Certified, Professional Care Manager John Doxey, MA, CMC

When families conclude that it’s no longer safe or feasible for an elderly relative to remain in his or her own home and the search begins for long-term care facilities, the first thought that comes to mind for most people is “assisted living.” And when thinking of assisted living, the image that pops to mind most often is a large, hotel-like facility with multiple dining rooms, an upscale ambience and a robust activity program.

But there is another, often overlooked type of assisted living facility, commonly known as “board and care,” that can be a good option for older adults needing residential care, particularly those with dementia or complicated medical conditions that require regular monitoring.

Board and cares are smaller-scale facilities, often converted family homes tucked into residential neighborhoods, and most are licensed to provide care to between four and six residents. Unlike the larger assisted living communities, which are often owned by regional and national chains like Aegis and Sunrise, board and care homes are typically owned and operated by individuals or families.

Although they aren’t as widely known as their larger-scale cousins, board and cares have been around for decades. And more people than you may think live in board and cares: about one-third of all American assisted living residents live in facilities with fewer than 16 residents, according to the National Council on Assisted Living.

Like other assisted living facilities, board and cares help residents with activities of daily living such as bathing, eating, dressing and using the bathroom. Live-in staff also provide meals, activities, transportation to appointments, medications management and other services. Most board and cares are licensed and equipped to accept non-ambulatory residents, most can accept “wanderers” as long as there are alarms on the doors, and many have waivers that allow them to accept residents with dementia and hospice care.

One major advantage of board and cares is their high staff-to-resident ratio – usually two staff members for every six residents. In comparison, standard assisted living facilities, which often have more than 100 apartments, typically have about one staff member for every eight residents during daytime hours and as few as two staff members for every 100 residents at night, although staff ratios are higher on floors with higher-acuity residents.

The higher staff ratio allows staff to get to know residents more intimately and to keep a closer eye on their habits and routines, such as whether they are eating less or sleeping more than usual. The higher ratio gives staff more time to help residents with high levels of physical or cognitive care needs, including those with moderate to advanced dementia, Parkinson’s disease, incontinence and problem behaviors like resisting care.

Their smaller scale and home-like environment can also make board and cares a more comfortable place for people with dementia, who may become confused or over-stimulated in facilities with long halls, large dining rooms, and lots of staff and residents.

Another reason to consider board and cares is their cost. While basic fees at larger, upscale assisted living facilities average around $2,500 to $5,000 per month for a studio apartment in areas like Walnut Creek, Lafayette and Moraga, basic fees at board and cares in the same areas range from about $3,000 to $4,500 per month for a private room. And unlike most assisted living facilities, board and cares typically do not charge extra for medication reminders or use tiered pricing that raises monthly fees as residents’ care needs increase. Long-term care insurance and other types of assistance programs may help people pay for board and cares, which is also the case with standard assisted living.

Naturally, board and cares are not the right fit for everyone. Older adults seeking a higher level of social interaction and a wider variety of stimulating activities, and those who are more independent and need less care, may find a better fit in larger assisted living buildings. Board and cares generally offer fewer activities and residents often spend a lot of time watching TV.

Some families may also feel more comfortable moving their loved ones into larger assisted living buildings because they are a more familiar commodity, with a standardization enforced by national and regional chains. There is greater variation among board and care homes, and therefore a greater need for due diligence by family members both before and after a loved one moves in.

In addition, some people may be turned off by the home-like atmosphere at many board and cares. The daughter of one of my clients told me she wouldn’t consider moving her father into a board and care because it felt too much like their family’s home and that her father would prefer a more upscale and more institutional environment.

So…different strokes for different folks. But board and care homes are often an option worth considering.