What’s a Board & Care Home for Seniors?

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

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As time goes on, more and more senior housing options are becoming available, thanks to the growing demographic of aging adults and the diversity of choice desired. Along with all of those choices comes decisions.

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Most seniors say that they want to age at home, but that might not be possible or the safest. What initially seemed manageable becomes more difficult as care needs increase or family caregivers can no longer provide assistance.

That is where board and care homes come in. Board and care homes are a unique alternative to assisted living in that they are smaller, more affordable, and have a home-like atmosphere that many people prefer. The large anonymous feel of some assisted living communities is not for everyone. A board and care home could be the answer.

What’s a Board and Care Home?

A board and care home is for seniors who are usually more able, independent and want a home-like atmosphere. Keep in mind that board and care go by different terms in different states. Some are called group homes, and others are called residential care homes, or adult foster care homes, but they all fall under the concept of cohousing for seniors.

Aging adults may recognize that they need more care down the road, but choose board and care in the interim. People who own board and care homes typically adapt their homes or other residential houses to comply with local and state licensing requirements. 

For the owner, a board and care home offers the opportunity to care for and be with a smaller, more intimate group of seniors. Houses usually have no more than three to ten residents.

Some of the other defining characteristics of board and care homes include the following:

  • Three meals a day along with snacks
  • Some personal care including assistance with bathing, grooming, and dressing
  • Medication management if supervised by licensed personnel
  • 24-hour supervision
  • A more homelike atmosphere where meals are shared, but with a private bedroom
  • Many board and care homes are in residential neighborhoods.
  • Transportation might be provided to other healthcare appointments.

Difference between assisted living and board and care

A lot of the characteristics and features of a board and care home can sound like an assisted living facility, but they are not the same. The main differences between assisted living and board and care have to do with size and services. Let’s break it down.

Assisted living

Assisted living communities can be large and institutional, with hundreds of rooms. Some are high rises with memory care and independent living as part of their communities. Certain floors might be designated as independent, assisted, or memory care.

A key thing to remember is that assisted living is all about the services that accommodate the growing medical needs of seniors over time. Although assisted living communities are licensed and regulated by the states, they continue to push the boundaries of care. It is not unusual in assisted living to see seniors on walkers or in motorized chairs.

Although it is rare for assisted living to offer 24-hour nursing, they may have a nurse available during regular business hours. Care staff can help residents with most of their personal care needs. This includes bathing, grooming, dressing, medication management, ambulating, and accompaniment to meals.

All of these additional services in assisted living come with a cost. A base price is a monthly fee for renting the apartment and includes amenities such as meals, activities, cleaning, and transportation. Once you need help in assisted living, you will pay extra. Some places have tiers of care, depending on how many hours of help you need each month. Each level will add to your base monthly rate.

Board and care

Board and care homes will be much smaller and average between two and ten residents. Amenities are variable and depend on the community. In most cases, a nurse will not be available. However, some of these homes may provide limited personal care, making it very important to find out exactly what you can expect before making a decision.

If you need additional help as a resident of board and care, you can hire private caregivers or nurses, but of course, that adds to the cost. Transportation might also be limited to specific times and days, and activities will not be as robust or diverse. Someone is on-site 24-hours a day, but the residence may not have the level of security that a larger assisted living has.

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How Do You Know If Someone’s Ready for Board and Care?

Deciding to move from home is an emotional decision, and one that you might make on your own or with your family’s input. Long-term care planning should be at the forefront of any decision you make as you age. As part of that process, try and anticipate what you might need in the future while acknowledging the importance of staying flexible.

Board and care is a transition for many people between home and assisted living, hoping that someone can stay there for the long term.  Knowing whether someone is ready for board and care will probably hinge on these factors, such as managing care, your own home, and mitigating loneliness.

As you age, it is challenging to manage care at home. As a family caregiver, you might have reached your limit in terms of energy, time, and ability. Or hiring caregivers is impractical due to cost and management. 

It is also challenging to manage the home. Care of someone doesn’t just involve the person. It also applies to the household. Cleaning, maintenance, and yard care can get to be too difficult, unsafe, or expensive. While independence is important, at a certain point it can be unsafe to climb up a ladder to fix something or head downstairs to do laundry.

Finally, social isolation can adversely affect you or your loved one’s mental health. Social isolation and loneliness have serious effects on an aging adult’s physical and psychological health. This is especially true for someone who has stopped driving or has lost longtime friends.

Pros and Cons of Board and Care

Weigh the pros and cons of board and care carefully with your long term plan in mind. Every senior housing option has pros and cons, and it is important to remember that there is no perfect place.

Pros of board and care

It may be a potentially less traumatic move since your loved one is moving from one home to another, so the adjustment may not be as intense. In most cases, board and care will be less expensive than assisted living.

Also, with a smaller home, you will still have a smaller staff to resident ratio. Having fewer people to keep track of and monitor can be a benefit. Staff can notice changes or problems and act on them, whereas in assisted living, someone can get lost in the crowd.

With a board and care home, you will have the opportunity to build closer relationships with staff and other residents thanks to the homelike and less institutional environment. In addition, if the board and care is in a residential neighborhood, it can feel more like home and provide a sense of belonging.

Cons of board and care

The biggest detractor to a board and care home is that it may not offer enough care for what your loved one requires. Board and care doesn’t have the flexibility to augment care beyond a certain point. You can hire care, but you might have to move if needs start to exceed what can safely be provided by the home you are in. 

Also, board and care communities can’t handle severe forms of dementia. Board and care homes are more informal and flexible by nature, but they don’t have the staff or security to manage wandering or other unsafe behaviors.

While it’s a smaller community, you might have to share a room. Some board and care will offer private rooms, but one might not be available when you are ready to move. 

And finally, while they may be licensed by the state, a board and care home can fly under the radar in terms of oversight. They are more likely to have unreported complaints and problems depending on ownership. 

How to Find a Board and Care Facility

The first thing to remember is that when looking for a board and care home in your particular state, this type of home might go by a different name. If you can’t find what you are looking for under the term board and care, try residential care homes or group homes. Talk with your loved one’s healthcare providers to get some recommendations. 

You will also want to check with your local Aging and Adult Services office to see what they recommend. Board and care homes are more likely to change hands or go out of business than larger corporately owned assisted living. It might take more effort to find what you are looking for.

Once you have identified a possible place, ask these questions and do a little detective work:

  • How long have you been in business, and who is the owner?
  • What is the staff to resident ratio?
  • Are there licensed staff, and if so, what specifically can they do?
  • What is the cost, and is a certain amount of care included in the price?
  • Are there specific criteria to meet when seeking a higher level of community care?
  • Ask about special diets. Can the home accommodate a diabetic or vegetarian diet?

You will also want to call the state Ombudsman office to ask about any complaints the residence has received. Before making any decision, visit the home and pay close attention to safety features like handrails, emergency response systems, and protocols. Also, check out cleanliness and the kitchen set up.

Board and Care Homes for Seniors

As you or your family members become older, staying at home might not be the safest option. Depending upon where you live, you may have many choices for senior housing.

The direction you go depends on your long term plan and personal preference, but board and care homes can be a viable and economic alternative to assisted living. By doing your homework, you increase the chances of being happier with the decision you make over time.

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