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Adult Care Homes

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Adult care homes (ACH) (also known as group homes or residential care homes) are single-family residences that offer care to seniors and people with disabilities. These homes are located in residential areas throughout the United States, and they offer an alternative to assisted living and nursing homes.

You may not even recognize an Adult Care Home in your neighborhood, as they look like any other home. You probably drive by one every day without knowing. Adult care homes are non-institutional. That’s why many of my clients choose a care home over assisted living, as they offer “family-style” living which, for the right person, can feel more personal, warm, and welcoming.

Adult Care Homes Versus Assisted Living

While no two care homes are built exactly the same, they generally share many traits.
Seniors receiving care are called residents, not patients. On average, there are no more than five to ten residents at a time living in an ACH, and the staff to resident ratio is usually much higher than other types of senior care facilities.

In terms of personal care, some highly skilled Adult Care Homes specialize in bariatric care, ventilator care, recovery from cosmetic surgery, and psychiatric care. This level of care is often an excellent alternative to nursing homes; however, these types of facilities can be difficult to find in more rural parts of the country.

Many older adults transition to an adult care home setting from assisted living. My grandmother lived in assisted living for several years before “outgrowing” the level of care assisted living was able to provide. When compared to assisted living, care homes have a lot in common. They both offer meals, housekeeping, private or semi-private rooms, and 24-hour assistance with both everyday tasks and emergency situations. However, there are some key differences.

Adult Care Homes Assisted Living
  • Typically house five to ten residents
  • Situated in a one or two-family residential home
  • Higher level of personalized care, due to the greater staff-to-resident ratio
  • Sometimes can cater to a specific condition such as diabetes or Alzheimer’s
  • Amenities vary but often don’t include outings or other in-depth activities like cooking or fitness classes
  • Range from $1,500-$4,000 per month
  • Typically house around 30 residents
  • Situated in larger, apartment-style buildings
  • Wide range of care levels offered at each facility
  • Often offer resort-like amenities
  • Usually have 24/7 trained medical professionals on-site
  • Range from $3,000 – $6,000 per month

All About Adult Care Homes

While care homes feel low key and home-like, they’re still highly regulated by state licensers, to a degree similar to that of nursing homes. Each home must be licensed and inspected for structural and safety concerns. The Department of Aging & Disability mandates basic home requirements such as:

  • Square footage
  • Accessibility
  • Fire and safety systems
  • Accessibility of caregivers

Management of Adult Care Homes

Each home’s owner and operator is also licensed. This person may have a background as a licensed medical professional, but this is not required. To qualify for licensing, the owner or operator must have a minimum of experience in providing elder care. Usually, they’ve worked in a nursing home or another type of elder care facility.

The homeowner is liable and responsible to follow all of the state rules and regulations. Providers must at least pass a criminal background check, complete basic training, and pass an English exam. Maintaining a license requires staying compliant and completing ongoing education each year.

Oftentimes, the home’s operator lives in the home and provides day-to-day care, but this will vary depending on the setting. In lieu of living onsite, they may hire qualified caregivers. The caregivers will either work part-time to cover days off or act as daily helpers. The owner may live off-premises or even own several care homes. In this case, they’ll hire a live-in caregiver who acts as “Resident Manager.”

24/7 Support: The important thing to note about care homes is that residents are never left unattended. Regardless of the state, a qualified caregiver must always be on the premises.

Inspections and Accountability

All care homes are inspected at least once a year. Inspections are unannounced. A licensor or other state or county employee conducts the inspection.

Inspections include a review of:

  • Records kept of all residents
  • Medication administration logs
  • Physician orders
  • Written care plans for each resident
  • Notes made about changes in condition
  • Resident contracts
  • The secure storage of resident medications
  • Proper storage and disposal of hazardous materials
  • Maintenance of safe water temperatures to prevent burns
  • Fire evacuation safety drills

Services Provided in Adult Care Homes

Just like assisted living facilities, the services provided in a care home will vary greatly from place to place. Regardless of facility, however, a care home will include in its rent:

  • Room and board
  • Meals and snacks
  • Laundry services
  • Housekeeping

Care providers develop a care plan for each resident. This plan is based on the diagnoses, daily help needed, and what’s ordered by the resident’s doctor. Typical care plans will include some, if not all of, the following:

  • Bathing, dressing, grooming, and hygiene
  • Toileting assistance
  • Transfer and mobility assistance
  • Behavior monitoring and cognitive assistance
  • Special diets and eating assistance
  • Medication management
  • Hospice and palliative care

When licensed, adult care homes may be classified by care level. A higher classification depends on the certifications, background, and experience of the provider. Technically speaking, a care home does not need licensed medical professionals living on site. With that said, facilities with registered nurses, therapists, CNAs, or other certified professionals will merit higher classifications.

