Board and care homes vs assisted living Which setting fits your parent

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A board and care home is a small private house, usually 20 or fewer residents. Assisted living runs from as few as 25 residents to over 100. Both offer the same non-medical personal care. They differ in size and activities.

The brochure difference stops about there. The harder question is which setting your parent belongs in. Three things answer it. Federal survey data shows who already lives in each. A national cost survey covers only one of the two. And a federal complaint ledger names what goes wrong in both.

Board and care homes are small, licensed, and named six different ways

The National Institute on Aging calls these small private facilities, also known as residential care facilities or group homes, and says they usually have 20 or fewer residents, in rooms that may be private or shared. Residents receive personal care and meals, staff are available around the clock, and nursing and medical care usually are not provided at the home. NIA last reviewed that page in October 2023.

The naming problem is real, and it is worth knowing before you start searching. When the National Center for Health Statistics defines the category it surveys, it groups several kinds of home under one heading: assisted living communities sit alongside personal care homes, adult care homes, board care homes, and adult foster care, all as residential care communities, and your state may license the same kind of house under any of those labels. To be counted in that federal survey at all, a home has to be regulated by its state. The regulation has to cover room and board with at least two meals a day and around-the-clock on-site supervision, and it also has to cover help with personal care such as bathing and dressing, or with health-related services such as medication management. The home also needs four or more licensed, certified, or registered beds.

There were 32,231 residential care communities in the United States according to the 2022 National Post-acute and Long-term Care Study, a figure NCHS carries on its FastStats page as of its September 2025 review. That single count covers both settings compared here, because the federal survey files them under one heading.

Assisted living starts around 25 residents and adds an apartment

NIA describes assisted living as being for people who need help with daily care, but not as much help as a nursing home provides, and says these facilities range in size from as few as 25 residents to 100 or more. Residents usually live in their own apartments or rooms and share common areas. The services NIA lists include up to three meals a day, assistance with personal care, help with medications, and housekeeping and laundry, plus 24-hour supervision, security and on-site staff, and social and recreational activities. Typically a few levels of care are offered, and residents pay more if they need extra services or special care. Our breakdown of what assisted living costs and includes goes through what the base rate covers and what gets billed on top of it.

Set the two NIA descriptions side by side and the overlap is larger than the gap. Personal care, meals, medication help, and around-the-clock staff appear in both. What appears in the assisted living entry and not in the board and care entry is the private apartment and the shared common areas, and the housekeeping and laundry and the social and recreational program are there too. So in NIA's own wording, what changes between the two is the building and the amount of organized life inside it.

The residents themselves differ more than the descriptions do

In December 2022, NCHS published Data Brief 454, which compared residential care residents by the size of the community they lived in, using 2020 survey data. Of residents in communities with 4 to 25 beds, 79% needed help with bathing, against 60% in communities with more than 50 beds, and for eating the split was 38% against 17%. Help with walking, dressing, toileting, and transferring in or out of a bed or chair was likewise needed by a higher share of residents in the smallest communities. NCHS summarized it plainly: the percentage of residents needing assistance in bathing, dressing, toileting, transferring, walking, and eating was highest in communities with 4 to 25 beds.

The same brief found 51% of residents in 4 to 25 bed communities had been diagnosed with Alzheimer disease or other dementias, against 47% in 26 to 50 bed communities and 39% in communities over 50 beds. Medicaid ran the same direction, paying for at least some services for 24% of residents in the smallest communities and 15% in the largest, while age ran the other way: 45% of residents in the smallest communities were 85 and over, against 51% in the largest. Read together, the 2020 figures put the heavier average care load in the smaller communities. For a parent with significant memory loss, our comparison of memory care and standard assisted living covers the specialized end of that range.

Now the correction, because the paragraph above is easy to misread. NCHS measured who was living in each size of community in 2020, and it did not measure who did better there; the brief states that its purpose is to inform policy makers, providers, researchers, and consumer advocates planning for an aging population. A survey of who lives somewhere cannot say why they went there. So the right use of these figures is narrow. They tell you that a small home is a plausible place for a parent who needs hands-on help with most of the day, and that the people already living there are likely to need that much help too. They do not tell you that any particular house is good at it.

Is a board and care home cheaper?

Half of that comparison has no national number behind it. The CareScout Cost of Care Survey puts the 2025 national median for an assisted living community at $6,200 a month, or $74,400 a year, up 5% from $5,900 in 2024. CareScout ran that survey from July through November 2025, contacting 211,985 long-term care providers and completing about 16,000 surveys, of which 4,944 were with licensed assisted living communities. If you were looking for the Genworth survey this figure used to be attributed to, it is the same survey under new branding, and CareScout's own methodology section still calls it the Genworth Cost of Care Survey when it explains the 434 regions it covers.

