Adult Foster Care: Costs & How to Find Care


Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Adult foster care might seem like a strange term. You’re probably more familiar with the term “foster care” as it applies to children or teens; however, foster care is also for adults. Foster care for any age group provides a safe place to live when there isn’t another desirable alternative. Or, families choose adult foster care for other reasons, including cost and a higher staff-to-resident ratio.

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It’s also important to understand that the term adult foster care can have several meanings depending upon where you live. Some states classify adult foster care homes as licensed facilities under local or state departments of housing and adult services.

Other states use the term adult foster care much more broadly to describe any smaller residential home. Some are referred to as board and care homes, residential homes, group homes, or adult care homes. Licensing and or certification may fall under assisted living requirements, or there may be few licensing requirements. 

What Is Adult Foster Care?

Adult foster care, whether licensed or not, is typically housed in a residential, home-like atmosphere. Depending upon state regulations and certification, some adult foster care homes will limit the number of residents per home. Since there are no national standards for adult foster care, quality and other safety standards can vary. That’s why it is essential to evaluate the safety and staffing of any adult foster home you’re interested in. 

Even in cases where an adult foster home falls under the supervision of state agencies, they may not be as well monitored as larger assisted living communities. Many adult foster care homes provide excellent care for their residents, but others may not. 

One particular category of adult foster care is the VA Medical Foster Care program. The VA Medical Foster Home program is unique in that it serves as an alternative to nursing home placement and has stringent participation requirements. It’s similar to other adult foster care programs in that veterans live in someone’s home. But it differs in that participants have a high level of need, and a team of medical personnel provides services on site. 

Adult foster care in the traditional sense does not offer round-the-clock nursing or any medical treatment. Still, there might be assistance with activities of daily living such as dressing, bathing, eating, and hygiene.

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Who Is Adult Foster Care Typically For and Not For?

In general, depending on state requirements, adult foster care is for people who do not have complex medical needs. You can think of adult foster care as an option between independent and assisted living. Staffing in adult foster care is typically not as robust as assisted living or memory care. 

Who is adult foster care for?

  • Adults who prefer a more home-like atmosphere with more one on one attention
  • Adults who need some assistance but can manage more independently
  • Adults who don’t like the impersonal atmosphere of larger senior living communities
  • Adults who may need senior living with some more affordable services
  • Adults who live in more rural areas and may not have access to larger, multi-unit senior housing

Who is adult foster care not for?

  • Adults with complex medical needs that can’t be managed by on-site staff
  • Adults with significant cognitive impairment who require supervision and are prone to wandering
  • Adults who prefer more amenities like those offered in assisted living such as fitness rooms, diverse activities, movie theatres, etc.
  • Adults who have significant mobility issues or need lots of help transferring or walking
  • Adults who need access to 24-hour nursing care

Signs Someone May Need Adult Foster Care

Adult foster care isn’t for everyone. But if you talk with your loved one and they’re open to the idea, there are some signs to look for that they might be ready. And frankly, you might be ready, too. As a family caregiver, your involvement may have become too stressful and time-consuming, and you could use some support in a supervised environment.  

Difficulty with activities of daily living (ADLs)

Your loved one may begin to have difficulty with ADLs, including dressing, bathing, cooking, and cleaning. They may not be able to access transportation easily or may have stopped driving altogether. In other words, there are beginning signs of some deficits, but not enough to warrant more intensive institutional care. 

Trouble managing medications

Organizing and correctly taking medications may be becoming difficult. Most adult boarding homes will dispense medications to residents. Trouble managing medications usually occurs along with other functional problems that require some level of support and assistance.

Social isolation

We now know that loneliness, which is often the result of social isolation, can have devastating emotional and physical consequences. When your loved one can no longer access social activities, it might be time for adult foster care. Some adults prefer a larger community with scores of other people to connect with. But others like the small, quieter environment of an adult foster home. 

Early cognitive impairment

Sometimes, early cognitive impairment can affect someone’s ability to manage their household and financial affairs. By moving to an adult boarding home, managing those responsibilities can be easier. Being relieved of the stress of dealing with a home can allow someone to focus on improving other skills, like socializing and trying new activities.

How Do You Typically Pay for Adult Foster Care?

Most people pay for adult foster care privately, just as they do with assisted living. Medicare doesn’t pay for adult foster care. But some states have Medicaid programs that will pay for adult foster care. Qualifying for Medicaid is state-specific, but generally, you must have few assets and a very low income. 

If you have long-term care insurance, it may pay for adult foster care, but you’ll need to check your policy. Some policies only cover assisted living or nursing home care. 

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How to Find Adult Foster Care Near You

Finding adult foster care could be a challenge. Many of these communities are under the radar and don’t market heavily, so they don’t have a visible presence. You can take some steps to find one near you—it just might take some digging and time. 

1. Aging and adult services

You can be almost certain that your local Aging and Adult Services program has information about adult foster care homes. They’re an excellent resource for all senior living options in your area. 

2. Professional senior care specialist

A local senior care specialist who has expertise in senior living can direct you to adult foster care homes. A good one will know which homes have good reputations and which ones to avoid. A professional senior care specialist has usually had some feedback from clients who have chosen adult foster care. 

3. Look online

Although many of these communities don’t advertise much, searching online might help. Put in terms like “board and care,” “residential care homes,” “assisted living,” and “adult care homes” to help you narrow down your search.

4. Healthcare providers

Check with your loved one’s doctors and home care providers. They often know about adult foster care homes because their patients request them. 

5. Geriatric care manager

If you live in a larger community, you could access one or more geriatric care managers. Although you have to pay for their services, they can be a valuable asset in searching for the appropriate placement.

6. Ombudsman programs

Your state ombudsman program investigates complaints about all senior care facilities. They might have information about local adult foster care homes, such as any safety or staffing problems. 

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Alternatives to Adult Foster Care

Most of the alternatives to adult foster care fall within the typical options available to adults needing increasing care. If you’re considering alternatives to assisted living and you aren’t comfortable with adult foster care, there are a few other options to consider. But keep in mind that, if your loved one’s needs become more complex, you may have to think about an environment that provides more care. 

In-home care

Bringing care into the home is a logical but costly alternative to adult foster care. The costs associated with in-home care depend on how much care your loved one requires. If they only need a few hours a week, hiring private caregivers to assist with ADLs, cooking and transportation could be a good option. When those hours increase, the expense could start to outweigh the benefits.

Independent senior living

Independent senior living may have the same assisted living amenities, such as meals, transportation, and activities. But what they don’t offer is help with ADLs. If your loved one needs help with ADLs, you can hire in-home help, but then you have the cost of that service in addition to the price of housing. 

Home sharing

Home sharing is when two or more people decide to share a home. The advantage is cost. Sharing a home and utilities can be very affordable. The disadvantage is that with sharing a home, there are no amenities or assistance. Any assistance someone needs would have to be arranged privately by the resident.

The other factor to consider with home-sharing is safety features like stairs or railings. Many homes don’t have built-in accessibility additions for people who need assistance.  

Adult daycare

Adult daycare is not residential but can be a good choice for periodic respite. Many adult daycare centers offer personal care, meals, some medical intervention, and transportation. Although adult daycare doesn’t replace adult foster care, it can keep a loved one in their own home longer and serve as a reasonable alternative.

Adult Foster Care: Another Option for Seniors and Their Families

As families look for creative and affordable options for senior care, adult foster care is worth considering. Talk with your loved one about their preferences, needs, and values. Make your decision together to find the best option for both of you.   


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