Group Homes: Pros and Cons for Senior Care


If you’re looking at long-term care options but not loving the hospital or institutional feeling that some of these communities present, you may want to investigate group homes for seniors.

Also known as adult family homes or board and care homes, group homes for older adults offer a cozy, family-style alternative to nursing homes or assisted living facilities. Read on for everything you need to know about this long-term care option that’s growing in popularity.

What Is a Group Home for Seniors?

Group homes for seniors are typically small residences — private homes that have been renovated or expanded to support senior care needs — that look like a standard house and are usually found in regular neighborhoods. But unlike a regular home, group homes for seniors offer care and support services around the clock.

In these homes, for instance, older adults who require help with their daily personal needs, and who may have dementia or cognitive impairment, live among peers with 24/7 assistance and supervision from caregivers. Some group homes offer skilled nursing care, similar to a nursing home, in a home-like setting, which can be highly attractive for some seniors.

“They’re a good fit when people need more one-on-assistance, particularly if they’re a fall risk or need additional help with toileting or eating,” says Lisa Mayfield, the founder of Aging Wisdom, a care management practice in the Seattle area, and a past president of the Aging Life Care Association. “Also, there are smaller settings to navigate, which can be an advantage as mobility decreases. They tend to be on one level, which makes navigating easier and safe.”

As with other long-term care options, legally operating group homes are licensed in their state and must meet certain standards. Staff members undergo mandatory yearly training, plus additional education and training by the facility.

[READ Understanding the Different Elder Care Options]

Services and amenities in senior group homes

Group home definitions, licensure, costs, services and availability vary from state to state.

Common services and amenities include:

— Assistance with the activities of daily living, including eating, toileting and bathing.

— Housekeeping and laundry services.

— Medication management.

— Transportation.

— Entertainment and engagement activities.

— Safety features, such as grab bars and ramps.

Each home is unique. In Washington, for instance, adult family homes provide skilled nursing care, in addition to personal caregiving and assistance with activities of daily living, for older adults. Each home has a relationship with a nurse delegator, who can supervise and oversee nursing skills or tasks that residents require. In addition, residents have an array of health care services available, when needed.

“In our state, there are many visiting medical providers who will visit the adult family home to provide the primary care on-site,” Mayfield says.

These homes can help coordinate care for residents with providers such as primary care physicians, physical and occupational therapists and extra nursing support.

“You can even engage hospice support in adult family homes,” she notes.

Because group homes may be privately owned, “you really need to dig in to find out what services and supports they offer,” adds Sandy Markwood, the CEO of USAging, formerly known as the National Association of Area Agencies on Aging.

[READ What Are the Levels of Senior Living?]

How Much Do Senior Group Homes Cost?

Typically, group home care costs less than traditional long-term care options, particularly if you’re paying for long-term care out of pocket. But the cost of a residential care home can vary widely depending on the location of the home, the mix of services offered and the level of services you need.

To give you an idea of general senior living costs, Genworth Financial’s 2023 Cost of Care Survey results found that the national monthly median cost of an assisted living community is $5,350. That figure includes the monthly private pay rates ranging from basic care to more substantial care for a one-bedroom unit in an assisted living facility. A semi-private room in a nursing home averages $8,669 per month, while a private room runs about $9,733 monthly, Genworth Financial notes.

[READ Assisted Living Costs and How to Pay]

Pros and Cons of Living in a Senior Group Home

If you’re considering moving into a group home setting, it’s essential to research, visit, ask questions and compare your options, because each group home is unique. These are some basic pros and cons:


Higher staff-to-resident ratio that allows individualized care. “You get more personalized care because they’re usually five to 10, maybe maximum 20 people in a facility, so the staff-client ratio is much better,” Markwood says.

Homelike vs. more institutional feel. “In some ways, it’s much more homelike,” Markwood says. “Sometimes the meals are much better because they’re not as institutional as they may be in an assisted living (community).”

Typically lower-cost than nursing homes or assisted living facilities in the surrounding area.

Smaller, more manageable spaces for those with mobility issues.

When group homes are a suitable choice, feedback from families is positive, Mayfield says.

“We find that when people move to adult family homes, they actually tend to improve because they’re getting that extra attention and TLC,” she notes. “The caregivers can really dote on them and make sure they’re getting their meds, and eating and drinking.”