Higher classifications can provide specialized and complex medical care. These care services might include things like:

  • Brittle, sliding-scale diabetic care
  • Wound care
  • Aspiration risk
  • Bedbound and dependent care
  • Ventilator care
  • Psychiatric or dementia care

Assisted Living Fact: About 20 percent of assisted living communities have dementia-specific wings or programs.

Do Adult Care Homes Provide Night Care?

Most homes do not provide an awake caregiver at night. Caregivers live and work in the home but need to sleep at night. They’ll respond to occasional bouts of illness or accidents, but if a resident needs consistent night-time help, then you’ll want to consider a different care option.

With that said, circumstances can vary greatly between different facilities. When my grandmother was on hospice near the end of her life, she required 24-hour care. Her adult care home providers worked around the clock to keep her comfortable and safe. While not a feasible routine long-term, many providers will provide similar care and accommodations for their current residents at the end of life.

If a home has two live-in caregivers, then they may offer night care. Alternatively, a home might hire a caregiver specifically for night care, but you can expect a significant increase in cost if this is the case.

Amenities in Adult Care Homes

Since they have designs much like residential homes, care homes vary in size and amenities. Some were designed and built as care homes while others have been retrofitted and modified with grab bars, safety rails, ramps, and emergency help buttons.

Most homes offer private bedrooms. Many offer bedrooms with private en-suite half-baths. In older, converted homes, bathrooms are often shared. A private room rarely includes a private shower; rather, a separate shower room is standard and used for scheduled bathing.

Usually, resident bedrooms don’t have separate heat and a/c controls. Most homes have central systems. Bedrooms can come furnished; however, most families bring personal knick-knacks or small pieces of furniture in order to make the place feel more personal. Homes generally provide basic cable TV service with premium channels and phones costing extra.

It’s important that residents can call for help when needed and that caregivers respond. You’ll find a variety of call systems in care homes, including hard-wired, baby monitors, buzzers, bells, and medical alerts.

FYI: If you’re looking to put a medical alert system in your home, check out my rundown of this year’s best medical alerts.

In the last decade, newly constructed custom-built care homes have changed the market. These homes have all the latest innovations such as:

  • Roll-in showers
  • Intercom systems
  • Security systems
  • Private bedrooms with private bathrooms
  • Spacious common areas

The larger, newer homes, with more amenities, meet the expectations of today’s consumers. With that said, homes with all the latest and greatest amenities don’t necessarily provide better care. Really, the best quality indicators of a care home are the staff and the residents. Since these facilities become close-knit communities, it’s important to find a good fit for your loved one.

What Does the Peer Group Look Like?

Individual states limit how many residents can live in the home. Typically, you’ll find five to ten people in a home; however, some states allow up to 20.

Limiting the number of residents helps keep the home-like, family atmosphere. The smaller group helps to ensure:

  • Consistency of care
  • Fewer mistakes
  • Closer supervision
  • More personalized attention
  • Emotional connections between residents and caregivers

Adult Care Homes Are Multi-generational

Care providers and their families often live in the home alongside residents. This means children of wide-ranging ages may be present. Usually, the care home has two distinct sections: a private family side and a resident side. If kids are young, providers must have extra help on site. Also, children must respect elder residents and stay out of their bedrooms.

Intergenerational Living: A growing body of research suggests that seniors and young children benefit from interacting with each other. This is one of the great benefits of a care home.

Interacting with children gives a lot of joy to many elders. Older kids often play games, color at the table, read out loud, or entertain residents with live piano.

My grandmother lived in an adult care home with children. Initially, we didn’t think much of it but soon realized that the daily interaction with the children in the home greatly impacted her quality of life. She loved seeing the children and hearing about their day at school. They brought light and excitement to the day with their chatter and interactions with the residents.

Social & Activity Programs

Activity and social occasions are organic in nature and depend on the group’s dynamics. Eating meals, having snacks, and watching TV together is enough socialization for some, while other communities might stage regular events such as board games nights or craft activities.

Providers try offering sing-alongs, puzzles, and painting. Sometimes volunteers provide live music, or the provider hires a musician to come in. Birthdays and holidays are a chance to party and celebrate, and the families of residents are usually invited, adding to the familial feeling of a care home.

Care homes don’t generally provide transportation. Outings and field trips are rare. It’s expected that families take their loved one to doctor’s appointments. Or, if they can’t, providers can arrange other services

Costs & Finances

Adult Care Homes charge month-to-month. A monthly base rate includes room, board, and basic services. Care and personal services (the care plan) are in addition to the monthly rate. Care plan charges increase as care escalates.

Monthly base rates vary depending on where you live. Across the US base rates range between $2500 – $6000 per month.

