How to evaluate a board and care home

If you or someone you support wants a residential community with a home-like atmosphere but doesn't need round-the-clock medical care, a board and care home may be a good fit. Also called a residential personal care home or adult foster care home, this type of community typically provides living arrangements and meals to a small group of older adults, often in a single-family home. Board and care homes may also support residents living with dementia or Alzheimer's disease.

If you're considering this option, here's what you can expect from a board and care home, along with practical steps you can take to investigate and evaluate specific residential care options.

What to expect from a board and care home

Board and care homes typically look like the other single-family homes in their neighborhoods. When you visit the options available to you, you may not immediately recognize them as residential care settings because they often blend into the surrounding community.

These residential personal care homes typically have about one staff member for every four residents. You're unlikely to find staff members with medical licenses on-site, but staff are often trained to help residents with activities of daily living (ADLs), including bathing, grooming, dressing, and medication management.

Because board and care homes don't have large medical staffs or the extensive amenities found in larger communities, they are typically more affordable than assisted living communities or other large senior living communities. This can mean lower costs for residents. Residents are also more likely to receive assistance from Medicaid than people living in assisted living or nursing homes.

In a residential personal care home, you can expect a room rather than an apartment. In some homes, residents share a room with a roommate. Housekeeping services are provided, and residents typically eat together in a communal dining room.

Questions to ask before you visit

You can learn a lot about the board and care homes you're considering before you ever visit them in person. Start by reviewing any inspection reports available through your state's licensing division. Personal care homes are typically required to keep this information on-site, but you should also be able to request it from the appropriate government office.

If your state licenses board and care homes, make sure the home's operating license is current. Your state may also require the administrator to hold a license, which you can check as well. If you're eligible for Medicaid, confirm that the home is certified for Medicaid. You can also ask what training staff members have completed and whether they have undergone background checks.

You can ask other questions ahead of time to narrow down the communities you want to visit. Ask about the staff-to-resident ratio, and don't forget to ask what that ratio is at night. If you or the person you support has a specific medical condition, ask whether the community accepts and supports residents with that condition.

It may also be easier to ask financial questions before your visit. How much does the board and care home cost? Is there an entrance fee, and is it refundable if you or the person you support needs to make other arrangements? Understanding the full financial obligations ahead of time can help you narrow down your options.

What to look for during your visit

Your first impression can tell you a lot when you visit a board and care home for yourself or someone you support. From the moment the front door opens, notice whether the home appears clean and whether it smells fresh or unpleasant.

Take a close look at the room where you or the person you support may live. Is it large enough to be comfortable? Is there enough room for personal belongings? If the room is shared, does the potential roommate seem like someone you could live with peacefully? Ask whether residents may bring their own furniture or add personal touches to make the room feel like home.

As you walk through the common rooms, consider whether they feel comfortable and welcoming. Are current residents using the common areas? Is the home in good condition overall? Look closely at the lighting, flooring, and general maintenance. Also check for handrails and guardrails in bathrooms and near steps.

What to ask when visiting a board and care home

You'll likely have many questions when visiting the board and care homes you're considering. Start with the staff member leading the tour, who may be able to provide many of the answers you need. If possible, talk with residents about how they feel about the home and what it's like to live there. Bring a written list so you don't overlook anything important during the visit. These questions can help you decide whether a residential care home is the right fit:

• What is a typical day like for residents? Does that routine sound like one in which you or the person you support could thrive?

• How does the staff help residents who have problems with incontinence? Are incontinence supplies included in the residence fees, or do residents pay for them separately?

• What safety precautions are in place for residents with memory problems or a tendency to wander?

• Does the board and care home provide transportation to medical appointments? Is transportation also available for shopping or entertainment?

• What opportunities are available for exercise? How does the staff encourage residents to maintain a healthy, active lifestyle?

• Does the staff help with health monitoring activities, such as blood pressure checks?

• How are weekly menus prepared? If you or the person you support has special dietary needs, how does the home accommodate them?

• Are snacks available between meals? Can residents eat in their rooms if they prefer?

• May friends and relatives visit? What kind of privacy do residents and visitors have during those visits?

• What emergency procedures are in place?

These questions can give you a practical starting point for evaluating a board and care home. When you're ready to decide, compare what you learned from each home and consider which option best fits your needs or those of the person you support. A thoughtful comparison can help you move forward with greater confidence.