If your parent needs daily help but would be lost in a big building, a board and care home can be a good fit, though in most cases your parent pays the cost of a board and care home. The National Institute on Aging says Medicare does not cover board and care homes, which are small private homes, usually with 20 or fewer residents, that provide meals, personal care and round-the-clock staff but usually no nursing care. Here's what you get, who pays, and how to check a home out before you sign.

In This Guide

What Is a Board and Care Home?

Picture a regular house on a regular street, with a small group of older adults living in it and a caregiver who's always there. That's the basic idea.

The National Institute on Aging describes board and care homes as small private facilities, also called residential care facilities or group homes, that usually have 20 or fewer residents. Rooms may be private or shared. Residents get personal care and meals, and staff are available around the clock.

The Administration for Community Living (ACL), the federal agency behind the LongTermCare.gov glossary, adds a few useful details. ACL's glossary says a board and care home provides housing, meals, housekeeping and personal care services, that at least one caregiver is on the premises at all times, and that board and care homes are often owned and managed by an individual or family involved in their everyday operation.

So the "board" is the room and meals, and the "care" is hands-on help with the business of daily life. What's usually missing is the medical side, and that single fact decides a lot about who a board and care home fits.

If you're still sorting through every kind of senior care, from a few hours of help at home to a nursing home, start with our guide to the types of senior care and come back here.

What You Get in a Board and Care Home, and What You Usually Don't

Here's the practical breakdown, straight from the NIA and ACL descriptions.

Typically included Usually not provided at the home
A room, private or shared Nursing care
Meals Medical care
Housekeeping
Personal care, such as help with daily tasks
Staff available around the clock (ACL: at least one caregiver on the premises at all times)

The word "usually" matters in that second column. NIA says nursing and medical care usually are not provided at the home, which isn't the same as never, and what a given home is allowed to do depends on its state license. Ask each home directly what it will and won't handle.

Why Board and Care Homes Go by So Many Names

You'll search "board and care homes" and find the same kind of place called three or four different things. There's a reason for that.

ASPE, the planning and evaluation office of the U.S. Department of Health and Human Services, says residential care settings are licensed and regulated at the state level, that every state has at least one category of residential care, and that state requirements vary considerably. Because licensing happens state by state, each state names and defines its own categories.

Even the federal sources use more than one name. NIA uses "board and care homes," "residential care facilities" and "group homes." ACL's glossary lists "group home" as another name for a board and care home.

States also set up their own residential categories. In the District of Columbia, for example, the District's supplemental payment program, described in the cost section below, groups certified residential facilities and assisted living facilities together under the label Adult Foster Care Home. Depending on your state, you may also run into listings for adult family homes, personal care homes or residential care homes. The label matters less than what the state license lets that particular home do. For how a few states handle their own categories, see our guides for Washington State, Pennsylvania and Georgia.

One federal rule does reach into residential settings that take Medicaid money. ASPE notes that in 2014 the Centers for Medicare & Medicaid Services (CMS) set requirements for community-based providers, including residential care settings that receive Medicaid payment for residents' services, covering the standards a setting must meet to count as non-institutional. The CMS settings requirement is a condition of Medicaid payment, not a national license, and it doesn't reach homes that take no Medicaid money.

Board and Care Home vs. Assisted Living vs. Nursing Home

These three get lumped together, and they overlap more than you'd think. ACL groups assisted living and board and care homes together as group living settings that generally do not provide medical care.

Board and care home Assisted living Nursing home
Setting Small private home, usually 20 or fewer residents Own apartment or room with shared common areas; facilities range from small homes to large apartment-style complexes Licensed facility, also called a skilled nursing facility
Daily help Personal care, meals, housekeeping Personal care, help with medications, up to three meals a day, housekeeping and laundry Assistance with everyday activities, three meals a day
Staffing Staff around the clock 24-hour supervision and on-site staff 24-hour supervision
Medical care Usually not provided at the home Some health care possible, less intensive than a nursing home Nursing care; physical, occupational and speech therapy available

Sources for the table: the board and care column is from NIA and ACL, the assisted living column from NIA and ACL, and the nursing home column from NIA and ACL.

Where the federal descriptions differ is size, ownership and the list of services. NIA says board and care homes usually have 20 or fewer residents, and ACL says board and care homes are often owned and managed by an individual or family involved in their everyday operation, so the person helping your parent in the morning may well be the owner. ACL says assisted living facilities range from small homes to large apartment-style complexes. NIA lists help with medications among assisted living services and says assisted living typically offers a few levels of care, with residents paying more for extra services.

A nursing home is a different category altogether. NIA says nursing home services focus more on medical care than most assisted living facilities or board and care homes, and ACL describes nursing facilities as the most service-intensive housing option, with skilled nursing services and therapies as needed.