Paying for Adult Care Homes

Medicare does not pay for adult care homes, meaning payment for monthly charges comes from:

  • Private funds
  • Long-term care insurance policies
  • Medicaid, if the home has a Medicaid contract.
  • Veteran’s benefits

Not every home has a contract with the State to accept Medicaid reimbursement. Also, a home that does have a contract is not obligated to accept a new resident who’s on Medicaid. Additionally, many homes carry a contract so their long-term residents, who run out of private funds, can stay in their home.

How to Find Adult Care Homes

Finding the right adult care home for your loved one can be an overwhelming task. In areas where adult care homes exist, there can be dozens, if not hundreds to choose from. For example, in the Portland, OR area alone, there are over 1,200 licensed adult care home providers.

Homes will vary in cost, amenities, and care types offered. Additionally, due to the small setting, it’s important to consider the personality and manners of the caregivers and how your loved one will engage with them. Think about the peer group as well, what types of behaviors and personalities will be important for your loved one to be around? Unlike assisted living facilities, which have a large number of staff and residents, care homes are defined by the closeness of their communities.

Working with someone who is familiar with the adult care homes in your area is imperative to making the right decision. A professional referral agency will have first-hand knowledge of the local senior housing options and will be able to help you narrow down your list to resources that are right for your budget, medical needs, and preferences.

Bottom Line

If your loved one would do well in an intimate, family-oriented setting with home-cooked meals, an adult care home might be the right choice. There are some key differences between assisted living and adult care homes, make sure you understand your options before making a choice. When you find the right fit, a care home can be one of the most rewarding places to provide care for a loved one.

A Complete Guide to Adult Care Homes Infographic

Written By
Amie Clark

Amie has been writing about senior care products and services for the last decade. She is particularly passionate about new technologies that help improve the quality of life for seniors and their families. Seeing her parents and grandparents age made Amie ask herself, “Would this be good enough for my loved ones?” In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. Learn more about Amie here


