Three older adult women sit on a green velvet couch and laugh together.

Assisted living communities, residential care homes, and adult foster care are similar senior living options that help older adults live independently, but they provide different levels of care and come at different price points. These senior living solutions serve many preferences, styles, needs, and budgets. If you have researched the popular assisted living solution and think this type of care would suit your situation, you can also open up your research to include adult foster care and residential care homes. Here’s a breakdown of how assisted living, adult foster care, and residential care differ so that you can determine which might be best for you or your loved one.

What is assisted living?

Assisted living communities provide personalized assistance with household chores and personal care tasks in a residential setting. These communities serve many residents, with some small communities having a few dozen residents and larger communities having hundreds.

Assisted living is often referred to by different terms in each state, such as “personal care” in certain states, like Pennsylvania. This is because each state regulates assisted living, so each state has different terminology and rules for these communities. Typically, though, communities feature apartments for residents in multiple floor plans, such as studio, one-bedroom, and two-bedroom options. They also have varying rules about other assistance, such as medication management, household chores, meal preparation, and help with activities of daily living.

What is adult foster care?

Adult foster care provides personalized assistance with household chores and personal care tasks in a home. These homes serve smaller groups of residents. Based on state regulations, adult foster care homes can vary in size, but most homes serve fewer than four residents.

Adult foster care can also be called a senior group home. Regulations vary from state to state, but in general, the owner of the adult foster home completes training to become a foster care provider. Residents live in private or semi-private bedrooms in the home and share bathrooms as well as other communal spaces. These homes are often found in smaller towns or neighborhoods and in rural areas.

What is residential care?

Residential care homes also provide personalized assistance with household chores and personal care tasks in a home. Residential care homes typically serve fewer than 10 residents, and each resident has a private or semi-private bedroom. 

Residential care homes can also be called group homes, board and care homes, or residential care facilities for the elderly (RCFE). You can find residential care homes in large cities tucked in residential areas or in smaller towns or rural areas.

Differences in care

The definitions of assisted living, adult foster care, and residential care are similar. Each of these senior living options provides personalized assistance with household chores and personal care tasks. Caregivers provide customized support with activities of daily living, such as grooming, showering, or dressing. Residents are provided nutritious meals daily, served alongside their neighbors.

But there are some notable differences among these three types of residential care.

The first difference is the presence of nursing oversight. Assisted living communities have on-site nurses who create care plans, assist with medication management, and communicate with physicians on behalf of the residents. Adult foster care and residential care homes do not typically have this nursing presence. They might have a visiting nurse come in to provide consultation, but this nurse is not available consistently throughout the day.

The next difference is the presence of caregivers. Assisted living communities and residential care homes provide caregivers around the clock. State regulations require varying numbers of caregivers, but most states require that at least one caregiver is always awake. Adult foster care homes also have caregivers on-site around-the-clock, but those caregivers do not have to be awake at all times. This is typical because the caregiver also sleeps at night in the home.

Assisted living communities also typically have wellness and health services available that residential care or adult foster care may not. For example, it is common for assisted living communities to have on-site physical and occupational therapy, wellness fairs, and even physician hours in a check-up room in the community. These are services not typically offered at adult foster or residential care homes.

Assisted living communities often have specialized memory care neighborhoods in their building for those living with Alzheimer’s disease or another type of dementia. In many cases, someone living with dementia would not be able to continue safely living in an adult foster care or residential care home, as these senior living solutions are not designed to meet the challenges of cognitive decline related to dementia.

A benefit of adult foster care and residential care homes, though, is that they can often serve residents with higher care needs with the assistance of in-home medical care. In-home caregivers from medical home care agencies can provide higher levels of care at the home as needed but are billed to the individual resident. This can mean residents can stay home longer with this additional in-home medical support.

Differences in amenities and services

Amenities and services add to the perks that a senior living lifestyle provides. Assisted living, adult foster care, and residential care homes all offer a low-maintenance lifestyle to residents. The seniors there typically don’t have to worry about household chores, landscaping, or snow removal. Residents also receive regular housekeeping visits and even laundry services. However, there are some differences in amenities and services as well.

Assisted living communities typically offer more amenities and services simply because they can due to the size of the building or campus. You’ll often find on-site barbershops and salons, private dining rooms, walking paths, and scheduled transportation. Adult foster care and residential care homes don’t have the space to offer these amenities. But you’ll still find outdoor access points and shared community spaces like living rooms, libraries, and eat-in dining rooms. You might even find scheduled transportation, but it might be at an additional cost.

Assisted living communities also typically offer restaurant-style dining with chef-prepared meals, while adult foster care and residential care homes might feature catered meals or meals prepared by caregivers. Assisted living communities feature life enrichment or activities departments, where team members create and implement events throughout the day and evening. You’ll still find activities at an adult foster care or residential care home, but they won’t be at the same scale or as robust as in assisted living.

Remember though, bigger isn’t always better. While assisted living communities can provide luxury amenities and services due to their size, some older adults thrive in the smaller environment that adult foster care or residential care homes offer.

Cost considerations

Assisted living communities average $4,500 per month for residents. Adult foster care and residential care homes can cost a bit less, with the range in California documented starting at $3,500 per month. Costs can vary greatly by location and by services offered, however. You should contact communities and homes in your desired location to get information to best plan your budget.

Medicare does not cover assisted living, adult foster care, or residential care. But, Medicaid can cover some of the monthly care costs for eligible residents. Medicaid-covered assisted living can be difficult to find, so you might need to be on a waiting list. In contrast, Medicaid-covered adult foster care or residential care can be easier to find, meaning you might not need to wait months before moving in.

If you have VA benefits or long-term care insurance, it is best to consult your policy to determine if you can offset the costs of assisted living, adult foster care, or residential care. If you aren’t sure, speak to a financial advisor or ask the communities or homes you are researching to see if they accept those benefits.

Which is right for me?

When it comes down to it, choosing between assisted living, adult foster care, and residential care is all about size and amenities. Some seniors thrive in a huge assisted living community with many convenient services and luxury amenities. Others prefer the smaller and less stimulating environment of adult foster care or residential care, where they can easily meet friends and receive more home-like and family attention.

If you are undecided, take time to tour each option. You’ll know which one feels best to you.