What is a residential care home? Understand the care, cost and more

Deciding on senior housing can be a stressful and overwhelming process, particularly if you or your loved one are hesitant to leave the comfort of home. For some, a residential care home can be the right next step, as it mimics a family home environment.

“A residential care home is just what it sounds like: care in a home,” explains Sondra “Sam” Cradduck, gerontologist, psychologist and owner of The Living Room, a non-medical senior home care agency in Phelan, California. Typically, they are homes in a regular neighborhood that have been renovated and licensed to care for a small number of residents, she adds.

With their intimate spaces and lack of hotel-like amenities that assisted living communities are known for, residential care homes are more likely to feel like someone’s house than a facility. Here experts share how residential care homes function, how much they cost and how to choose the best fit for yourself or a loved one.

What is a residential care home?

A residential care home (sometimes called a private care home) is “usually a regular house in a neighborhood where a small group of older adults live together and get help with things like meals, getting dressed, taking medications and staying safe throughout the day,” says Christen Bergeron, founder of Navigating Senior Living, a one-on-one support and membership community that guides families through the complexities of aging parent care.

In addition to providing oversight and assistance with activities of daily living (ADLs), these homes tend to have far fewer residents (often in the single digits) than a typical assisted living community and are therefore able to offer more personalized care. “Because of that smaller scale, caregivers really get to know each resident,” says Bergeron. “They learn their routines and preferences, and they’re often quicker to notice when something’s off.”

Types of residential care homes

Under the umbrella of residential care homes, there are some differences in what services and levels of care may be offered. The main defining feature of a residential care home is that it’s care in a residential home, not a building, says Cradduck. Beyond that, they may differ by specializing in one or more of the following, for example:

• Memory care.
• Hospice or end-of-life care.
• Support for higher medical needs.

What a location is able to offer may be a result of owner decisions, or it may be due to state regulations. Some residential care homes are designed for more independent residents, says Bergeron, while others are licensed to provide more advanced care. 
“Every state has its own regulations that define what level of care can be offered in a residential care home versus a larger assisted living community,” she adds. “In some states, the differences are minimal. In others, the licensing rules are much more distinct.”

“Because of that smaller scale, caregivers really get to know each resident. They learn their routines and preferences, and they’re often quicker to notice when something’s off.”

— Christen Bergeron, senior living expert and advisor

Benefits of residential care homes

Residential care homes aren’t the right fit for everyone, but they can offer a lot to the right person. “The environment tends to be calmer, with fewer people and less stimulation,” says Bergeron. “That can make it easier for someone to settle in, especially if they’re coming out of the hospital, dealing with cognitive changes or just feeling anxious about the transition.”

Here are some of the other benefits, according to experts.

• Personalized, hands-on care. This is one of the biggest benefits of a residential care home, says Ryan McEniff, a dementia care advocate and chief executive officer of Minute Women. By contrast, “in assisted living facilities, you are not going to receive more than an hour or two of one-on-one care from a personal care attendant as they need to care for dozens, if not hundreds of people,” he adds.
• A traditional bedroom, as opposed to potentially a shared suite.
• Flexibility of care. “In a residential care home, the structure isn’t as rigid as a large institution,” says Cradduck. If a resident wants to sleep in, take a bath instead of a shower or eat their favorite meal every day, they can. She adds that care plans can also be more easily adapted. If a person is showing signs of confusion, for example, “staff can quickly shift the approach, schedule or even bring in additional support without waiting for a boardroom meeting.”
• Familiar caregivers. Residents may have the same caregivers every day, which builds trust, says Cradduck.
• Homemade meals. With a smaller number of people to feed, meals may be homemade and adjusted to personal tastes, depending on the home.

The cost of residential care homes

Residential care homes are likely to be comparable or even potentially slightly cheaper than a larger assisted living facility, according to the experts we spoke to. Instead of “paying for the gym, the movie theater or the bistro like you would in a big community, you’re paying for care — and in many homes, you’re getting more of it for the cost,” says Cradduck.

Genworth places the cost of residential care homes under the larger umbrella of assisted living communities. According to them, the national median monthly rate for assisted living communities/residential care homes in 2024 was $5,900.

Due to the variety of locations, levels of care and amenities, the cost of residential care homes can vary, however. Always ask what’s included, advises Cradduck. “Some homes offer all-inclusive pricing, while others charge add-ons.”

How to pay for a residential care home

While there are a few different ways to pay for a residential care home, it isn’t a small expense. It’s important to begin discussions early with family and a care advisor or elder law attorney early and make a plan, says Cradduck. Here are some of the forms of payment you may be able to use for a residential care home.

