Residential care homes, also known as residential care facilities, board and care homes, certified family homes, or personal care homes , are usually private homes serving 20 of fewer residents—more often 6 or fewer. They provide many of the same services of an assisted living facility, such as assistance in activities of daily living, medication management, and social opportunities, but with a more personal approach to care.
Residential Care Homes vs. Assisted Living Facilities
Residential care homes, like assisted living facilities, are licensed or certified and regulated by the state in which they are located. However, they are smaller, and thus more like a single home than an apartment within a larger complex.
Because residential care homes are often smaller than assisted living facilities, they can have a higher staff-to-resident ratio and offer more personalized service.
The majority of residential care homes are custodial only, meaning that they do not manage major medical needs on site. Common services are:
- 24-hour staff availability
- Assistance with activities of daily life, like bathing, grooming, and getting dressed
- Laundry and housekeeping services
- Meal preparation and dining services
- Medication management
- And some planned social activities
The focus on personalized approach to care can make up for offering fewer services – like guaranteed transportation support or more advanced medical needs – than an assisted living facility or nursing home.
Who benefits the most from living in a residential care home
Residential care homes can be a very dignified and cost-effective alternative to living independently or to assisted living.
Someone looking for:
- assistance with activities of daily living, but not advanced medical care
- less formal social events and programming so that there is a high degree of independence
- the family to be more involved with care coordination
- or just a smaller experience that feels more like “home” can find residential care homes ideal.
For those suffering from Alzheimer’s or other forms of dementia, there are residential care homes that may be certified in memory care providing a unique care experience for them as well. With fewer residents and a smaller staff than large facilities, a resident may have lower stress and anxiety as they become more familiar with the faces they see.
Because of the wide range of services offered, consumers should look closely at the cost and program of each residential care facility to determine what will meet their specific needs and budgets.
Considerations when selecting a residential care facility
Beyond visiting the residential care home and getting a feel for the environment and people, there are several specific topics to consider:
- Are they licensed and certified? Confirm that the home is licensed by your state and the license is current. If they advertise specialized care, such as for dementia, ask to see the certification for that specialty. If they don’t have certification, ask what experience they have in the area.
- What are the staff’s qualifications? Ask about training, qualifications, and certifications of the staff as well as the staff-to-resident ratio. The importance of advanced training may vary depending on the current the future needs of the resident.
- What are the available meal options? Ask to see a representative weekly menu and verify that any special dietary needs may be met, if appropriate. Ask about flexibility in meal schedules.
- What is the living environment like? Assess the comfort and cleanliness of the space. Verify that residents have comfortable and private accommodations. Verify that safety features such as handrails and adequate lighting are in place.
- Does the care home offer ‘memory care’ ? This is often a marketing term, and the care home may not have the actual knowledge and capabilities to support dementia or Alzheimer’s patients. If you are looking at a facility that describes itself this way, make sure to find out the additional services they provide and if they meet the state licensing requirements for dementia care.
- What do the current residents think? Ask to speak with current residents in private. Look for online reviews, both positive and negative. If possible, talk with families of current and former residents.
- How will the potential resident’s health progress? Factor in the likely progression of the resident’s health and if the care home will be adequate as needs increase or if the home is not willing to care for certain needs and the resident will have to be moved.
- What are the levels of communication pertaining to care wishes? If you are the caregiver or person responsible for the resident, ask how and how often you will be communicated with. Make sure the staff has all relevant documents, such as advance directives, POLSTs, or DNRs, as well as instructions on whom to contact in the event of an emergency.
We also encourage you to read our section on What to Consider When Planning Alternative to In-Home Care — particularly the sections on “free” referral services and the care option contract’s fine print. This information can help prepare ahead for conversations about residential care facility’s practices.
Residential care facility requirements and regulations
Each state regulates residential care homes and assisted living facilities differently. The National Center for Assisted Living has collected all the states’ licensing requirements on their website.
On the site you will find summaries for each state covering:
- Which agency in that state responsible for licensure. Be sure to visit that agency’s site and verify that the facility’s license is current.
- Information on any Medicaid waiver programs that may be applicable.
In some states, upon request, a facility must show you the most recent copy of its annual inspection report and a copy of any substantiated complaints in the past year. Inspection reports and substantiated complaints may also be available on your state’s governing agency website.
It’s important to keep in mind, while these facilities are regulated and licensed by states, states may be unable to do frequent inspections. Residential care facilities can be the perfect solution for care as they are less expensive than the other options and may offer truly warm, personalized care. A lack of oversight has led to some facilities being problematic– with reports of residents being neglected or property being stolen.
We advise doing your diligence and visiting often so that the quality of care meets your expectations and needs.
Paying for a residential care home
In general, residential care homes are less expensive than assisted living facilities or nursing homes. For reference the median monthly cost of assisted living was $6200 and of nursing homes was $10,800 in the US in 2025. Costs will vary substantially by region. Like assisted living facilities, however, residential care homes are paid for by the resident. To pay for a residential care home, residents can look into using:
- Savings
- Long-term care insurance payments
- And Medicaid waivers (also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.)
If considering using a Medicaid waiver, be aware that non-waiver Medicaid usually does not cover the cost of a residential care home.
It’s also important to know that residential care facilities may raise their rates at-will. In some states, 60-day notice must be given, but increases for increased intensity of care may be made immediately. Make sure to ask about the facilities’ fee structure, and if it changes over time or as the needs of the resident change.
Residential care facilities are good options for many communities, but do your research
More than any other out-of-the-home care option, the quality of residential care homes and what services they provide can vary greatly. You can use the information we’ve provided to help you ask the questions you need to ask in order to determine if a residential care home is right for you or your loved one.
Other alternatives to in-home care
Be sure to see what other care facility options are available in your area as well:
