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For many people looking into senior living options, there’s confusion about the difference between assisted living facilities and board and care homes. While these options sound similar — both provide non-medical care and personal living space — there are some key distinctions that set them apart from one another.
Simply put, an assisted living facility is a “residential facility that offers a step up in care from independent living,” says Amy Goyer, AARP family and caregiving expert and author of “Juggling Life, Work and Caregiving.” Assisted living facilities are larger, similar to apartment complexes, and with more residents, staff members and extensive amenities, she adds.
On the other hand, a board and care home — sometimes referred to as a group home or residential care home — offers similar services to an assisted living facility, “but in a more homelike setting,” Goyer explains. They are typically smaller and may offer more personalized care. Here, Goyer and other experts dive into the differences and similarities of assisted living vs. board and care in detail to help you make the best choice.
Key takeaways
- Assisted living facilities tend to have more amenities than board and care homes, including fitness centers and daily activities. But board and care homes often offer more personalized care.
- While board and care homes may have an average of six residents, many assisted living facilities can house 30 or more residents.
- In general, board and care homes are less expensive than assisted living, though costs for both options can vary significantly by location.
Assisted living vs. board and care: Key differences in care
Each assisted living and board and care facility is unique in terms of the type and levels of care they offer residents.
Both board and care homes and assisted living facilities can help residents with the activities of daily living, such as bathing, dressing and medication management. But they may vary in terms of amenities, the patient to caregiver ratio and other specifics of care. Here are the specifics.
1. Size and capacity
Generally, board and care homes are smaller than assisted living facilities. “Assisted living is a lot more communal, often ranging from 30 units or more, while board and care homes usually only have around six beds,” says Christina Bremner, founder and CEO of Purple Door Finders, an online resource for senior and assisted living.
2.Personalized care
Small board and care homes often have the capacity to offer higher levels of personalized care because of their size. “They’re not pulling from a large pool of caregivers who take care of several different residents,” Bremner shares. In some cases, board and care homes are even able to offer 1:1 care, Goyer adds, though not all of them do.
“If a loved one needs a bit more help — such as making sure they eat their meals, etc. — a board and care home may be better,” Goyer says. However, she suggests researching each board and care home you are interested in because the quality of care in these homes can vary widely.
Assisted living facilities tend to be best for people who need help with tasks like medication management, meals and housekeeping, but who don’t need as much attention throughout the day. And, while assisted living may not offer 1:1 care, what they do offer is 24-hour care, says Goyer. Not all board and care homes have staff members available 24 hours, whereas assisted living facilities typically do. Keep in mind, though, that this doesn’t necessarily mean these staff members are supervising you at all times, Goyer emphasizes. It just means they are available, should the need arise.
3. Continuing care as needs change
If care needs increase, it’s likely you might need to move out of assisted living. For instance, people who require high levels of medical care often move into a skilled nursing facility, and people with dementia may eventually move to a memory care unit.
If you are looking for care that changes as your needs change, a board and care home may be more likely to meet this requirement, though not all are able to. “In my experience, some board and care homes will allow residents to stay even as their needs increase and will allow families to pay for a 1:1 care aide or hospice care to come in so they can stay in the same setting,” Goyer says.
Of course, this will vary by facility. It’s important to ask questions about continuing care as you research and tour each option.
“If you’re looking for a smaller, more affordable setting, a board and care home will be your best option. Assisted living offers a more communal setting with communal resources and tends to be best for those prioritizing activity and socialization.”
— Christina Bremner, senior and assisted living expert
Assisted living vs. board and care: Living arrangements
Assisted living most commonly houses residents in private rooms or apartments with private bathrooms and kitchenettes. Shared rooms are less common. Board and Care homes, on the other hand, may offer a private bedroom with shared common areas (living room and kitchen, primarily). Shared rooms may also be available.
For this reason, personality and lifestyle are important considerations when deciding between assisted living or board and care. If an aging adult is social and enjoys a wide range of activities, assisted living may be a better fit. If they prefer a quiet, intimate setting with more one-on-one attention, a board and care home could be the ideal choice.
Board and care vs. assisted living: Amenities
Because assisted living facilities are larger, they typically offer more amenities than board and care homes. For instance, depending on the facility, an assisted living community may offer:
- Fitness centers.
- Swimming pools.
- Communal, catered dining.
- Social and recreational activities, like art classes, music programming and cultural events.
- Transportation to local activities, appointments and shopping.
While some board and care homes may offer limited activities, they typically don’t have daily programming or major amenities like fitness centers. “Board and care homes often offer a more personalized experience with fewer communal amenities,” Bremner shares.
Assisted living vs. board and care: Cost
Board and care homes typically cost less than assisted living facilities, which can range from $3,409 to $11,000 per month, depending on location. Other factors impact assisted living costs, too. “Some assisted living [facilities] have a flat, inclusive fee, but many have a basic fee and then you pay more a la carte for additional services,” Goyer shares. “So the cost can rise.”
How much cheaper a board and care home is depends on the level of care a resident needs, Goyer says. “You may pay more if they need more intense help with personal care,” she explains. “The price may also be different depending on whether you have a private bedroom or share a bedroom with a roommate.”
How to pay for assisted living or board and care
It’s important to keep in mind that health insurance — including Medicare — typically does not pay for either assisted living or board and care homes. “There are lots of different ways families pay for these, Bremner says, including:
- Long-term care insurance.
- Assisted living waivers on life insurance policies.
- Private pay.
Board and care facility or assisted living: Which is right for you?
When it comes to choosing assisted living or board and care, making the best choice for yourself means considering the exact type of care you need and the kind of lifestyle you are looking for.
“If you’re looking for a smaller, more affordable setting, a board and care home will be your best option,” Bremner shares. “Assisted living offers a more communal setting with communal resources and tends to be best for those prioritizing activity and socialization.”
Here’s how to choose the best option for you:
Visit each care provider
Goyer emphasizes visiting as many board and care homes and assisted living facilities as possible during your search. This can help you get a sense of what each place is like and if it will be able to meet your needs. According to Goyer, some factors to consider as you make these visits include:
- Clear cost info, including any hidden fees.
- Staff ratios, training and when care is available.
- Cleanliness, including smell and if the rooms and residents are clean
- Quality of life, including socialization, food quality, activities, general atmosphere and proximity to loved ones.
- State regulations and if they are up-to-date on licensing and certification.
Vet the options thoroughly
Consider talking with families of current residents and find out how they feel about the care their loved one receives. Additionally, check online reviews and the Better Business Bureau for any complaints. During tours, ask the following questions:
- Is there a waitlist?
- What are the rules on providing care?
- When are visiting hours?
- How does the facility manage infection control, and what measures are taken if a resident has the flu, COVID or another infectious disease?
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Get support from senior care experts
You might also consider reaching out to a geriatric social worker, who may have more insight about the care facilities in your area and whether or not they may be able to meet your needs. A senior care advisor can also offer helpful advice and support.
Finally, if you need further help deciding on a care facility for yourself or a loved one, reach out to a healthcare provider who understands your personal needs and how they might change over time.
