Last updated 2026-07-23
TL;DR
A board and care home is a small licensed residential setting, often 2-6 residents, offering non-medical help with daily living. It differs from assisted living (larger, more services) and nursing homes (skilled medical care). To find one, use your state licensing agency's facility directory or the Eldercare Locator. To open one, you'll need a license, a compliant property, staffing, and a policy manual specific to your state.
What is a board and care home, and how do I find one near me?
A board and care home is a small residential property, usually somebody's converted single-family house, where a few adults live together and get help with daily things like bathing, dressing, meals, and medication. Many states cap the smallest license category at six residents, though other license types in the same state allow more beds. These homes aren't hospitals and they aren't nursing homes. Think of them as a family-style alternative to a big assisted living building. The "near me" part of that search usually means one of two things. Either you're trying to place a parent or family member somewhere close by, or you're an operator scouting the local market before applying for a license. For placement searches, your best starting points are your state's licensing agency (every state runs a searchable database of licensed facilities, though the database name varies), the Eldercare Locator run by the federal Administration for Community Living, and your local Area Agency on Aging. Names for this same basic setup shift by state. California calls its small senior homes Residential Care Facilities for the Elderly, licensed through the state's Community Care Licensing division [1]. Other states use adult family homes, personal care homes, or simply board and care. Confirm the exact terminology, bed limits, and license category with your state licensing agency before you assume anything carries over from a neighboring state.
What is a group home?
A group home is a licensed residential setting where a small number of unrelated people live together with paid staff support, usually because they need help due to age, disability, mental illness, or a recovery need. The term gets used loosely across the industry. Some states license "group homes" specifically for people with intellectual or developmental disabilities, kept as a separate category from board and care homes serving seniors. Functionally, a group home and a board and care home can look almost identical from the street: a house, a handful of bedrooms, staff working shifts, meals cooked in a real kitchen. The differences show up in the license category, the population the state expects the home to serve, and the specific training and staffing rules attached to that license. A home licensed for adults with intellectual or developmental disabilities typically carries different staff training and ratio requirements than one licensed for seniors needing help with activities of daily living. If you're planning to open one, don't guess which license category fits your target population. Pull the actual regulation text from your state licensing agency site first, since applying under the wrong category can delay or sink an application entirely.
What is assisted living, and what is an assisted living facility?
Assisted living is a level of long-term care that sits between fully independent living and a nursing home. An assisted living facility is the licensed building or program delivering that care: private or semi-private apartments, staff on-site around the clock, and help with activities of daily living such as bathing, dressing, toileting, and medication management, along with meals and social activities. The National Institute on Aging describes assisted living as an option "for people who need help with daily care, but not as much help as a nursing home provides" [2]. That's about the cleanest one-line definition available, and it's a useful anchor because it separates assisted living from board and care (smaller, more home-like, sometimes lighter regulation) and from nursing homes (skilled medical care, higher staffing, heavier federal oversight). If you're comparing specific license paths or researching requirements state by state, see our guides on assisted living and assisted living facility licensing.
What does assisted living provide day to day?
A typical assisted living facility provides help with activities of daily living (bathing, dressing, grooming, toileting, transferring), medication management or reminders, three meals a day plus snacks, housekeeping and laundry, transportation to appointments, social and recreational programming, and 24-hour staff availability for emergencies. What it does not typically provide is ongoing skilled nursing care, IV therapy, or wound care beyond basic first aid, the kind of service you'd get in a nursing home. Every state licenses assisted living a little differently, so the exact service list on paper varies. Some states let assisted living communities keep residents with moderate memory care needs; others require a separate memory care license once dementia symptoms hit a certain severity. If continence care, wandering risk, or two-person transfer assistance becomes a daily need, many assisted living contracts require the resident to either add private-duty aide hours or move up to a higher level of care. For a look at how service scope compares across settings, see assisted living facilities. Families weighing whether a residential move is even necessary sometimes look at assisted living at home arrangements first, where aides deliver similar support inside the person's existing house.
What's the difference between assisted living and a nursing home?