Want the state-by-state version of these comparisons? See assisted living by state and nursing homes by state.

What Does a Board and Care Home Cost, and Who Pays?

Let's start with the honest part. We don't quote a national price for board and care homes, because we haven't found one from a source we can verify.

What we can give you is a sourced yardstick. The CareScout Cost of Care Survey for 2025, released March 2, 2026, put the U.S. national median cost of an assisted living community at $6,200 a month, or $74,400 a year, and a semi-private nursing home room at $315 a day, or $114,975 a year. CareScout reports its national medians for nursing homes, assisted living, in-home care and adult day health care. CareScout also cautions that actual costs vary with care needs, provider availability and local market conditions.

So treat a board and care home's price as something you collect, home by home. Get the monthly rate in writing, along with what it includes and what costs extra.

Who pays for a board and care home

The short answer: in most cases, the resident pays out of pocket. NIA says that in most cases residents must pay the costs of living at a board and care home.

Medicare: NIA says Medicare does not cover the costs of a board and care home. Medicare.gov explains the general rule behind that answer: since most long-term care is non-medical, Medicare and most health insurance don't pay for long-term care services, including care in a nursing home or in the community. Medicare doesn't cover custodial care, meaning help with bathing, dressing and using the bathroom, when that help is the only care a person needs. Our guide to Medicare and long-term care walks through what Medicare does pay for.

Medicaid: NIA says Medicaid may provide partial coverage of board and care costs, depending on the state and whether the person is eligible. Medicare.gov likewise says a person may be eligible for long-term care through Medicaid if they meet their state's eligibility requirements. Which Medicaid programs your state runs, and whether they reach small residential homes, is a state-by-state question; our HCBS waivers by state guide is the place to start.

Long-term care insurance: For long-term care insurance, the National Institute on Aging advises checking the policy to see whether it covers care in a board and care home. Our long-term care insurance guide covers what to look for in a policy.

SSI and state supplements: One example of a local supplement to Supplemental Security Income (SSI) comes from the District of Columbia. The DC Optional State Supplemental Payment (OSSP) program, run by the Social Security Administration with the District, adds a monthly payment for eligible residents of a District-licensed Adult Foster Care Home, a DC category that covers certified residential facilities and assisted living facilities. For calendar year 2026, the combined SSI-plus-OSSP monthly payment for an individual in a DC adult foster care home with 50 or fewer beds is $1,675 ($994 federal SSI plus $681 OSSP). The DC OSSP is one jurisdiction's program, not a national rule, so ask your state's Medicaid or aging agency whether your state pays a supplement for residents of licensed residential care settings.

For the bigger picture on paying for any kind of care, see how to pay for senior care.

Who a Board and Care Home Suits, and Who It Doesn't

Go back to the definition, because it answers most of this. A board and care home gives personal care, meals and someone on hand around the clock, and it usually doesn't give nursing or medical care.

So a board and care home tends to suit a parent who:

  • needs regular help with daily tasks like bathing or dressing, but not skilled nursing
  • shouldn't be alone at night, and would feel safer knowing a caregiver is on the premises at all times
  • would do better in a small private home, usually with 20 or fewer residents, than in a large building

A board and care home usually isn't the right fit when your parent needs ongoing medical care. NIA describes nursing homes as the setting for people who can't care for themselves anymore and may need ongoing medical care. If your parent is already there, look at nursing homes by state or our guide on how to choose a nursing home.

What about dementia? Whether a particular home can take a resident with dementia depends on the home and its license, since ACL notes that in many states the license sets the number and type of residents a board and care home can care for. For a parent with Alzheimer's, NIA suggests asking any facility how many of its residents have Alzheimer's, whether there's a safe place for the person to go outside, and what is included in the fee versus what costs extra. If your parent's dementia is advancing, compare against memory care by state too.

And if your parent's real need is a few hours of help a day, not a new address, personal care services at home may be the better first step.

How to Check Out a Board and Care Home Before You Commit

A small home is only as good as the people running it, so do the checking yourself. Here's how.

1. Confirm the license

ACL says that in many states, board and care homes are licensed or certified and must meet criteria for facility safety, the types of services provided, and the number and type of residents they can care for. Ask the home which state license or certification it holds, then confirm it with the state agency that issued it. Ask, too, whether the license covers a resident with your parent's needs.

2. Ask the state for its standards and violation list

Section 1616(e) of the Social Security Act requires each state to set and enforce standards for the categories of institutions, foster homes or group living arrangements where, as the state determines, a significant number of SSI recipients live or are likely to live. Under Section 1616(e), those standards must cover matters such as admission policies, safety, sanitation and protection of civil rights.

The useful part for a family: Section 1616(e) also requires each state to make available to any interested individual a copy of those standards, along with the state's enforcement procedures and a list of any waivers of the standards and any violations that have come to the attention of the enforcing authority. Which settings a state covers is the state's call, so ask your state's aging or licensing agency which authority sets the Section 1616(e) standards for small group homes, then ask for the standards and the violations list.

