Guide

Board and care homes: small care homes for seniors in the U.S.

Updated October 15, 2026 · Reviewed against official sources

Many Latino families are looking for something in between: their mom can no longer stay alone, but a big building feels cold or confusing to her. Small care homes can be that option: just a few people, a home kitchen and a calm routine. This guide explains what they are, what they're called in some states, how they're paid for and what to ask before you decide. If you're still comparing types of care, start with types of senior living and care.

What a small care home is

You'll hear it called a board and care home, residential care home, adult family home, adult foster care or personal care home. In Spanish, people say casa de cuidado, residencia pequeña or hogar familiar. What they have in common:

• It's a residential house, not an apartment building or a hospital.
• A small group of residents lives there, with caregivers who work in shifts or live in the house.
• It offers a room, meals, supervision and personal care. It's not a place with 24-hour nursing care, like a nursing home.

Each state sets its own rules. Here are three examples.

California: RCFE

In California, these homes are RCFEs (Residential Care Facilities for the Elderly). According to the California Department of Aging, an RCFE provides non-medical care and supervision to people 60 or older who shouldn't need ongoing medical care from the staff. Many board and care homes are six-bed houses in residential neighborhoods, although much larger facilities also operate under the same license. They are licensed by the Community Care Licensing Division of the Department of Social Services (CDSS). In our directory they're listed as assisted living in California.

Washington: adult family home

Washington law (RCW 70.128.010) defines an adult family home as a residential home where one or more people provide personal care, room and board to more than one but not more than six adults who are not related to them. With state approval, it can serve up to eight. They are licensed by the Department of Social and Health Services (DSHS).

Florida: adult family-care home

In Florida (statute 429.65), it's a family-style living arrangement in a private home: the person who owns or rents the home provides room, board and 24-hour personal care to no more than five frail older adults or adults with disabilities who are not related to them. They are licensed by the Agency for Health Care Administration (AHCA).

In Puerto Rico, the closest equivalent is the hogar sustituto (substitute home): read hogares de cuido and égidas in Puerto Rico. In other states, ask the state licensing agency or the Eldercare Locator at 1-800-677-1116, Monday through Friday from 9 a.m. to 8 p.m. Eastern time; if you prefer Spanish, ask for it when you call.

Who it's usually a good fit for

• People who need daily help and supervision, but not skilled nursing care all day.
• People who feel calmer with just a few people around, less noise and a home routine.
• Families who value staff who get to know their loved one well and food that's like home cooking.

It may not be the best option if your loved one needs 24-hour nursing care, complex medical equipment or lots of social activities. In that case, compare it with a larger assisted living community or a nursing home. Our Katz and Lawton scales help you sort out how much help they need (they're only a guide, not a diagnosis). If there is memory loss, also read about memory care.

How it's paid for

Paying out of pocket

This is the most common way: Social Security, a pension, savings or help from the children. Ask for the monthly rate in writing and ask what it includes (laundry, incontinence supplies, rides to appointments) and what costs extra if your loved one needs more help over time.

SSI and state supplements

Federal SSI (Supplemental Security Income) is $994 a month for one person in 2026. Some states add a supplement for people who live in a licensed care home:

• California: for "nonmedical out-of-home care," the SSI payment plus the state supplement (SSP) is $1,626.07 a month in 2026 ($994 from SSI and $632.07 from SSP). If a home accepts residents on SSI, ask whether it takes that amount as full payment and what it includes.
• Florida: there is an Optional State Supplementation program for people who receive SSI, or whom the state considers eligible, and who live in an assisted living facility or an adult family-care home. The state sets the amount based on that year's funding; ask the Department of Children and Families (DCF).

Medicaid

Under federal rules, Medicaid home and community-based programs (waivers) don't pay for room and board, with exceptions such as respite care for the caregiver. They can pay for care services in some states. In Washington, for example, the law distinguishes between adult family homes that receive payments from Medicaid long-term care programs and those that don't. Ask the home whether it accepts Medicaid and read Medicaid home care programs (waivers).