Assisted living and nursing homes both house people who need help, but the amount of medical care draws the line between them. Nursing homes, also called skilled nursing facilities, are staffed and equipped for people who need daily medical or nursing care, rehabilitation after a hospital stay, or management of complex health conditions. Under federal regulation, a Medicare- or Medicaid-certified nursing home "must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week," per 42 CFR 483.35(b)(1), with a licensed nurse required on duty around the clock. Assisted living facilities don't carry that requirement. Staff help with daily living tasks and coordinate care, but they generally aren't delivering skilled nursing services like IV medication, ventilator management, or complex wound care. Nursing homes are also far more likely to be paid for through Medicaid or Medicare (for short rehab stays); assisted living is overwhelmingly private pay or long-term care insurance, with a growing but still limited number of state Medicaid waivers covering part of the service cost [3]. For a fuller side-by-side on how facility types compare on paper, see our facility assisted living comparison guide.
How do board and care homes, group homes, assisted living, and nursing homes compare?
| Board and care / small residential home | 2-6 residents (varies by state) | Non-medical caregivers, awake overnight staff common | Help with daily living, medication reminders | Private pay, state SSI supplement in some states, some Medicaid waivers | |
|---|---|---|---|---|---|
| Group home (IDD, mental health, recovery) | 4-8 residents typically | Direct support staff, ratios set by state | Support and skill-building, not medical | Medicaid HCBS waivers, state agency funding, private pay | |
| Assisted living facility | Ranges from a handful of beds to 100+ in larger communities | Aides, medication techs, activities staff, 24-hour coverage | Daily living help, medication management, no routine skilled nursing | Private pay, long-term care insurance, limited Medicaid waiver coverage | |
| Nursing home / skilled nursing facility | 60-120 residents is common | RN required at least 8 hrs/day, licensed nurse 24/7 | Skilled nursing, rehab, complex medical needs | Medicare (short stays), Medicaid (long-term), private pay | The National Center for Assisted Living, the trade association for the sector, tracks these distinctions closely for its members and publishes state-level profiles of how assisted living is regulated. If you're an operator, the license type you pick determines almost everything downstream, from the fire code your building has to meet to which residents you're legally allowed to admit. |
Here's the same comparison laid out directly, since size, staffing, and payer mix are usually what decide which setting fits a given person or business plan. | Setting | Typical size | Staffing | Medical care level | Usual payer |
Does Medicare cover assisted living facilities or board and care homes?
No, generally not. Medicare does not pay for the room and board or personal care costs of assisted living facilities, board and care homes, or group homes. Medicare.gov's coverage guidance explains that long-term custodial care, meaning help with daily activities that doesn't require skilled medical care, sits outside what Medicare pays for [4]. Medicare will pay for medically necessary skilled nursing or rehab in a certified nursing facility for a limited period after a qualifying hospital stay, and it covers home health and hospice services regardless of where someone lives, but it won't pay the monthly bill at an assisted living community or board and care home. Medicaid is a different story, sort of. Traditional Medicaid also doesn't cover room and board in these settings, but most states run Home and Community Based Services (HCBS) waivers under Medicaid authority that can pay for personal care, case management, and other in-home-style services delivered inside an assisted living or board and care setting, as long as the facility enrolls as an approved waiver provider [3]. Some states also offer a state supplementary payment on top of federal Supplemental Security Income specifically aimed at helping cover board and care costs. Waiver names, eligibility, and payment rates differ by state, so confirm current details with your state Medicaid agency before you build a placement or a business plan around this funding.
How do I actually find board and care homes near me?
Start with the Eldercare Locator (eldercare.acl.gov), a free federal service that connects callers to their local Area Agency on Aging and community resources. Ask specifically for licensed board and care, adult family home, or residential care facility listings, since front-line staff sometimes default to suggesting larger assisted living communities first. Second, go straight to your state's licensing agency website and look for its facility search tool. Most states publish a public database of every currently licensed home, including capacity, license type, and recent inspection history. This is also the fastest way to check whether a home you're considering, or competing against as an operator, has any pending complaints or violations on file. Third, if the resident has Medicaid, call the managed care plan or case manager. They keep lists of in-network board and care and assisted living providers that accept HCBS waiver payment, which narrows the search fast when cost is a factor. For seniors specifically, our senior assisted living facilities near me guide walks through the same search process with more detail on what to ask during a tour.
