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Group Homes: A Small-Scale Option for Assisted Living

Residential care facilities offer older adults who can’t age in place an alternative to large institutions


spinner image Residents of a group care home playing a game together while a female aide looks on
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Most people want to age at home, but that is not always possible, physically or financially.

Rather than move to a large assisted living community or a skilled nursing facility, another alternative exists, perhaps in an area near home. Depending on where you live, the concept may be called adult family homes, board and care homes, residential assisted living or residential care homes.

States, which license the homes, have more than 30 terms to refer to these types of living arrangements. Think of it as assisted living but in a house.

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In Wisconsin, about half of the assisted living providers are adult family homes, but they offer only about 1 in 7 of all assisted living beds. In many states, these small homes are an option that often slips under the radar.

Residential care homes can provide the same basic services as large assisted living centers. Staffers help with personal needs such as bathing, dressing, eating, medication management and toileting and can respond to emergencies. Some states allow for various levels of care in the homes, from independent living to high levels of assisted living, so make sure you know what’s included.

Most offer transportation to medical appointments or will contract with a third party. What you won’t find is the same level of care as in a nursing home.

Group homes are licensed by states under the same requirements as any other assisted living community. They typically house five to 10 people (but there may be as many as 20, depending on state regulations). Staff who directly care for residents have mandated annual training.

Residents must have care plans. Employees are required to keep records on them, too.

Some homes allow pets or have staff that can speak multiple languages. Some focus on memory care, specific disease management or general care. Someone is on site 24/7.

Group homes are usually owned by private individuals, although some are owned by companies that may operate several facilities. Staff may live in the house, sometimes along with their families.

Residential care homes often cheaper

The cost for services at board and care homes across the country hasn’t been precisely calculated. A 2021 cost-of-care survey from Genworth, a Richmond, Virginia-based company that sells long-term care insurance, puts the national median charge for assisted living at $54,000 a year and the median annual charge for skilled nursing at $95,000 to $108,000, depending on whether a resident is living in a double or single room.

The report does not include the costs at group homes, but the fees are typically less than traditional assisted living or skilled nursing.

For example, in California — one of the most expensive states to live in, according to the Council for Community and Economic Research’s annual Cost-of-Living Index — Genworth estimates median annual costs of $63,000 for assisted living and $117,530 to $146,000 for a nursing home.

However, a shared bedroom in a six-bed group home costs about $34,000 a year, and a private room runs from $48,000 to $78,000, according to William Young, founder and president of Residential Care Facilities for the Elderly, an association of California group homes.

Group homes generally charge less than larger assisted living communities, in part because they offer fewer amenities such as on-site beauty salons or art classes. Expect homes that specialize in dementia care to be on the higher side because of additional safeguards to keep residents from wandering or engaging in other behavior that could put them in danger.

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Monthly charges are either paid out of your own pocket, through long-term care insurance or, if the home has a Medicaid contract, via government financing. A veterans benefit called Aid and Attendance can help former service members and their surviving spouses cover group home costs.

How group home living is different

The lower price, higher staff-to-client ratio — for example, Florida limits its adult family care homes to five residents at most — and family-oriented setting distinguish this option from assisted living communities and nursing homes.

Residential care homes also had fewer pandemic restrictions than larger facilities, according to Young. They generally didn’t confine people to their rooms and allowed family members to visit, which helped them retain residents, he says.

Advantages of group homes can include:

  • A higher staff-to-client ratio than in assisted living complexes or nursing homes.
  • More personalized care and greater continuity of care. With fewer residents to monitor, staff can more easily detect physical and emotional changes.
  • A homelike setting that encourages socialization and can facilitate bonding with other residents and staff. It may also be a better fit for people with dementia.
  • Meals are home-cooked and can be customized.

The disadvantages of small scale

Living in a small house with just a few people can feel homey, but it isn’t going to fit every older adult’s needs. Here are some possible downsides to this arrangement.

  • Fewer opportunities to discover compatible friends.
  • Fewer amenities and activities than at larger assisted living communities. That can mean less stimulation.
  • Potentially less privacy. Residents live in closer quarters, more akin to boarding in a private home than having an apartment in assisted living.
  • No physician and rarely an on-site nurse. Some group homes do contract with a medical professional or practice to make house visits, but residents who need more frequent or complex medical attention will likely need to bring in help or move to a nursing home.

What to ask when visiting

To explore residential care homes for your loved one or yourself, you need to visit and ask a lot of questions. This is a major move, so you’ll want to look at places more than once and at different times of the day.

Before you go further, though, make sure state officials have licensed the home. Depending on where you live, that might be a department of health, social services or aging services. While you’re at it, see if the agency’s website lists any formal complaints against the home.

Taking the pulse of the place is a must. Does it seem relaxed? Are residents up and about? Are staff warm, welcoming and receptive, or do they seem rushed and indifferent? See how they interact with residents.

If you can, ask residents about their experiences and definitely talk to their families. Find out what they like or don’t like about the place. Are their needs being met? Is the staff responsive?

Many of the questions you’ll want answered are the same ones that would be on a checklist for vetting assisting living facilities. Here are some other things you’ll want to know about.

  • Ownership. Who are the owners? What is their background, and how long have they been in business? Do they live on-site, and how involved are they?
  • Staffing. Is there a staff member on duty at all times? What is the staff-to-resident ratio? What are employees’ qualifications?
  • Cleanliness and safety. How clean are residents’ rooms and common spaces? Are private and shared rooms available? Where are the bathrooms? Are there handrails and call buttons? (And if there aren’t call buttons, how do residents reach staff?) Ask to see an inspection report and complaints against the home; officials are required to show you.
  • Costs. What does the monthly fee include? Three meals a day, snacks, housekeeping, laundry, cable TV and internet access? Does the home have more than one pricing model?
  • Health care. How do residents access medical services? Does the home arrange transportation to appointments, and is that included in the monthly fee? Does it work with medical professionals who make house calls? If someone needs more help than is routinely offered, what is the next step? What happens when a resident is hospitalized?
  • Other residents. How many others live in the home, and what are their needs? How independent or impaired are they? What measures are in place to care for and safeguard residents with dementia?
  • Social interaction. What happens on a typical day? Does the staff organize activities? What are the house rules?

And don’t forget the most important question of all: Can you see yourself, or can your loved ones see themselves, living here? Does it feel like the right fit? If you’re not sure, take a look at other group homes. One of them is likely to feel the most like home.

House hunting for group homes

Because most group homes are a fraction of the size of assisted living communities, you won’t see advertisements as you often do for the larger facilities, but you can get personalized help:

  • The Eldercare Locator, a service of the federal Administration for Community Living, can steer you to local resources online (or call 800-677-1116 between 9 a.m. to 8 p.m. ET weekdays to speak to a specialist).
  • Your local senior center or county senior services department can offer referrals.
  • geriatric care manager can act as a private advocate for you or your loved one and help you find a group home. These aging-services specialists typically charge an initial assessment fee of several hundred hours and hourly rates ranging from $90 to $250. This service is not covered by Medicare or most private insurance plans.

In addition, state governments offer searchable or downloadable listings of licensed residential care homes. Here’s where to find information in the 10 states with the most residents age 65 and older as of 2020 (according to U.S. Census Bureau estimates):

Sally Abrahms, a longtime AARP contributor, cared for both her parents and in-laws. She writes on aging and boomers for national publications.

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