  1. How can I get a list of ACH’s in the NYC tri-state area? I’m looking for a home with spanish-speaking staff.
    1. Hi Lissett- I would recommend calling your local Area Agency on Aging for a list. If they don’t have one, I’ll bet they can point you to the correct department. Hope that helps, Amie.
  2. My mom is 92 with dementia. I’m looking for a ACH with reasonable rates in the Phoenix area. She needs assistance with bathing and toileting.
  3. My mom is 65 she need a home with her own space but needs supervision with cooking laundry and medication preparation she has Parkinson’s disease we live in Michigan can i get some help please
  4. Looking for young adult age 34 who has a hard time walking must use walker and his speech is very bad as well as j His eye sight. He has a brain tumor that is inoperable. Getting difficult for me to handle j Him.
  5. I was looking for an adult residential home in the n.y tri state area for my mom who is 63 who still wants her own space but needs supervision that’s professional
  6. I am looking for a place in Washington State, either Port Angeles or Sequim for my Father with dementia. He is very high functioning and needs a place with more higher functioning, more stimulating atmosphere, than the facility he is currently in.
    1. Hi Becky, Hope you found a good spot for your dad. Can you tell me what afh be was in? I am placing my husband tomorrow in an afh in the Seattle area, but hope to move out of Sea in the next year and have been looking towards PASequim. It would be great if I had a lead on an afh in the area….my husband is not in need of stimulation…pretty far into the ALZ journey.
  7. I am looking to turn my 3000 square foot home / with in-law where 89 year old mother lives, into a board and care home in CT. Any help in the correct direction would certainly be appreciated. Thanks, Dan
  8. We have problems with the home care in our neighborhood. Who do we contact. It seems like the people at the house do not care for it is an on going problem.
  9. Any facilities in las Vegas..the adult care home…I’m be looking for a friend of mine…
  10. I’m looking for a board and care home for my father who is 76. She does not want an assisted living or other institution like situation, so I was thinking a board and care may be the best choice for him. We live in NY -Long Island
  11. I’m looking for a board and care home for my mom who is 90. She does not want an assisted living or other institution like situation, so I was thinking a board and care may be the best choice for her. We live in MA.
    1. Me and my daughter are growing our boarding care and currently have Private Master bedroom and bathroom available..with unl im minted caregiver service available..Missouri City TX
  12. It’s great to know more about choosing an adult care center. I like how you said that each home must be licensed and inspected for safety. Finding a good care facility is important for us with our mom right now, so I’ll try to find a place with up-to-date licenses and inspections.
  13. Anyone know of any adult care homes in ocean county New Jersey. My dad is 97 and I am really not interested in a nursing home. If not then maybe we will hire someone to come in and be with him in his house.
    1. Dear Patricia My husband has advanced Alzheimer’s and is 73 years old did you happen to find an adult home care facility for your father that you can direct me to I saw that you are if she counter where I reside please let me know
  14. I’m looking for a good adult family home in Tacoma. This would be a home for elderly and alert people. It needs to have a Medicaid option. Any recommendations? Thanks!
  15. My mother and I are starting adult foster care in our home. This will not be your typical senior living, out home will be resort living and an active lifestyle. Our home is currently being custom made to be handicapped accessible the home should take 8 to 10 weeks to build. We are nestled between the Gulf of Mexico, which means the beach is near by only 40 min or less drive and the Mexico boarder is near by as well, also a short drive. Out lovely city basks in warm temperatures all year round. Our gated community offers many activities year round including a non denominational church, fitness center, pool, and hot tub as well. As a resident you will have your own room personal services we will offer but not limited to onsite caregivers that live in the home, help with bathing, dressing, meals provided and snacks, cleaning, laundry, transportation, appointments, medication reminders, nurse to come in biweekly. Come be a part of our family.
    1. I am looking for alternate places for my dad besides a nursing home. Can you send me any information?
      1. My name is Stanley and am a nurse by professional. Have 15 years of nursing experience. My wife and I have recently opened an Adult Family where we will dedicate ourselves in helping seniors with their daily activities. We affirm, “Our family is committed to yours”. Please check our website for more information. Website: joystanafh[dot]com
      2. Hi Christine, What you choose depends on what your dad needs to assist him in daily living. If he is able cognitively and physically then maybe a retirement complex would be best. Most of these complexes have call lights connected to a nursing home, in the bathrooms. Some come with garages if your father is still able to drive. If your father has dementia or Alzheimers and needs minimal assistance then an assisted living or CBRF as they are called would be best. You may want to consider an adult family home. This is where 2-5 residents reside in the same house. There is staff usually on site 24/7. I hope this helps.
  16. I am recommending Willamette Oaks, located in Eugene, Oregon is a senior apartment and retirement community providing the finest care and community in the Cottage Grove area. Come home to a welcoming retirement living community, a fir-lined setting, and a Eugene, Oregon location convenient to everything.
    1. Hi Hayk! Im looking to open a new AFH in Clackamas County Oregon. What did you like the most about the place? What qualities could I try to adopt?
  17. Sanborn Manor Adult Care Home is located in Eugene Oregon. We maintain a clean, calm, safe environment and provide all private rooms with some rooms having their own bathroom. Our caregivers currently have 5-30 years of caregiving experience. We have a 1-2 year private pay requirement, but have a Medicaid contract as well so our clients do not have to move. If you are looking in the Eugene area, please give me a call or visit our website at sanbornmanorach[dot]com
  18. Adult Care Home opening in Portland Oregon across from beautiful golf course, stunning view , large room, outstanding fresh home cooked meals and loving care team to help with all your care needs and more
  19. II will be opening an adult residential home next month . I am located in New Orleans LA. I will provide cared forf seniors on all aspects of care. Hope to hear from prospective clients
  20. GRAND OPENING of new clean Adult Care Home in Elberton Georgia. 3 or 4 people only. Large rooms, Jacuzzi tub, own bathroom and closet possible. Private rooms — No doubling up or sharing of rooms. Friendly experienced staff, 3 great meals provided, $3000 minimum per month. Possibly higher cost depending on needs. Great alternative to a nursing home facility. This is a residential home.
  21. Looking for an adult home with independent living & my own room, no roommates. Preferably, Suffolk County South Shore, open to other possibilities as well. Thank-You.
  22. We are looking for total care clients. Champion Adult Family Home, Lynnwood, WA. Husband/wife team, both nurses, combined 45+ years LTC exp. [phone num redacted – admin].
  23. I have a friend who is 62 who lives in Dallas, TX. She has spent her entire life since graduating college, nurturing and caring for her parents. When her last parent died several years ago, the family house had to be sold and she was/is homeless. She didn’t get much money from her father’s will because her siblings took her to court because their father left everything to my friend. Unfortunately, after a couple of years in the court, most of the money she received was given to the attorney. Currently, she is living -and has for a couple of years- on a friend’s sofa with many restrictions placed on her coming and going. The fellow she lives with is so controlling and fearful that she would move out that he insisted she quit her job and take care of him. And, sadly, she was very used to that role. What I was wondering was if there was an adult group home for people who really can’t or don’t want to live alone. Honestly, I am afraid if she isn’t given a hand to get her out of this situation, she might become mentally unwell. Do you know of a home such as I have described? She would have to get on Medicaid, I assume for funding. Thanks for your consideration, Kim
    1. Hello and I’d like to help her . Im opening an Adult Family Care at my house and can try to help her. Let me know!

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