Can walk outside, feel part of community
✗ Disadvantages
- Fewer amenities: No gym, salon, movie theater on-site
- Limited activities: Smaller activity program than large facilities
- Less privacy: Shared bathrooms may be common
- Variable quality: Quality depends heavily on the operator
- May need to move: If needs exceed what the home can provide
- Fewer residents: Less social variety
- No on-site medical: Nurses not typically on staff
- Harder to find: Less marketing than large facilities
Who Is Adult Foster Care Right For?
Good Candidates
- People who get overwhelmed by large, busy environments
- Those with dementia who do better in smaller, calmer settings
- Introverts who prefer small group interactions
- People who value consistent relationships with caregivers
- Those who dislike institutional settings
- Families on a budget who need 24-hour care
May Not Be Right For
- People with complex medical needs requiring nursing care
- Those who want lots of organized activities and amenities
- People who value privacy highly (private apartment)
- Those who thrive on lots of social variety
- People whose care needs may quickly exceed what the home provides
Costs and Payment
Typical Monthly Costs (2026)
- National average: $2,500-$5,000/month
- Lower cost areas: $1,800-$3,000/month
- Higher cost areas: $4,000-$7,000/month
- Compare to assisted living average: $4,500-$6,000/month
What Affects the Price
- Geographic location
- Private vs. shared room
- Level of care needed
- Quality of the home and food
- Whether specialized dementia care is offered
Payment Options
- Private pay: Most common payment method
- Medicaid: Many states cover adult foster care through Medicaid waiver programs
- Veterans benefits: Aid & Attendance may help pay
- Long-term care insurance: Many policies cover adult foster care
- SSI: Supplemental Security Income may contribute
Medicaid Coverage Varies by State
Some states have robust Medicaid waiver programs that pay for adult foster care. Others have limited or no coverage. Contact your state's Medicaid office or Area Agency on Aging to learn what's available in your area.
How to Find Adult Foster Care Homes
Resources for Finding Homes
- Area Agency on Aging: Local office can provide lists
- State licensing agency: Maintains database of licensed homes
- Hospital discharge planners: Know local options
- Geriatric care managers: Can assess and recommend
- Word of mouth: Ask doctors, social workers, other families
- Online directories: Caring.com, A Place for Mom (though coverage varies)
What to Look for in a Home
- Licensing: Current state license (verify with state agency)
- Cleanliness: Home should be clean and odor-free
- Safety: Handrails, accessible bathrooms, fire safety
- Happy residents: Do current residents seem content?
- Engaged staff: Are caregivers attentive and kind?
- Good food: Visit during a meal if possible
- Compatible residents: Mix of care levels and personalities
Questions to Ask When Visiting
About the Home
- How long have you been operating?
- What's your licensing status? Any violations?
- How many residents do you have? Maximum capacity?
- What's the staff-to-resident ratio day and night?
- Does an owner or manager live on-site?
About Care
- What level of care can you provide?
- How do you handle medications?
- What would require my parent to move out?
- How do you handle medical emergencies?
- Do you accept residents with dementia? How do you manage behaviors?
- How do you handle nighttime needs?
About Daily Life
- What does a typical day look like?
- Can residents have their own furniture or decorations?
- What activities do you offer?
- How do you handle dietary restrictions or preferences?
- What's your visitor policy?
- Can my parent's pet come with them?
About Costs
- What's the monthly cost? What's included?
- Are there additional fees as care needs increase?
- Do you accept Medicaid? VA benefits?
- What's the notice period for rate increases?
- What's required to move out? Refund policy?
Red Flags to Watch For
Warning Signs
- Unlicensed or license issues when you check with the state
- Strong urine or other odors
- Residents left unattended or in soiled clothing
- Staff who seem stressed, frustrated, or disengaged
- Reluctance to let you visit unannounced
- Vague answers about licensing, staff training, or costs
- Pressure to make quick decisions
- Current residents who seem withdrawn, fearful, or neglected
Making the Transition
Before Move-In
- Visit multiple times, including unannounced
- Have your parent visit and meet residents if possible
- Review the contract carefully (consider having an attorney review)
- Understand what would require your parent to leave
- Arrange for medication transfer and doctor communication
First Weeks
- Visit frequently but briefly at first
- Bring familiar items: photos, blanket, clock
- Expect an adjustment period (can take 2-4 weeks or more)
- Communicate openly with staff about preferences and concerns
- Watch for signs of good or poor adjustment
Monitoring Quality Over Time
- Visit regularly, sometimes unannounced
- Talk to your parent privately about how things are going
- Notice changes in mood, appearance, weight
- Check that medications are being given correctly
- Build relationships with staff
- Attend care plan meetings
- Know your state's complaint process if issues arise
Trust Your Instincts
If something feels wrong, investigate. Good operators welcome involved families and address concerns promptly. If concerns aren't resolved, contact your state licensing agency.