A board and care home is a licensed house where a small group of residents, usually 20 or fewer, get meals, personal care and round-the-clock staff. Assisted living communities are larger, with more staff, apartments and activities. California licenses both the same way, while Washington and Oregon give small homes their own license. The main differences are size, night staff, daily life and price.
Key facts
- The National Institute on Aging says board and care homes usually have 20 or fewer residents, with staff there around the clock. (NIA, 2023)
- California's night supervision rule (10 p.m. to 6 a.m.) requires a qualified person on call on the premises in facilities with fewer than 16 residents, and at least one awake employee plus one on call within 10 minutes in facilities with 16 to 100 residents. (Cornell LII, n.d.)
- Washington licenses adult family homes for up to six adults and assisted living facilities for seven or more. (Washington State DSHS, 2019)
- In 2020, 51% of residents in residential care communities with 4 to 25 beds had Alzheimer's disease or another dementia, compared with 39% in communities with more than 50 beds. (CDC/NCHS, 2022)
- The CareScout Cost of Care Survey put the national median for assisted living at $6,200 a month in 2025. (CareScout, 2026)
The list from the hospital social worker has two kinds of names on it. Some are buildings with a dining room and an activity calendar. Others are plain houses on quiet streets, with six beds each. This post explains board and care vs assisted living in plain terms: what each is called in your state, who is on duty at night, what daily life looks like, what it costs, and how to look up a home's inspection record.
The question that tells you the most about a small home is who is awake there at 3 a.m. It's in the section on staffing.
This post explains how these settings differ. Which one fits your parent is a decision for your parent and your family, with help from their doctor.
What is a board and care home?
A board and care home is a small, licensed home where residents get meals, help with personal care and supervision. The National Institute on Aging (NIA) says these homes usually have 20 or fewer residents. Rooms may be private or shared, and staff are there around the clock. Nursing and medical care usually aren't provided in the home.
The name changes from state to state. NIA lists residential care facility and group home as other names. Three Western states show how much the label and the license can differ.
| State | What the small home is called | How many residents | The larger setting |
|---|---|---|---|
| California | Residential Care Facility for the Elderly (RCFE), often called a board and care home | Some care for six residents or fewer, others for more than 100, under the same license type | Also an RCFE, often called assisted living |
| Washington | Adult family home | Up to six adults, in a regular house in a residential neighborhood | Assisted living facility, licensed for seven or more people |
| Oregon | Adult foster home | Five or fewer adults who aren't related to the provider | A place with more residents isn't an adult foster home under this law. Ask which license it holds. |
Other states use names like personal care home or adult care home. The CDC's national surveys group all of these with assisted living under one label, "residential care communities." So when you search, try your state's own term as well as "board and care."
How is a board and care home different from assisted living?
The biggest difference is size, and most of the others follow from it. A home with five residents runs like a household, with one kitchen table and one living room. A community with 80 apartments has a dining room and a bigger staff. NIA says assisted living ranges from about 25 residents to 100 or more.
| Board and care home | Larger assisted living community | |
|---|---|---|
| Size | Usually 20 or fewer residents. In Washington and Oregon, six or fewer. | About 25 to 100 or more residents |
| Living space | A private or shared bedroom in a house | Usually an apartment or room of one's own, with shared common areas |
| Who runs it | In Washington, a family, a single person or business partners, who may hire staff | An administrator and a larger team. Ask which roles are on site. |
| Night staff in California | Under 16 residents: a qualified person on call on the premises | 16 to 100 residents: at least one employee awake, plus one on call within 10 minutes |
| Activities | California requires a planned activities program in every RCFE, big or small | Social and recreational activities. Ask for the calendar. |
| Nursing | Usually not provided in the home | Varies. Ask when a nurse is on site. |
| Who pays | Mostly private pay. Medicare doesn't pay. Medicaid may pay part, depending on the state. | |
One license can cover both. In California, a six-bed house and a building with more than 100 residents can both be RCFEs, and some rules change with size. In Washington and Oregon, the small home holds a different license from larger settings. If you want the basics of the larger option first, start with what assisted living includes and what it doesn't.