The survey publishes national medians for five things: non-medical in-home care, skilled nursing in the home, adult day health care, assisted living communities, and nursing homes. Board and care homes are not one of them. So anyone telling you the small homes are cheaper is working from local knowledge or from a sales sheet, not from a national figure, because no national figure exists. CareScout itself warns that the cost for any particular provider may differ significantly from the median cost of care for similar providers in your location. Price the specific houses on your list against each other. If in-home help is still on the table, our comparison of in-home care and assisted living works through that trade on cost, safety, and caregiver load.

Medicare pays for neither, and Medicaid depends on your state

Medicare's own coverage page for long-term care opens with the line "Medicare doesn't pay for long-term care". The page explains that because most long-term care is non-medical, Medicare and most health insurance, including Medicare Supplement Insurance, do not pay for long-term care services. The page states that you can get non-medical long-term care services at home, in the community, in an assisted living facility, or in a nursing home. You pay all costs for non-covered services. NIA says the same thing separately for each setting: Medicare does not cover the costs of a board and care home, and Medicare does not pay for assisted living.

Medicaid is the conditional one, and the conditions are set by your state. NIA's wording is that Medicaid may provide partial coverage of a board and care home, depending on the state and whether the person is eligible. NIA says Medicaid may also provide coverage for some aspects of assisted living, on the same two conditions. Nothing in that is a guarantee, and eligibility is decided by your state Medicaid agency, not by the home. It does happen at scale, though. NCHS found that in 2020, Medicaid paid some or all of the long-term care services of 18% of all residential care community residents. That is measured over the 30 days before the survey. The share was highest in the smallest communities. If your parent's savings will not carry a $6,200 monthly bill for long, call the state Medicaid agency before a deposit is paid.

Ask any referral service who is paying it

Referral services and matching directories sit between families and homes in both categories. Arizona has written into statute how such an agency is paid. A.R.S. 36-446.14 requires a referral agency to make a disclosure at the time of or before any referral. The disclosure is that the assisted living facility or assisted living home pays the agency a fee in connection with the referral. The agency also has to give the amount of the fee or a good faith estimate.

The statute prescribes the wording: "We are in the business of referring residents to assisted living facilities and assisted living homes. We will be paid by the facility or home if you move into one of the referred facilities or homes. The fee we receive from the facility or home into which you move typically ranges from (____) to (____) percent of your first month's rent and care charges or from ($____) to ($____)." Arizona also lets a prospective resident terminate all of the agency's services at any time by giving written or electronic notice.

Arizona's statute binds nobody in another state. Read as a description of the business model, though, it travels, and it hands you a question with a checkable answer: who pays you, and how much. FamilyCareWise takes no placement fees and lists no sponsored homes, which is why this page compares categories instead of naming a shortlist. Use a directory for its listings if the listings help, and verify the license yourself.

Check the license and the complaint record before the tour

Every state has an advocate assigned to residents of both settings. The Long-Term Care Ombudsman Program is authorized under the Older Americans Act. It works to resolve problems related to the health, safety, welfare, and rights of residents, who live in nursing homes, board and care and assisted living facilities, and other residential care communities. The Administration for Community Living reports that the program operates in all states, the District of Columbia, Puerto Rico, and Guam, and that in federal fiscal year 2023 it worked to resolve 202,894 complaints, resolving or partially resolving 71% of them to the satisfaction of the resident or complainant.

The National Long-Term Care Ombudsman Resource Center states that all services the program provides are free and confidential, and that anyone can contact the program with a concern.

ACL also publishes what those complaints were about, and the list is the closest thing to a preview of what can go wrong. In fiscal 2023, the five most frequent complaint categories were discharge or eviction, medications, food services, physical abuse, and staffing. That covers board and care, assisted living, and other residential care communities. That is a ranking of complaints the program handled, not a measure of how often those things happen. Even so, discharge sitting at the top of that list is worth acting on. Ask every home what happens when a resident's care needs increase. Read the answer in the contract instead of taking it in the hallway.

NIA's guidance on how to choose a long-term care facility gives the rest. Ask how many people live there and what it costs. On a visit, look for state licensing, Medicare and Medicaid certification, and accessibility for people with disabilities. Look for residents who look appropriately dressed and well cared for, warm and respectful interaction between staff and residents, and a clean, fresh-smelling, comfortable, well-maintained building. Ask how many care providers there are per resident and what training they have. Ask how long the director and heads of nursing and food service have worked there, and whether there is a special unit for dementia. Then make a second visit without calling ahead, on a different day of the week or time of day, and stop by at mealtime. NIA also says to read the contract carefully once you select a facility, and to read it again before signing.

To find any of this locally, NIA points to the Eldercare Locator at eldercare.acl.gov or 800-677-1116, a service of the Administration for Community Living. NIA also points to your local Area Agency on Aging. The licensing agency itself is a state office, and what it publishes varies. California's Community Care Licensing Division, for one, runs a complaint hotline, a facility search, and a published list of the deficiencies it cites most often. Ask your own state's equivalent about a specific home before the tour.