Adult family homes, also called board and care or residential care homes, offer personal care in a small house setting rather than a large facility. This guide explains what they cost, who they fit, and how to find one near you.
What is an adult family home?
An adult family home is a licensed residence, typically a single-family house, where a small group of seniors (usually 2 to 6) live together and receive personal care. Staff help with bathing, dressing, medication reminders, meals, and mobility, with 24-hour supervision. Because the resident-to-caregiver ratio is small, care often feels more personal than in a large assisted living community. Names vary by state: "adult family home" is common in Washington and Oregon, while other states use "board and care home," "personal care home," or "residential care facility." All describe the same small-home care model, regulated and licensed at the state level.
How much do adult family homes cost near you?
Nationally, small residential care homes run roughly $4,500 to $5,500 per month for a shared room, with private rooms and higher care needs costing more (Genworth Cost of Care Survey, 2024). Prices vary widely by city, room type, and the level of help required. Most homes charge a flat monthly rate that bundles room, meals, and personal care, though some add fees for memory care or two-person transfers. Always ask for an itemized written quote. We never quote a fixed carrier price by phone because rates depend on your location and needs, but an advisor can give you a realistic local range. Call 1-800-MEDIGAP.
Adult family home vs. assisted living: which fits?
Adult family homes suit seniors who want a quiet, intimate setting with close one-on-one attention, including many with dementia or complex daily needs. Assisted living communities are larger (often 25 to 120+ residents) with more amenities, activities, and social options, but a higher caregiver-to-resident ratio. If your loved one is overwhelmed by big buildings or needs hands-on help, a small home often works better. If they are active and social, assisted living may fit. Cost is similar at the median, so the choice usually comes down to environment and care intensity, not price alone.
Does Medicare or Medicaid pay for adult family homes?
Original Medicare does not pay for room and board or long-term personal care in an adult family home, since it is considered custodial (non-medical) care. Medicare may still cover doctor visits, hospital stays, and short-term skilled care provided to a resident. Medicaid, through state Home and Community-Based Services (HCBS) waivers, may cover care costs in licensed homes for those who qualify financially, though waiting lists are common (Medicaid.gov). Long-term care insurance and veterans' Aid and Attendance benefits can also help. To sort out what you qualify for, call 1-800-MEDIGAP for free guidance.
How to find and vet an adult family home near you
Start by confirming the home is licensed and in good standing with your state's licensing agency; ask to see recent inspection reports. Visit in person, ideally unannounced, and watch how staff interact with residents. Ask about caregiver training, staff-to-resident ratio, how medications are handled, meal flexibility, and what happens if care needs increase. Request the full fee schedule and the move-out policy in writing. Talk to current residents' families if you can. To skip the cold-calling and get matched to vetted homes near you at no cost, call 1-800-MEDIGAP (1-800-633-4427).