How do I start a group home or board and care home?
Starting a group home or board and care home is a licensing project before it's a real estate project. Here's the rough order most states expect, though exact steps, timelines, and agency names vary: 1. Decide which population and license type you're targeting (seniors, intellectual/developmental disability, mental health, recovery) and pull the licensing regulations for that category directly from your state licensing agency. 2. Write your policy and procedure manual, staffing plan, and emergency or disaster plan. Most states require these documents before they'll even schedule your first inspection. 3. Find a property zoned correctly for residential care use. Zoning disputes kill more group home plans than paperwork does, so confirm zoning before you sign a lease or a mortgage. 4. Complete required operator or administrator training and background checks, including fingerprinting and abuse registry checks, for yourself and any staff you plan to hire. 5. Submit your license application with the required fee, floor plan, and supporting documents to your state agency. 6. Pass your pre-licensing inspection, covering fire safety, building code, and program requirements. 7. Get your license, then keep operating in compliance for the ongoing inspections that follow, usually annual and sometimes unannounced. That list looks short. It isn't, in practice, mostly because every state writes its own version of steps one through six, and the paperwork volume adds up fast. If you'd rather not build a policy manual and staffing plan from a blank page, our $299 State Group Home Licensing Kit gives you a state-specific application checklist, policy templates, and a staffing plan format built around your actual state's requirements, as a one-time purchase instead of paying a consultant by the hour. You can start building yours at /licensing-kit-builder.
What staffing and inspection requirements should I expect as an operator?
Common baseline requirements show up across most states, though ratios and specifics vary: background checks and fingerprinting for owners and direct care staff, CPR and first aid certification, a minimum number of direct care hours per resident per day, at least one staff member awake or immediately available overnight, and documented initial and ongoing training hours. Inspections typically check life safety items (smoke detectors, fire extinguishers, marked exits, sprinkler requirements depending on building size), sanitation, medication storage and administration records, resident care plans, and staff personnel files. Most states inspect newly licensed homes within the first few months of opening and then move to an annual cycle after that, with authority to show up unannounced in response to a complaint. Don't treat the pre-licensing inspection as the finish line. It's the first of many, and the citation history on your home usually becomes part of the public record your state licensing agency posts online for anyone, including prospective families and competitors, to see.
What does it cost to start a board and care home, and how does funding work?
Startup costs for a board and care home swing widely depending on your market, whether you buy or lease, and how much renovation the property needs to meet fire and life-safety code for a licensed care facility. A property already built out for residential care in a state with light licensing fees costs a lot less to open than a from-scratch build in a state with heavy sprinkler and accessibility retrofit requirements. Rather than trusting a national average that won't match your situation, pull your state's actual license fee schedule and talk to a local contractor familiar with residential care fire code before you set a budget. On the resident funding side, the main sources are private pay, long-term care insurance, VA Aid and Attendance benefits for eligible veterans, state SSI supplements, and Medicaid HCBS waivers where the state has approved your home as a waiver provider [3]. Building a business plan around one single funding source is risky. Waiver rates change, VA benefit backlogs happen, and private-pay families sometimes run through savings mid-stay. Plan occupancy and cash flow assuming a mixed payer base, not a best-case scenario where everyone pays full private rate on day one.
Frequently asked questions
What is assisted living?
Assisted living is a level of long-term care between independent living and a nursing home. Residents live in an assisted living facility, get help with daily activities like bathing and medication, and receive meals and social programming, but don't need the round-the-clock skilled nursing care a nursing home provides.
What is a group home?
A group home is a small licensed residential setting where unrelated adults live together with staff support, typically due to age, disability, mental illness, or a recovery need. States often license group homes separately by population (seniors versus intellectual/developmental disability versus mental health), each with its own training and staffing rules.
What is an assisted living facility?
