When people picture assisted living, they often think of a large building with a dining room and activity calendar. But in many states, a large share of licensed assisted living settings are small care homes: ordinary houses in residential neighborhoods where a few older adults live with caregivers.
Both can be good choices. This guide compares them so you can decide which kind of setting suits your parent's personality and needs.
Side-by-side comparison
| Care home | Assisted living community | |
|---|---|---|
| Size | Usually 6 or fewer residents | Dozens to hundreds |
| Setting | A house in a neighborhood | Apartment-style building |
| Staff | A few caregivers, often the same faces | Larger team with set roles |
| Activities | Informal, home-based | Full calendar, outings |
| Meals | Home-cooked, shared table | Dining room, more choice |
| Private space | Private or shared bedroom | Private or shared apartment |
| Licensing | State license, often as assisted living | State license |
Names and rules vary by state. Ask each provider exactly what its license allows.
What a care home is
A care home is a private house where several people who can no longer live alone receive care. At least one caregiver is on site at all times, and staff cook meals, help with grooming and medicines, and look after other needs1.
Depending on the state, you may see them called board and care homes, residential care homes, adult family homes, adult foster care, personal care homes or residential care facilities for the elderly. Many states license them as a category of assisted living2. Our care homes guide explains more.
What an assisted living community is
An assisted living community combines private apartments, shared dining and activity spaces, and around-the-clock help with daily activities3. Larger communities often have a nurse on staff, a wellness or care director, an activities team, housekeeping and transportation, and may offer several levels of care.
See our assisted living guide for a full overview.
Read moreAssisted Living Services and Amenities: What's Usually Included
Pros and cons of each
Care homes: what families like
- A quiet, familiar home setting, often in a regular neighborhood.
- A small group of residents and caregivers who get to know each other well.
- Higher staff-to-resident ratios in many homes, with more one-on-one attention.
- Home-cooked meals and flexible routines.
- Often a good fit for people who are overwhelmed by crowds or noise.
Care homes: what to weigh
- Fewer planned activities and outings, and fewer people to socialize with.
- Less space and fewer amenities.
- A lot depends on the owner and a small number of caregivers; staffing changes have a big impact.
- Some homes have limited ability to care for people with heavier or changing needs.
Assisted living communities: what families like
- More activities, clubs, outings and chances to make friends.
- More dining choices and amenities like salons, gyms and gardens.
- Larger teams, often with a nurse and specialized staff.
- Often several levels of care, sometimes memory care, on one campus.
Assisted living communities: what to weigh
- A larger, busier setting can feel impersonal or confusing.
- More staff turnover and different caregivers from shift to shift.
- Extra charges for higher levels of care can add up.
Who each setting suits
A care home may suit someone who:
- Prefers a quiet, family-like setting.
- Needs a lot of personal attention or supervision.
- Has dementia and does better with fewer people and a consistent routine.
- Isn't interested in a busy activity calendar.
An assisted living community may suit someone who:
- Is sociable and wants lots of activities and people around.
- Values privacy and their own apartment.
- Wants amenities like a fitness center, chapel or café.
- Might need more care in future and wants to stay on one campus.
Licensing and oversight
In most states, care homes need a state license, and many are licensed under the same rules as larger assisted living communities, with some rules adjusted for size. Some homes may face lighter inspection than larger facilities1, so it's especially important to check the license and any inspection or complaint records before choosing. Our guide to checking a license and inspection report shows how.
Ask who the licensed operator is, who's in charge when the owner isn't there, and what training caregivers have.
How costs compare
Care homes and assisted living communities both charge monthly, usually covering room, meals and some level of care. Care home prices are sometimes simpler, with fewer add-on charges, but they vary as much as community prices do. Compare what's included rather than the headline rate.
Payment options are similar for both: private funds, long-term care insurance if the policy covers the setting4, VA benefits for eligible veterans, and in some states Medicaid waiver programs that help with services5. See our assisted living costs guide for more.
What to notice when you visit a care home
Visiting a small home is different from touring a large community. There's no marketing office or model apartment, so you see real daily life. Pay attention to:
- How caregivers speak to residents, and whether residents seem comfortable with them.
- Whether the house is clean, bright and free of odors, with clear walkways and grab bars in bathrooms.
- What residents are doing. Are they engaged, chatting, helping in the kitchen, or mostly in front of the TV?
- The bedroom your parent would have: its size, window, closet and closeness to a bathroom.
- Safety features such as smoke alarms, an emergency plan and, for people with dementia, secure doors.
- Meals. Ask to see a menu or visit at lunchtime.
Because so much depends on a few people, meet the owner or operator and the main caregivers. Ask how long they've worked there. A home with long-serving staff is often a good sign.
Questions to ask a care home
- How many residents live here, and how many caregivers are on duty day and night?
- Does a caregiver live on site? Who covers when they're off?
- What training do caregivers have, especially in dementia care?
- What care needs can you meet, and when would a resident need to move?
- How are medicines handled and recorded?
- What does a typical day look like? Are there outings or visitors?
- Can I see your license and most recent inspection report?
For larger communities, use our assisted living tour checklist.