• Private funds. In most situations, this is how you will pay for a residential care home, says Bergeron. This might mean utilizing social security payments, pensions, retirement savings or the proceeds from selling a home. In some cases, long-term care insurance may also cover care in residential settings, she adds.
• Medicaid waivers. In some situations, Medicaid can “help offset some of the cost of a residential care home, but income requirements need to be met,” says McEniff. “The state will reimburse the company providing the care home services, with the family paying the remaining balance.”
• Veterans Aid and Attendance can help with the cost of residential care homes, says Cradduck. This can apply to widows and spouses of a veteran, as well, she adds. For assistance, she recommends reaching out to Elder Veterans Legal Aid Group, P.C.

How to choose a residential care home

When it comes time to start shopping around for a residential care home, you probably have a general sense of what you’re looking for: If there are certain services you require or an area you want to stay in, for example. To find the right home, here are some steps to take and additional factors to consider, according to the experts.

1. Ask to meet the owner or administrator

“This isn’t just about credentials — it’s about culture,” says Cradduck. “If the person leading the home is kind, engaged and invested, that trickles down to the entire team.” Ask yourself, “Are they present? Do they know the residents by name? Do they light up when they talk about their staff or just quote policies?” Cradduck advises. “If they’re nowhere to be found or treat your questions like a nuisance, that’s a warning sign.”

2. Inspect the food situation

Food is a big part of daily life. And with appetite loss being a common concern for seniors, having fresh and appealing options are important. So ask who’s cooking the meals and where the ingredients come from. And look in the fridge, advises Cradduck. 

“Are the shelves clean and organized? Is the food fresh? Are there things you’d actually want to eat? Are there choices, or just bulk institutional food? If you see favorite snacks, labeled leftovers and fresh fruit, that’s a good sign. If everything is frozen dinners or there’s nothing but condiments and takeout containers, ask questions,” she says. 

3. Talk to caregivers and ask about staffing

The caregivers your loved one encounters will have a direct affect on their happiness, so it’s important to pay special attention to them, according to the experts. Consider the following.

• What does staffing look like during the day? Ask what the staffing ratios are. 
• What about overnight? You want to know who is caring for your loved one at 2 am. 
• Do caregivers sleep in shifts? If it’s a one-person show, that can lead to burnout. 
• How long have caregivers been there? If caregivers are rotating constantly, you won’t get continuity of care. 
• Do they seem engaged? 

“People who thrive in residential care homes tend to enjoy quieter spaces, routine and familiarity.”

— Sondra “Sam” Cradduck, gerontologist and psychologist

4. Observe the home and residents

When touring a home, you’ll learn a lot just by walking around and observing, says Bergeron. “Take a minute to look around,” she advises. “Is it clean and well-kept?” Does it smell like urine, or does it smell fresh? If the cleanliness is subpar or lacking, it may indicate staffing shortages or other issues.

Additionally — and this may seem obvious — pay attention to the existing residents. Do they appear happy and engaged in activity or with one another, or do they look sedated and out of it? What you see is likely what you can expect.

Is a residential care home the right choice?

Choosing a new home for yourself or your loved one is an important decision. “At the end of the day, you’re not just choosing a place, you’re choosing the people [you or]your parent will rely on every day,” says Bergeron. With that in mind, a residential care home may be the right fit for you or your loved one if the following apply. 

You prefer a smaller, home-like atmosphere

In its own way, a residential care home can resemble a family home, with group meals around the kitchen table and intimate activities. “People who thrive in residential care homes tend to enjoy quieter spaces, routine and familiarity,” says Cradduck. If someone finds noise and crowds overwhelming “or struggles with change, a small home can be just the right fit,” she adds.

On the flip side, residential care homes won’t offer some of the extras that a larger assisted living facility might, such as “group outings, transportation or on-site amenities like a salon,” says Bergeron. “For some, that’s ideal. For others, that makes it not the right fit.”

The home meets all care needs

While this can vary, “most care homes aren’t licensed for advanced memory care or nursing services,” warns Bergeron. “Make sure you know what they can and can’t provide.” It’s also important to ask if they have relationships with other providers or communities if care needs change in the future, she adds.

Family members want to be a part of the care plan

For some family members — those who are already overwhelmed or burned out — being asked to stay involved in their senior loved one’s care can feel like too much, says Cradduck. If that sounds familiar, a residential care home may not be a good fit for you or your loved one. “But for families who want to remain connected and collaborate — maybe attend care meetings or be part of celebrations — it can be a huge comfort,” she adds.

You or your loved one feel right at home

“It’s human nature to gravitate toward what we’d personally want, but your parent may feel at home in a very different environment than you would,” cautions Bergeron. Make sure you slow down, consider the features of a residential care home compared to other senior living solutions and ask yourself what is truly the best choice.