An assisted living facility is the licensed building or program that delivers assisted living care: private or semi-private rooms, staff available 24 hours a day, help with daily activities, medication management, meals, and activities, but generally not skilled nursing or complex medical care.
What is the difference between assisted living and a nursing home?
The main difference is medical staffing level. Nursing homes must have a registered nurse on duty at least 8 hours a day under federal regulation and provide skilled nursing and rehab care. Assisted living facilities help with daily living tasks but don't typically provide ongoing skilled nursing or complex medical treatment.
What does assisted living provide?
Assisted living provides help with bathing, dressing, grooming, and medication management, plus meals, housekeeping, transportation, social activities, and 24-hour staff availability. It does not typically provide ongoing skilled nursing care, IV therapy, or complex wound care, which are nursing home services.
How do I start a group home?
Pick your target population and license type, pull that state's regulations, write your policy manual and staffing plan, secure a correctly zoned property, complete required training and background checks, submit your license application, and pass your pre-licensing inspection. Exact steps and fees vary by state, so confirm details with your state licensing agency before applying.
Does Medicare cover assisted living facilities?
No. Medicare doesn't cover the room, board, or personal care costs at assisted living facilities or board and care homes because that's considered custodial, not skilled medical, care. Medicare may cover a short skilled nursing facility stay after a qualifying hospital admission, plus home health and hospice, regardless of where someone lives.
Is a board and care home the same as a group home?
They're similar in size and setup, but not always the same license. Board and care usually refers to small senior-focused homes, while group home often refers to homes licensed for people with intellectual/developmental disabilities or mental health needs. The license category, not the physical building, decides which term applies.
How many residents can a board and care home have?
It depends entirely on the state and license category. Many states set a small-home threshold around six residents with simplified requirements, then allow larger license tiers with additional staffing and fire safety rules. Confirm the exact bed limit for your license type with your state licensing agency.
Can Medicaid pay for a group home or board and care home?
Medicaid usually doesn't pay room and board directly, but most states run Home and Community Based Services (HCBS) waivers that can cover personal care and related services delivered inside a licensed group home or board and care home, if that home is an approved waiver provider. Rules and rates vary by state.
Do board and care homes need a nurse on staff?
Not usually. Board and care homes are staffed by non-medical caregivers who help with activities of daily living and medication reminders. Full-time nursing staff is a federal requirement for skilled nursing facilities, not board and care or assisted living settings, though some states require periodic nurse consultation or oversight.
How much does it cost to license a group home?
License fees vary widely by state and facility size, often ranging from a few hundred to a few thousand dollars for the application itself, separate from renovation and staffing costs. There's no reliable national figure worth quoting here; pull the current fee schedule from your specific state licensing agency.
What's the difference between a board and care home and a nursing home?
Board and care homes are small, non-medical residential settings for people who need help with daily activities. Nursing homes are larger, federally regulated facilities required to have a registered nurse on duty at least 8 hours a day for residents needing skilled medical or rehabilitation care.
Sources
- National Institute on Aging, Residential Facilities, Assisted Living, and Nursing Homes: Definition of assisted living as help with daily care short of nursing home level
- Medicaid.gov, Home & Community Based Services: Medicaid HCBS waivers can cover personal care services delivered in assisted living or board and care settings
- Medicare.gov, Long-Term Care Coverage: Medicare does not cover custodial long-term care such as assisted living room and board
- California Department of Social Services, Community Care Licensing Division: California licenses small senior homes as Residential Care Facilities for the Elderly
- U.S. Small Business Administration: Conducting market research and competitive analysis is a recommended early step when starting a small business such as a board and care home.
- U.S. Small Business Administration: SBA loan programs are a potential funding source for entrepreneurs looking to start a board and care home business.
- U.S. Department of Health & Human Services: Understanding the difference between Medicare and Medicaid is important when determining coverage for long-term care services like assisted living or board and care homes.
- Medicaid.gov: Medicaid provides coverage for institutional long-term care services, including nursing facility care, under certain eligibility requirements.
- National Institute on Aging: Nursing homes provide skilled nursing care for individuals who need a higher level of medical support than assisted living or board and care homes typically offer.