Navigating your senior care options can be challenging, and that’s especially true when it comes to choosing residential care. Some facilities are geared toward retirees who are active and independent, while other residential care communities serve those who need assistance with activities of daily living (ADLs), medical support or a specialized, therapeutic setting.

To help you narrow down your options, we’ve prepared this plain-language guide to explain the similarities and differences between two popular types of residential care for seniors — assisted living and board and care homes.

You’ll find information on the care and services offered in assisted living communities and board and care homes, as well as the average monthly rates. You’ll also learn who should consider each kind of residential placement and the similarities and differences between these two types of facilities.

Assisted LivingBoard and Care Homes
Average Number of Residents20 or moreFewer than 20
Care ProvidedAssistance with ADLs; medication management; room and boardAssistance with ADLs; medication management; room and board
Nationwide Average Annual Cost$51,600$51,600
Who Should ConsiderSeniors who need ongoing assistance with ADLsSeniors who need ongoing assistance with ADLs and prefer to reside in a small, homelike setting

Assisted Living

Assisted living communities provide seniors with long-term residential care in a communal setting. These communities are designed for adults who need some assistance with ADLs, such as getting dressed and preparing meals, but who don’t need the level of specialized support provided in a memory care facility or nursing home.

What’s Included With Assisted Living?

While services and amenities vary, most assisted living facilities offer:

  • Around-the-clock on-site awake caregivers
  • Semiprivate or private accommodations in either an apartment-style suite with a kitchenette or a bedroom with an en suite bathroom
  • Three meals daily, plus snacks served in a communal, restaurant-style dining room
  • Nonmedical assistance with activities of daily living
  • Daily social and recreational programming
  • Common areas for residents, such as small libraries, patios, courtyards, games rooms and media rooms
  • Transportation to local medical appointments and shopping areas
  • Weekly housekeeping and laundry services
  • On-site personal care services, such as hairdressing and foot care

While some assisted living communities are stand-alone facilities, it’s common to find assisted living services offered within a large continuing care facility, along with independent living, memory care and skilled nursing services. These larger senior living communities may be equipped with additional amenities, such as swimming pools, putting greens, chapels and clinic space for visiting rehabilitation and medical professionals.

Assisted living facilities are usually barrier-free and fully accessible for those who use mobility devices, such as walkers, wheelchairs or mobility scooters. Multistory facilities are often equipped with one or more elevators, fire suppression systems, and an in-house medical alert system that residents can use to call for assistance at any time.

Many assisted living communities are owned by large regional, national or multinational senior care companies, and a small number of these communities are operated by religious organizations and nonprofit agencies.

Who Should Consider Assisted Living?

Assisted living care may be a good option for seniors who are no longer able to safely and comfortably live on their own in the community but don’t require skilled nursing or memory care services.

Assisted Living Rates

According to Genworth’s 2020 Cost of Care Survey, nationwide, the average monthly cost of assisted living care is $4,300, which works out to $51,600 per year. Actual rates vary depending on the location and services offered.

Board and Care Homes

Board and care homes are designed for seniors who need help with ADLs and prefer to live in a small, intimate setting, rather than a larger senior living community. In some areas, these facilities may be called adult family care homes, adult foster care homes, group homes or personal care homes.

These small, homelike facilities are often located in residential neighborhoods or in rural settings on a small farm or ranch. It’s also common for board and care homes to be located in large historical properties, such as converted estate homes, hotels and inns, which may or may not be wheelchair-accessible. Some board and care homes only accept men or women, although most are coed.

What’s Included With Board and Care Homes?

Board and care home rates often include the following services and amenities:

  • A private or semiprivate bedroom, often with an en suite bathroom
  • Three daily meals served in a family-style dining room, plus snacks and beverages
  • Nonmedical assistance with ADLs
  • Around-the-clock staffing
  • Group and individual recreational programming, such as crafting, sing-alongs and outings to local restaurants and attractions
  • Weekly housekeeping and laundry services
  • Common areas, such as a living room with a television, a games room, resident gardens, a porch or patio and a crafting room

Many board and care homes are family-owned and -operated, and some are staffed by caregivers who live on-site in either an apartment or separate residence. Unlike larger residential facilities, which usually have a number of caregivers, these homes are usually staffed by a small team of caregivers.

Who Should Consider a Board and Care Home?

A board and care home may be ideal for seniors who need nonmedical assistance with ADLs and prefer to live in a small, homestyle setting, rather than a larger assisted living community. Because board and care homes tend to have far fewer amenities and add-on services than assisted living communities, board and care homes are best suited to seniors who feel most comfortable in a smaller residence.

Board and Care Home Rates

There’s no nationwide data documenting the average rates at board and care homes. Given that board and care homes provide services that are similar to assisted living in a smaller setting with fewer common amenities, it’s safe to assume that annual board and care rates are comparable to the average assisted living rate of $51,600 per year nationwide.

Frequently Asked Questions About Assisted Living vs. Board and Care Homes

Are both assisted living and board and care homes licensed and inspected?

While assisted living facilities are regulated by local and state laws, in some jurisdictions board and care homes aren’t subject to the same standards as other larger senior living communities. You can contact your local Area Agency on Aging to learn more about residential care licensing, standards and inspections in your region.

Does Medicaid cover placement in assisted living or a board and care home?

Medicaid coverage for residential care is state-specific. In general, facilities must be licensed in order to qualify for reimbursement for services through Medicaid, which means that Medicaid likely won’t pay for the cost of room and board in a nonlicensed board and care home.

My loved one has a progressive degenerative condition. Which type of care is the best option?

If your loved one’s current care needs can be met in assisted living, but they’re likely to require extra support in the foreseeable future, then an assisted living facility that also offers skilled nursing and memory care may be the best option. This would allow your loved one to remain as independent as possible while avoiding the stress of relocating to a different facility when their care needs change.