Adult foster care — the option many families don't know about

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.

When you're looking at options for your parent's care, you probably visited some assisted living facilities and maybe looked at nursing homes. You might have considered hiring in-home care. But there's a middle option that many families never even know exists: adult foster care. It's smaller, more intimate, less institutional, and it's not the right fit for everyone. But for the right parent, in the right home, it can feel like the best choice on a spectrum of hard choices.

Adult foster care is what it sounds like. A family opens their home to adults who need care, usually seniors. They're licensed and regulated by the state. They typically have between two and four residents, sometimes more depending on the state. The provider is there, the care is hands-on, the home feels like a home. It's the complete opposite of the institutional approach of a larger facility.

If you've never heard of this option before, you're probably not alone. It's not marketed the way assisted living is. Families doing adult foster care are often just quietly doing the work of caring for a few people in their home, not running a business that advertises. But if your parent is someone who would do much better in a small, family-like environment than in a facility, this is worth investigating.

What Adult Foster Care Is

An adult foster home is typically a single house or sometimes a duplex where the provider lives and cares for a small group of adults. The residents are usually paying for care out of private funds, though some states allow Medicaid to pay for adult foster care. The provider is licensed, and the home is inspected regularly to make sure it meets basic standards for safety and cleanliness.

The care looks different here than it does in a facility. The provider knows your parent's preferences about food, about how they like to be helped, about what makes them comfortable. They're not working from a care plan written by someone who doesn't know them. They're adapting day to day. Your parent gets a home-cooked meal because someone's cooking dinner. Your parent goes to the grocery store or the bank or the doctor because the provider is driving them there. It feels like family, even if it's not.

The staffing is also different. The provider is usually not a nurse. They're a person who's trained in care, often with significant experience, but without the clinical credentials of a nursing home staff member. This means adult foster care works well for people who need help with daily living but don't need a nurse on site. It works for people with early-stage dementia, people recovering from surgery, people whose bodies are slowing down but whose medical needs are stable.

There are rules about how many residents can be in a home, about how much training the provider needs, about supervision and care plans. These rules are set by the state, so they vary significantly. Some states have more regulated and higher-quality adult foster care systems. Some have fewer requirements. You need to understand what the requirements are in your state and how that facility measures up.

How It Differs From Assisted Living

The biggest difference is the scale and the feel. Assisted living facilities have dozens or sometimes hundreds of residents. They have a staff, activities, dining halls, medical oversight. Adult foster care is a home with a few people in it. That's radically different.

The second difference is the level of individual attention. In a facility, your parent is one of many. There's a schedule. There's structure. In adult foster care, the provider can be much more flexible. If your parent is having a bad day, the provider knows that. If your parent prefers a certain food, they can cook it. If your parent wants to sit on the porch, they can sit on the porch. There's not a schedule that requires everyone to participate in group activities.

The third difference is the formality. Assisted living facilities have formal care plans, regular medical reviews, structured activities. Adult foster care is often much less formal. That can be wonderful if your parent benefits from a relaxed environment. It can also mean less oversight if the provider is not particularly careful. The regulations exist, but the enforcement can be spotty in some states.

The cost is usually somewhere between hiring in-home care and assisted living. It's cheaper than a facility because you're paying one person to care for a few people. It's more expensive than in-home care because the provider is living there, available twenty-four hours, managing everything. Each state and each provider sets different rates.

Adult foster care often feels more personal and intimate than assisted living. It's also more dependent on finding the right provider and the right fit. In assisted living, you can transfer to a different facility if it's not working. In adult foster care, there are fewer options in most areas, so if this home isn't right, moving might be complicated.

When It Works Well

Adult foster care works best for people who do well in small groups, who don't need medical oversight that requires a nurse, whose care needs are relatively stable, who can benefit from a family-like environment. It works for people who've lived independent lives and struggle with the institutional feel of larger facilities. It works for people whose biggest need is help with daily tasks and safety, not medical complexity.

It also works best when you've found a good provider. Not all adult foster care providers are equal. Some are wonderful, genuinely called to care for older adults, attentive to individual needs, advocates for their residents. Some are doing it primarily for the income and don't really care about the people living in their homes. You need to do your homework.

When you're looking at a home, visit it multiple times. Observe how the provider interacts with the people living there. Talk to families of current residents if you can. Ask questions: what's the provider's training? What do they do if someone falls or has a medical emergency? How are medications managed? What happens if the resident's needs change and they need more care than the provider can give?

Watch the home itself. Is it clean? Is it comfortable? Do the residents seem happy? Can your parent have visitors? Can they go out if they want? What are the rules about personal autonomy? What happens if your parent wants to do something the provider doesn't think is wise?

A good adult foster care home feels like a place someone could actually live, not like an institution. The provider knows the residents' stories. The residents know each other. There's a sense of community among the people living there. That can be incredibly healing for someone transitioning to a different kind of life.

The challenge is finding these homes, because they don't advertise the way facilities do. Your parent's doctor might know of homes. Your social worker might have recommendations. You might find them through state licensing information. You need to be willing to look, to visit, to ask hard questions, to check references.

Adult foster care is not the right answer for everyone. For some parents, the structure of a larger facility is actually reassuring. For some, the medical needs are too complex. But for others, it's the perfect fit. It's small enough to feel like home, it's cared for by one person who actually knows them, and it offers the independence and dignity that some people need to feel like they're still living their lives, not just being cared for in their declining years.

How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different — what works for one may not work for another.