Who is on duty in a small home, day and night?
In a small home, you may see the same one or two caregivers most days. That can mean familiar faces and close attention. It also means a lot rests on a few people. Ask how the home covers days off and sick days.
Night rules are where size shows the most. California's rule for night supervision, from 10 p.m. to 6 a.m., works like this:
- Fewer than 16 residents: a qualified person on call on the premises.
- 16 to 100 residents: at least one employee on duty and awake, and another on call who can respond within 10 minutes.
The rule for small homes doesn't say the person on call has to be awake. If your parent gets up at night or needs help getting to the bathroom, that detail matters. Ask about it directly.
Oregon's law for adult foster homes takes a different approach. The provider must live in the home or hire a resident manager who lives there. A provider or substitute caregiver must be on duty 24 hours a day. The state can grant exceptions under its rules, so ask whether the home has one.
Questions that work in any state:
- Who is in the house overnight, and are they awake?
- What happens when two residents need help at the same time?
- Who takes over when the owner is away or sick?
- Is a nurse involved, and how often?
- Who helps with medications, and what training do they have?
For larger communities, the questions that reveal the most are in our post on assisted living staffing.
Who lives in board and care homes, and who fits each setting?
Small homes aren't only for people who need a little help. National data points the other way. The CDC's National Center for Health Statistics compared residential care communities by size in 2020. In communities with 4 to 25 beds, compared with those with more than 50 beds:
- 51% of residents had Alzheimer's disease or another dementia, against 39%.
- 79% needed help with bathing, against 60%.
- 38% needed help with eating, against 17%.
- 24% had at least some services paid by Medicaid, against 15%.
- 13% were under 65, against 4%.
These are national figures. One home can look quite unlike the average, so ask about the people who live there now. In a small home, your parent will share meals and a living room with them.
Some things may point toward a small home. Your parent may get tired in crowds or noise, want the same few faces each day, or need a lot of hands-on help. Other things may point toward a larger community. Your parent may want lots of activities, more people to choose friends from, or an apartment of their own. Treat these as questions to talk through with your parent.
Washington's state guide puts it plainly: the wishes of the person who will live there are the most important part of the choice. One way to ask:
"Dad, one kind of place is a house with five other people, one kitchen table and the same caregivers every day. The other is a building with your own apartment, a dining room and a lot going on. Which one sounds more like you?"
Is a board and care home cheaper than assisted living?
There's no official national price for board and care homes, so the only way to know is to compare written rates. The CareScout Cost of Care Survey put the national median for assisted living at $6,200 a month in 2025. CareScout doesn't report small homes as a separate group. For what drives the bill in larger communities, see how much assisted living costs.
Payment works much the same in both settings. NIA says most people pay for a board and care home themselves, and Medicare doesn't cover it. Medicaid may pay part, depending on the state and whether your parent qualifies. If your parent has long-term care insurance, check whether the policy covers this type of home.
Washington's list of homes shows which ones hold a state contract to care for residents on state funding. That matters if Medicaid may be needed now or later. Washington's guide suggests these cost questions, and they work anywhere:
- What is the basic rate for room, board and services? Can we have it in writing?
- What does that rate cover?
- What other services are there, and what do they cost?
- What are the payment and refund policies if someone leaves before the end of a month?
- How do rate increases work?
- Do you accept Medicaid, or allow a move to Medicaid later?
How do you check a board and care home's license and inspection reports?
Start with the state licensing agency. In all three states above, small homes are licensed and inspected, and each state has its own place to look.
- California: The Department of Social Services' Community Care Licensing Division runs a facility search. It shows license status, the date licensed, visits, complaints and licensing reports. The public file at the regional office holds citations, civil penalties and other actions. The home must post its license where visitors can see it. To report a concern, the state's complaint line is 1-844-538-8766.
- Washington: The Department of Social and Health Services (DSHS) posts reports for each home online under "Find an Adult Family Home." Its guide also suggests asking the home to show you its last state inspection report, and calling the long-term care ombudsman at 1-800-562-6028.
