A board and care home, also called a residential care home or adult family home, is a licensed home that provides a room, meals, help with personal care and round-the-clock supervision to a small group of older adults. They offer the same basic kind of help as assisted living, in a much smaller, more home-like setting.
What a board and care home is
The National Institute on Aging describes board and care homes as usually having 20 or fewer residents, who get personal care and meals, with staff available around the clock. Nursing and medical care usually are not provided on site.
Many are smaller still. The exact size limits, names and rules depend on the state, because states, not the federal government, license these homes. A few examples:
- California licenses board and care homes and larger assisted living communities under the same category: Residential Care Facilities for the Elderly (RCFEs). The state notes that some care for six residents or fewer, while others care for more than a hundred. A home serving six or fewer is legally treated as a residential use of the property, like a family home, for local zoning purposes.
- Washington calls them adult family homes. A 2023 state rule allowed certain providers to raise their capacity from six residents to eight.
- Arizona separates "assisted living homes," with ten or fewer residents, from "assisted living centers," with eleven or more.
Check your parent's state for the exact term and size limit.
What residents get
In California, every RCFE, whatever its size, must provide basic services including:
- Care and supervision
- Safe, healthy living accommodations
- Three balanced meals a day plus snacks, including doctor-prescribed diets such as low-salt
- Help with daily activities such as dressing, eating and bathing, and with taking prescribed medications
- Regular observation of each resident's physical and mental condition
- Arranging health care, including transportation to appointments
- A planned activities program
Other states set their own lists, but the core is similar: housing, meals, personal care and supervision. In California, an RCFE may allow limited medical services to be provided by a licensed home health agency when certain conditions are met. For ongoing skilled nursing, a nursing home is usually the right setting.
How they differ from larger assisted living
Both types offer non-medical help with daily life. The differences are mostly about scale.
Size and feel
A small home has a handful of residents sharing a living room and kitchen table. A large community may have more than a hundred residents, a dining room, an activities calendar and several wings. California's licensing agency points out that size and layout affect the feel of the living environment, and that only you can decide which your parent would be comfortable with.
Staff
In a small home, residents see the same few caregivers day to day. But there are fewer staff overall, so ask how the home covers nights, sick days and emergencies.
Amenities and activities
Larger communities usually have more on-site programs, outings and social options. Small homes tend to offer a quieter routine with activities scaled to a few people.
Location
Small homes can sit on ordinary residential streets. California law, for example, treats a home for six or fewer like a family home for zoning. That can make it easier to find one close to family or your parent's old neighborhood.
Who board and care homes suit
A small home may be a good fit if your parent:
- Needs help with bathing, dressing, medications or supervision, but not daily skilled nursing
- Feels overwhelmed by large buildings, crowds or long hallways
- Does better with a predictable routine and familiar faces
- Wants a home-like setting with home-style meals
It may be less of a fit if your parent:
- Is very social and wants a busy calendar and lots of peers
- Needs frequent skilled nursing or complex medical care
- Wants amenities such as a fitness room, a large dining room or on-site services
Some small homes specialize, for example in dementia care or end-of-life care, so ask about this directly rather than assuming.
What board and care homes cost
The NIA notes that in most cases you pay the costs of a board and care home yourself. Medicare does not cover it. Medicaid may provide partial coverage depending on the state and whether your parent is eligible.
Prices vary widely by state, city and level of care. CareScout's 2025 Cost of Care Survey doesn't break out small homes separately; its national median for assisted living was $6,200 a month in 2025. Treat that only as a rough benchmark. Call several homes in your parent's area for real numbers.
Some cost points to check:
- What the monthly rate includes: room, meals, laundry, medication help, incontinence care, transportation
- Whether price rises with care needs, and by how much
- Shared vs. private rooms: ask whether both are available and what each costs
- Public programs: In California, for example, the Medi-Cal Assisted Living Waiver can cover services in participating RCFEs for eligible people in 15 counties, but it has a waitlist and doesn't pay room and board. And someone receiving SSI who lives in a licensed facility in California gets a higher combined SSI/SSP payment: $1,626.07 a month for an individual in 2026. Ask each home whether it accepts residents on the waiver or on SSI.
Benefit rules are complicated and change. This isn't financial or legal advice, so check eligibility with your state or a qualified adviser.
How they're licensed and inspected
Because residential care is licensed and regulated by each state, the license and inspection record lives with the state agency. Every state has at least one licensing category for this type of care.
California as an example
California's Department of Social Services, Community Care Licensing Division, licenses RCFEs of every size.
- State law requires an annual unannounced inspection of every RCFE (since January 1, 2019).
- Inspection reports, lists of deficiencies and plans of correction are public records.
- The state's Facility Search website shows each home's license status, visits, complaints and licensing reports. For full details of citations and penalties, you can review the facility's public file through the local Regional Office.
- The license must be posted where visitors can see it. The state warns that some people provide care without a license, so confirm it.
- Anyone can file a complaint by calling 1-844-538-8766. The state says it makes an unannounced visit to start an investigation within ten days.
- For most rate increases, California requires at least 90 days' written notice explaining the reason.
Pairlo lists every licensed board and care home in California with a link to its state license and inspection record, alongside larger assisted living communities.
In other states, look for the state agency that licenses assisted living or residential care; it holds the inspection record.
Questions to ask a board and care home
Bring our touring checklist, and add these questions specific to small homes:
- How many residents are you licensed for, and how many live here now?
- How many caregivers are on duty during the day, and overnight? Is the overnight caregiver awake?
- Who is in charge when the administrator or owner isn't here?
- What happens when a caregiver calls in sick?
- What training do caregivers have, especially in dementia care?
- How are medications stored, given and documented?
- What care needs can you not handle? When would my parent have to move?
- Can home health, therapy or hospice come in?
- What's included in the monthly rate, and what costs extra?
- How much have rates gone up in the past few years, and how much notice do you give?
- What's your plan for emergencies, such as a fire, power outage or medical crisis?
- Can I visit at any time, and can I talk to other families?
Visit more than once, including once without calling ahead. In a small home you'll see most of daily life in a single visit: how caregivers speak to residents, whether the house is clean, what's cooking, and whether residents seem engaged or just parked in front of a TV.
Practical next steps
- List your parent's daily care needs and what kind of setting would suit them.
- Search small homes and larger communities near your parent on the senior living search, or browse by state.
- Check each home's license and inspection record with the state licensing agency.
- Call to confirm openings, rates and whether they can meet your parent's needs.
- Visit at least twice and ask the questions above.
- Read the admission agreement carefully before signing, and get your documents ready with our documents checklist.
- Note the number for your local long-term care ombudsman, who advocates for residents of board and care and assisted living homes. The Eldercare Locator (800-677-1116) can connect you.
If you can't visit in person, an aging life care manager can tour homes for you and tell you what they see.