3. Call the long-term care ombudsman

The Long-Term Care Ombudsman Program is the federally mandated advocate for people living in nursing homes, residential care communities and other similar adult care facilities. Every state, plus the District of Columbia, Puerto Rico and Guam, has an Office of the State Long-Term Care Ombudsman, and its services are free and confidential. Anyone can contact the ombudsman program with concerns, and the program represents residents, so it's the office to call if something goes wrong after the move.

4. Visit, more than once

NIA's advice for choosing a facility for a person with Alzheimer's works for anyone: visit at different times of day. A small home at 10 a.m. on a Tuesday and the same home at dinnertime can feel very different. While you're there, ask practical questions:

  • Who is on duty overnight, and how many residents are they responsible for?
  • What exactly does the monthly rate include, and what costs extra?
  • What happens if my parent's needs increase? At what point would you ask them to move?
  • Who handles medications, and who calls the doctor?
  • Is there a written agreement I can take home and read before signing?

A good owner will answer these without hesitating. If the answers get vague, that tells you something too.

Frequently Asked Questions

Is a board and care home inspected the same way as a nursing home?

No. A nursing facility certified for Medicare or Medicaid anywhere in the country must meet the same body of federal participation requirements in 42 CFR part 483, and the Medicaid and CHIP Payment and Access Commission (MACPAC) says certified nursing facilities must be inspected regularly by state survey agencies following CMS guidance. A board and care home has no equivalent national licensing standard: ASPE at HHS says residential care settings are licensed and regulated at the state level and that state requirements vary considerably, so the rules a board and care home must meet come from its state.

Can I file a complaint with the ombudsman for my parent in a board and care home?

Yes, anyone can contact the Long-Term Care Ombudsman Program with a concern, and the ombudsman program's services are free and confidential. The ombudsman program represents the resident, though, so when a family member files a complaint, the program must find out, as far as possible, what the resident wants and follow the resident's direction. Under the Older Americans Act, ombudsman programs investigate and resolve complaints and can represent residents' interests before government agencies.

Does Medicaid pay for a board and care home?

Any Medicaid help with board and care costs depends on the state and on whether your parent is eligible. So the useful next step is two questions for your state's Medicaid agency. First, does the state run a home and community-based services waiver that pays for care in small residential homes? Our HCBS waivers by state guide lists each state's waivers and is the place to start. Second, does the state pay a supplement to SSI for residents of licensed residential care settings, and does qualifying for that supplement open a door to Medicaid?

The District of Columbia is one example of how that second route can work. The DC Department of Health Care Finance says a person found eligible for the DC Optional State Supplemental Payment (OSSP) is automatically eligible for DC Medicaid. To qualify for the DC OSSP, a resident of a District-licensed Adult Foster Care Home must meet the SSI resource limits of $2,000 for an individual or $3,000 for a couple. Other states set their own rules, so treat the DC OSSP as an illustration, not a rule for your state.

Where does a parent with advancing dementia go if a board and care home can't keep up?

A nursing home is one option: ACL says nursing homes include all the services of an assisted living facility with the added service of full-time nursing care, 24 hours a day. The National Institute on Aging says some nursing homes have special Alzheimer's care units, often in separate sections of the building, where staff have special training to care for people with dementia. When you compare those units, NIA suggests asking what services the Alzheimer's unit provides and whether its costs differ from the rest of the facility.

Learn More

Care TypesTypes of Senior Care: A Guide to Every OptionFrom a few hours of help at home to 24-hour nursing care: the types of senior care, what each costs in 2026, whether Medicare or Medicaid pays, and how to pick. Care TypesAssisted Living by State: Costs, Rules and Medicaid CoverageWhat assisted living costs, how licensing and Medicaid coverage differ from state to state, plus a guide to all 50 states so you can jump straight to yours. Care TypesWhat Is Independent Living?Independent living is senior housing, not care: meals, housekeeping and activities, but no help with bathing or medications. What it costs and who pays for it. Care TypesMemory Care by State: Costs, Rules, and Your State's GuideMemory care is specialized assisted living for dementia. What it costs, who pays (Medicare doesn't), and how the rules change by state, with a guide to yours. FinancialHow to Pay for Senior CareHow to pay for senior care: what it costs nationally and how Medicaid, Medicare, VA benefits, and private pay each fit. Who qualifies, what's covered, in 2026. Care TypesAffordable Senior Housing: HUD Section 202, Public Housing and Rental HelpThree federal programs cut rent for older adults with low incomes: HUD Section 202, public housing and Section 8 vouchers. Who qualifies, rent, how to apply.

Find personalized help comparing board and care homes with assisted living for your parent at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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