- Oregon: Depending on the home, the licensing agency is the Oregon Department of Human Services or the Oregon Health Authority. Under state law, a licensed home has been investigated and approved, including an in-person site inspection. Ask the licensing office how to see a home's inspection and complaint history.
California's guide warns that some people try to provide care without a license. If you can't find a home in the state search, ask for its license number and look again. Then read the reports for the date, what was cited, and whether the same problem comes back. Our guide on reading an assisted living inspection report explains deficiencies and plans of correction.
What to ask when you call or visit a small home
Call before you drive over. A short call can rule a home in or out. Try something like:
"My mother needs help with bathing and dressing, and she gets up at night. Before we visit, can you tell me how many residents live there now and how many you're licensed for? Who is in the house overnight, and are they awake? Could you email me your rates and your last inspection report?"
On the visit, the California and Washington state guides suggest checking these things:
- How staff and residents talk to each other, and the mood of the residents
- Whether the layout works for a walker or wheelchair, and whether the bedroom is up a flight of stairs
- How the home handles medications
- The menu, and a meal if they offer one
- What activities and outings happen in a normal week, and whether transportation is available
- The residency agreement (California calls it the admission agreement), including extra fees and the rules for moving out
- Whether the home will show you its most recent licensing report
Washington's guide also suggests visiting more than once, at different times of day. The same house can feel different at 10 a.m. and at dinner. Use one list for every place, big or small, so you compare like with like. The assisted living tour questions give you the full set, and comparing communities side by side shows how to weigh the answers.
Score the small home and the big community on the same sheet
Parent Move Plan includes 41 tour questions and a weighted comparison of 12 criteria, so a six-bed house and a large community are judged on the same things. It works in Google Sheets or Excel, and you can share it with your family.
Get your first 3 days freeRules and prices differ by state. Assisted living rules and costs by state lists the medical exam, TB test, move-out notice, Medicaid and the median monthly cost for all 50 states, with sources.
Frequently asked questions
Is a board and care home the same as assisted living?
It depends on the state. California licenses both as Residential Care Facilities for the Elderly, which are often called assisted living or board and care homes. Washington licenses adult family homes for up to six adults and assisted living facilities for seven or more. Ask the state licensing agency which license a home holds.
Is board and care cheaper than assisted living?
There is no official national price for board and care homes. CareScout's 2025 survey put the national median for assisted living at $6,200 a month, but it doesn't list small homes as a separate group. Medicare doesn't pay for either, and Medicaid may pay part in some states for people who qualify. Compare written rates from each place.
Can a board and care home care for someone with dementia?
Some can. Washington's state guide notes that some adult family homes give specialized care to people living with dementia. In 2020, 51% of residents in residential care communities with 4 to 25 beds had Alzheimer's disease or another dementia, according to the CDC. Ask about dementia training, night staff and what happens if needs grow.
What is an adult family home?
It is Washington's name for a licensed home that gives housing and care to up to six adults in a regular house in a residential neighborhood. A family, a single person or business partners may run it, and they may hire other staff. Some allow pets, and in some homes more than one language is spoken.
Sources
- National Institute on Aging: Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care (accessed Oct 2026)
- CDC/NCHS: Variation in Residential Care Community Resident Characteristics, by Size of Community: United States, 2020 (Data Brief 454) (accessed Oct 2026)
- California Department of Social Services: Choosing a Residential Care Facility for Seniors in California, A Guide for Consumers (accessed Oct 2026)
- Cornell LII: Cal. Code Regs. tit. 22, 87415, Night Supervision (accessed Oct 2026)
- Washington State DSHS: Choosing Care in an Adult Family Home or Assisted Living Facility, DSHS 22-707 (accessed Oct 2026)
- Oregon Revised Statutes 443.705: Definitions for adult foster homes (accessed Oct 2026)
- Oregon Revised Statutes 443.725: License required, on-site provider required (accessed Oct 2026)
- CareScout: Cost of Care Survey 2025 (accessed Oct 2026)