A Guide to Residential Care Homes

The vast majority of seniors say they would like to stay in their own homes for as long as they can. But, that’s not always possible due to health issues and life circumstances that affect independence. 

Assisted living facilities and nursing homes make for an abrupt jump from the comfortable home environment, but there’s an in-between option that appeals to many seniors: residential care homes. These are small, home-like senior communities that, by 2020, more than 800,000 seniors called home. If you or your loved one may need residential care but you’re not interested in a large assisted living community, a care home may be a great option. 

In this guide, we answer the question of what makes residential care communities appealing, what it’s like to live in one of them and what you should look for in a residential care home for yourself or for senior loved ones.

Residential care homes are small group living communities for seniors. They usually have 25 or fewer residents in an environment designed to feel as much like a family home as possible. These facilities are often situated in large family homes in suburban neighborhoods. Rooms may be private or shared, meals are usually taken together in the dining room and the residents often form a close-knit community under the supervision of a house manager.

These homes are substantially different from other types of senior living arrangements due to their small size and consistent environments. Assisted living facilities vary widely in their designs and amenities, but they all tend to be larger and more impersonal than a residential care home. Skilled nursing homes are far more clinical than residential facilities, and they offer a far more medically oriented range of care services, such as medication management and tube feeding.

Residential care homes are built around comfort and basic daily care for their residents, rather than medical care and rehab services like in a nursing home. The residential care staff provides daily supervision. The staff may be as small as a single person, along with caregiver assistance with activities of daily living. Common residential care services include:

Residential care homes have a lot to offer seniors who decide to move into them after having a home of their own. That said, there are some drawbacks, and this isn’t a solution for everybody. The positives of residential care have to be balanced against the limitations of what is fundamentally a nonmedical living plan. 

• Closeness: Residential care homes are usually small, at something like four to 25 beds apiece. That can’t help but foster a closer community than a 500-bed assisted living facility. Many seniors thrive in the family-style environment of a care home like this.
• Comfort: The environment in a residential care home is intended to be as nonclinical as it can be. These homes often have carpet instead of linoleum, the decorations typical of a private home rather than a nursing facility, and the amenities of a private house such as a fireplace and a landscaped backyard.
• Visitation Policies for Families: Family members are usually welcome to visit with their senior loved ones at residential care homes with an open-door policy for guests. Assisted living facilities can be like this, but some aren’t, and nursing homes often have designated visitor hours and policies. The easy come-and-go of a residential care home promotes close family bonds and encourages relatives to stay involved in their loved ones’ care.

• Size: The small size of a residential care home is a bonus for many seniors, but it can also be a drawback. Some seniors prefer the larger, more diverse community of an assisted living facility, or they may want the less structured lifestyle of an independent living apartment complex.
• Staffing: Every state has standards for staff-to-resident ratios, but the smaller size of a residential care community means it might have only a single full-time worker on staff. This person might live on the premises, or a small number of workers may cycle through the home to provide 24-hour coverage. Larger facilities almost always have much larger staffs and can be more flexible.
• Limited Health Services: Residential care homes are distinguished by their lack of nursing and other specialty care. While some medical and mobility equipment such as CPAP machines and shower chairs turn up in a residential care setting, higher-level care is generally not available unless a resident moves up into skilled nursing. 

If you’re thinking about moving into a residential care home, you might be unsure whether it’s the ideal place to try out or whether another level of care might be better for you. Not everybody is a good fit for residential care, whether it’s because of special needs or just personal preference. Here are some questions for you to ask before you make your decision about where to live.

If you’re able to remain safe and thrive in your own home, that’s likely to be a priority for you. People start thinking about a residential care setting when this isn’t a realistic option anymore, but they’re not sure about which kind of setting to move to. Seniors who need a loose community around them with daily check-ins, but who don’t need closer care than that, may be able to thrive in an independent living setting. 

People who need closer care than this might have to give up some independence. Residential care homes are among the less-intrusive care types for seniors who can no longer stay in their own homes. This setting tends to be favored by seniors who want to keep a lot of their independence while enjoying the peace of mind 24-hour care brings.

Seniors have differing levels of need, and this conditions much of the thinking about where and how to live. Your needs might even change over a relatively short time, which can lead to moving from one setting to another as your condition develops. 

If you need a very high level of care, skilled nursing might be a good choice. Seniors who can get by with only occasional chore assistance or help with activities of daily living might even be able to stay in their own homes with periodic visits from a caregiver. Residential care settings fall between these levels of care, and they’re more appropriate for older adults with some needs but nothing beyond what a group setting can deliver.

Seniors are at their most independent while living in their own homes, followed closely by independent senior apartments. On the other end, older adults in skilled nursing homes may be under near-constant supervision and care. This is helpful for those who need it, but it limits their independence. Assisted living communities are less restrictive, but they tend to have institutional rules residents have to follow. 

