Residential Care Homes Explained


Michael Gill

Residential Care Homes or Small Assisted Living communities are a distinct segment within the larger Senior Living industry. These are communities that by regulatory definition have between 4 and 16 residents. They are variously known as Residential Care Homes, Personal Care Homes, Board and Care Homes, or are sometimes just called small Assisted Living communities. I use these names interchangeably.

Some people mistakenly call them Group Homes, but I think of that term applying to places where people are transitioning out of drug rehabilitation programs, or for mentally disabled youth, or for people suffering from severe psychiatric disorders. Group Home is not a term we use to describe anything in the Senior Living industry.

While we will tangentially mention Memory Care, Skilled Nursing, and large Assisted Living communities in this article, these market segments are not the focus here, and you can find a video on each of those on our YouTube channel.

Description of Residential Care Homes

Residential Care Homes come in a variety of shapes, sizes, colors, and personalities. Most often they are single-family, detached houses in normal neighborhoods that have been renovated to accommodate the needs of elderly residents. The house has been modified by enclosing the formal living room and formal dining room to make them into bedrooms. Sometimes the garage is turned into bedrooms as well. This allows what was once a 4-bedroom 3-bath house to accommodate around 10 residents, depending on the number of shared rooms. Usually, the bathrooms have been renovated to take out the bathtubs to make room for a roll-in shower, and extra space has been added to make room for wheelchairs and caregiving assistance.

Like all Assisted Living communities, these Residential Care Homes are for seniors who require help with Activities of Daily Living, or ADLs for short. The seven ADLs are dressing, bathing, eating, transferring, toileting, incontinence, and medication management. As these activities of daily living are all non-skilled services, Assisted Living is considered “Custodial Care.” In this sense, it is different from Skilled Nursing, which is for “Medical Necessity.”

Advantage: Highly Attentive Care

But here is the important point you need to keep in mind when considering Residential Care Homes: the care provided can be for the highest acuity and provided with the best quality anywhere in the Senior Living industry. While Residential Care Homes can’t perform all the services that Skilled Nursing can, such as ventilators, tracheotomies, feeding tubes, and intravenous drips, Residential Care Homes provide much, much more attentive personal care.

Fall Risk Residents

Residential Care Homes are great places for high fall-risk seniors, can handle transfer devices such as Hoyer Lifts, and generally do a very good job of keeping eyes on residents. Because these homes are physically so small, caregivers are never more than a few steps away, and within easy hearing distance. And because the caregivers know the residents so intimately, they can anticipate residents’ needs much better than in either a large Assisted Living or a Nursing home.

Dementia Residents

Probably 80 percent of the residents in Personal Care Homes have some dementia. Personal Care Homes are not appropriate for exit-seeking residents, or even residents who need space to move around a lot. I usually think of Personal Care Homes first when I encounter a client who is particularly fragile and needs a very high level of care and attention.


Personal Care Homes can also be less expensive than large Assisted Livings. They average $4,500 for a private room and $3,500 for a shared room, and frequently this is an all-inclusive price, meaning there is no additional charge for care. It of course includes three meals per day plus snacks, laundry service, medication management, all utilities, and all caregiving services. Typically the only additional charges are for incontinence supplies, a cell phone, and the beauty shop. Personal Care Homes in the Austin area top out at about $8,000 per month.

End of Life Care

Because of the high level of care, Residential Care Homes are an excellent choice for end-of-life situations, and typically half of the residents are on Hospice. Small Assisted Living communities are not required to have a nurse on-site, but rather to have “nurse supervision.” Usually, there is a “house manager” who may not have the credentialling of a nurse, but who usually has years of practical experience, and is more than up to the task of overseeing care needs. Like anyplace in the Senior Living industry, however, every resident needs a loved one to be their advocate, and this is more true in some Residential Care Homes than in others.

Down Side

The primary downside to these communities is that there is less intellectual stimulation in comparison to large Assisted Living communities. There is more TV watching in a Residential Care Home, as they rarely have a dedicated activities person. Activities are generally led by caregivers and are nowhere near as organized or creative as they would be if there were an activities director. Usually, however, the residents are at a time of life where this is less important than safe comfort care.

I hope this introduction to the Personal Care Home segment of Senior Living has been helpful. My name is Michael Gill of Texas Senior Living Locators, and if you need help finding an appropriate solution in Assisted Living, Memory Care, or Independent Retirement Living in the Austin area, please give me a call at (512) 630-7133.

This information is also available in a video on our YouTube Channel.

Residential Care Homes Explained

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