Veterans and insurance

• The VA pension with Aid and Attendance can help pay for the home: see our guide to veterans benefits.
• The VA also has Medical Foster Homes: private homes where a trained caregiver looks after a few people. The VA doesn't pay for them: the veteran agrees on the cost with the caregiver and must be enrolled in the VA's Home Based Primary Care program.
• Some long-term care insurance policies cover licensed care homes.

To see all the options together, read how to pay for long-term care.

What to ask when you visit

In a small home, a few people do all the work. These questions help you learn how they're organized:

1. What license do you have, and when was the last state inspection?
2. How many residents live here, and how many caregivers are there during the day and at night?
3. At night, are staff awake, or do they sleep in the house and get up if someone needs them?
4. Who gives the medications, how are they stored and how are they recorded?
5. Who fills in for the main caregiver if they get sick or go on vacation?
6. Does anyone speak Spanish? Can you cook the food my loved one likes?
7. Who takes residents to medical appointments? Does a nurse or a home health agency come to the home?
8. Up to what level of care can you look after my loved one here? If one day they need more, how much notice would we have to find another place?
9. What does the contract say about price increases, deposits and refunds?

Bring the visit checklist and come back on another day, at a different time, to get a feel for the home's daily rhythm. If language matters to you, read senior care with Spanish-speaking staff.

💬Frequently asked questions

Is a board and care home the same as assisted living?

In many states they share the same type of license; what changes is the size. In California, for example, the RCFE license covers both six-bed homes and large facilities.

Does Medicaid pay for a board and care home?

Medicaid doesn't pay for room and board. In some states it pays for care services through waivers, and SSI with a state supplement can cover part of the rest.

Who can help me if I have a concern about the care?

First, talk with the person in charge of the home. The long-term care ombudsman program also serves residents of board and care homes and assisted living.

This guide is for information only and is not legal or financial advice. Rules vary by state; confirm them with the licensing agency and with the home.

Sources

• California Department of Aging, Assisted Living Facilities (RCFE): https://aging.ca.gov/care_options/Assisted_Living_Facilities (accessed October 15, 2026)
• California DHCS, SSI/SSP Payment Standards Effective January 1, 2026 (ACWDL 25-29): https://www.dhcs.ca.gov/services/medi-cal-resources/medi-cal-eligibility-division/all-county-welfare-directors-medi-cal-eligibility-division-information-letters/ssi-ssp-payment-standards-effective-january-1-2026/ (accessed October 15, 2026)
• Washington State Legislature, RCW 70.128.010, adult family home definitions: https://app.leg.wa.gov/RCW/default.aspx?cite=70.128.010 (accessed October 15, 2026)
• Florida Legislature, Florida Statutes 429.65, adult family-care home definitions: https://www.flsenate.gov/Laws/Statutes/2025/429.65 (accessed October 15, 2026)
• Florida Legislature, Florida Statutes 409.212, Optional supplementation: https://www.flsenate.gov/Laws/Statutes/2025/409.212 (accessed October 15, 2026)
• CMS/CMCS, Informational Bulletin of December 9, 2025 (2026 SSI): https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf (accessed October 15, 2026)
• eCFR, 42 CFR 441.310, limits on federal payment for home and community-based services: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-G/section-441.310 (accessed October 15, 2026)
• U.S. Department of Veterans Affairs, Medical Foster Homes: https://www.va.gov/geriatrics/pages/medical_foster_homes.asp (accessed October 15, 2026)
• ACL, Long-Term Care Ombudsman Program (fact sheet): https://acl.gov/sites/default/files/programs/2019-08/Long_Term_Care_Ombudsman_Program%202019.pdf (accessed October 15, 2026)
• ACL, Eldercare Locator: https://acl.gov/HousingandServices/FindHelp (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

Types of senior care

Nursing homes, assisted living, board and care, memory care, adult day care, home care, and hospice: who each one is for, what it costs, and who pays.

What is assisted living

What assisted living is, who regulates it in each state (RCFEs in California, Type A and B in Texas), what it costs, and when Medicaid pays for services.

Choosing a place for care

How to choose a nursing home: assess the need, check the license, star ratings and inspections, visit, what to ask and how to read the contract.

Veterans: Aid and Attendance

VA Aid and Attendance pension: 2026 rates, the net worth limit, State Veterans Homes and VA facilities to help pay for a veteran's care.