A residential care home is less restrictive than a typical assisted living or nursing care home, but it has rules for seniors to follow. The supervision and care from the staff reduce seniors’ independence a bit more than private living, but for many seniors, it’s worth the trade.

Nursing homes provide inpatient medical services, usually delivered by a nurse and overseen by a physician. This is an appropriate level of care for seniors with chronic or potentially serious health problems. If your medical issues are manageable without trained medical personnel looking after you, then a less intensive level of care may be appropriate. 

There’s no hard-and-fast set of conditions that prevent you from choosing your own living situation, but as a rough guide, you should think about how often you need attention from a medical professional. Thus, controlled diabetes may not be a cause for nursing home placement, but COPD that requires supervised breathing treatments may be.

Residential care homes are very personal places to live. The small community size encourages close connections, and the even smaller staff drives one-on-one interactions. If you’re looking for a place where you can be on a first-name basis with the dozen or so people in the community, a small residential care home might be the best choice.

Not everybody likes this. People who would like to have less personal relationships and be a bit more private might prefer the more impersonal atmosphere of a large assisted living facility or the looser social environment of an independent senior community.

As your needs change, so will your ideal living conditions. While living in your own home might have been the best choice before you needed 24-hour care, a residential care home is only really a good choice if you can commit to at least a few years in residence. It’s usually not a popular choice to move into a new, close-knit community in a residential setting, only to move within a year or two into an assisted living facility or nursing home. Seniors with early-stage Alzheimer’s disease, for example, might have to plan for an eventual move into a memory care facility, which the residential care home might not be set up to manage.

So, should you move into a residential care home or another kind of senior living arrangement? The answer is that it depends on what you’re looking for. This table helps clarify the differences between the most popular care types.

The cost of residential care homes is generally similar to that of assisted living facilities in the same area. According to Genworth’s 2021 Cost of Care Survey, that makes for a national median cost of $4,500 a month. This varies enormously around the country. The average cost in South Dakota, for example, is as low as $3,350, while in Rhode Island, seniors pay an average of $6,826 a month for the same type of care.

Other types of care may fit your budget better. In-home care, for instance, averages $4,957 a month nationwide, while adult day health care comes in at $1,690. Nursing home care averages $7,908 for a semiprivate room and $9,034 a month for a private one. 

Medicare generally doesn’t pay for residential care home costs. It does pay for nursing home care and other medically necessary services, but not the nonmedical care seniors get in a residential community. You can learn more about Medicare coverage at Medicare.gov.

According to the National Institute on Aging, Medicaid is the most common way for seniors in the United States to pay for long-term care. Depending on the state you live in, this is usually going to be through a long-term care waiver. These waivers help prevent admission to a medically intensive care facility by covering some of the cost of residential care in a participating community. 

The standards for Medicaid eligibility vary somewhat by state. Your intake worker can help you understand the income, asset and medical need requirements where you live. As a rule, states with a medical need requirement for Medicaid consider being 65 and over a substitute for having a medical condition.

You can learn more about Medicaid coverage and eligibility at Medicaid.gov.

The Department of Veterans Affairs does pay for some long-term care costs regardless of the setting. If you are an honorably discharged veteran with qualifying income and a service-related disability, the VA may help you pay for a caregiver and certain medical costs. You can learn more about VA benefits and eligibility at VA.gov.

Private insurance policies generally don’t pay for residential care homes. Your policy might be different, though it’s rare for health insurance plans to cover nonmedical costs. Speak with your insurance provider for a definitive answer about your coverage limits.

Residential care homes vary in their quality and comfort. Before you settle on a place, review online reports and visit in person. Things to look for in a care home include:

• Location: Look for a place that’s close enough for family to visit, but in an area you’re comfortable going outside.
• Cost: Residential care varies a lot in cost, and every family has to strike a balance between location, amenities and a price they can afford.
• Services: Different services are offered at different care homes. Some offer pleasant touches such as concierge service, while others are less luxurious.
• Amenities: The shared amenities a care home offers affects the price and quality of life there. look for a pool and spa, library, piano lounge and other must-haves and nice-to-haves in a place you’re touring.
• Activities: Staff at residential care homes may organize community events, such as movie nights, sing-alongs and group travel for shopping and dining. Ask the tour guide about what the social life is like in the community.
• Online Reviews: People with firsthand experience often leave reviews online describing what the care home is like. Browse these reviews before you commit to see whether certain issues, such as hygiene, appear in multiple reports.
• Personal Rapport: Seniors have to get along with their fellow residents and staff. During your tour, watch for signs that the community gets along well and that staff treat residents with respect.
• General Vibe: Some places just feel right, while others really don’t. Listen to the gut feeling a place gives you, and trust your instincts about any place you’re thinking about moving.