Structured activities are minimal. If ongoing activities such as games, exercise classes or communal movie nights are important to an older adult, group homes might not be the best bet. “One of the biggest downsides in adult family homes is lack of structured activities that families would find in a setting such as assisted living or memory care — although families can certainly find ways to supplement social engagement or activities,” Mayfield says.

Privacy can be a challenge. Some group homes offer all private bedrooms, while two people share bedrooms in others. From a social and compatibility standpoint, “you’re with a smaller group of people, so you better hope you like them,” Markwood says. “You oftentimes have less privacy than you do in a larger-scale living situation.” Common areas are often smaller than those in larger assisted living facilities, she adds.

Private pay is the norm. “Some long-term care policies will cover it,” Mayfield says. “In our state, there are Medicaid-eligible adult family homes.”

How to Pay for Care in a Senior Group Home

As with other forms of long-term care, how you’ll pay for a senior group home can vary and may include paying out of pocket and/or using an insurance policy that specifically covers these kinds of costs.

It’s important to note that Medicare does not pay for assisted living and does not cover the cost of rent in any kind of assisted living arrangement, whether it’s in a larger facility or a group home.

Some options for paying for group home care include:

Long-term care insurance. Long-term care insurance can be used to pay for any kind of long-term care, including a senior group home. Policies can vary widely, so read the fine print before purchasing long-term care insurance.

Property. Many seniors sell their home or set up a reverse mortgage to help fund senior care later in life.

Social Security. Most seniors receive some income via the Social Security system. As of February 2024, the average monthly benefit was about $1,773, which may help offset some of the costs you’ll accrue in a senior care home.

Other pension or retirement plans. If you had a 401(k) or accumulated savings during your working years, you can use those funds to pay for senior care.

Veterans benefits. Some people who served in the military qualify for Aid and Attendance benefits from the Department of Veterans Affairs, which you can use to pay for senior care.

Medicaid. Some group homes work with Medicaid, and depending on the situation, your policy may cover at least part of your expenses in a senior care home.

Other health insurance. Depending on the specifics of your plan, if you have another kind of health insurance, you may be able to get some of your expenses in a senior group home covered, though these are typically restricted to paying for medically necessary services.

Green House Concept

Depending on where you live, a certain type of group home, called a Green House, may be an option.

“We think of group homes as smaller, congregate living settings that are really a home,” says Susan Ryan, Maryland-based senior director of the Green House Project, a not-for-profit organization focused on the right to age with dignity and offering an alternative model to traditional senior care facilities. “A Green House home is something very specific that is licensed as skilled nursing.”

Residents can continue to live in a Green House home as their care needs progress, without having to undergo transfers to other facilities, which can be more traumatic as people age.

Of the 372 Green House homes in 32 states across the U.S. to date, about 80% are skilled nursing residences, like nursing homes, but with only 10 to 12 people living there, Ryan explains. Some Green House homes are licensed as assisted living, still in a small-home setting.

Caregivers in Green House homes are certified nursing assistants with extra training to work in the group home model. In Green Houses and many other group homes, these caregivers are universal workers who typically do housekeeping, laundry and cooking along with engaging with residents and providing their daily care.

What to Look for in a Group Home

When you’re evaluating a group home as a possibility for a family member, in many ways it’s the same as for any long-term care option. Ask about and look for the following:


Group homes are licensed by the state and sometimes individual counties as well.

Not all group homes are licensed, however, so be sure to check with your state’s elder care authorities about whether a home you’re considering is operating above board. The American Health Care Association/National Center for Assisted Living offers a compendium of state regulatory resources online. The Administration for Community Living also offers a slew of online resources to help guide your search for this information.

First impression

“I always recommend that families trust their gut,” Mayfield says. “How does it feel in the home? What’s the environment like? I like homes that feel warm and inviting and where families would feel comfortable spending time with their loved ones. There are homes that feel more institutional and cold and not very inviting to guests.”

As you walk into a potential group home — or any long-term care setting — approach it with curiosity, Ryan suggests. Ask yourself some questions:

— Can you visualize your loved one there?

— Look at individual residents: Are they slumped over in their chairs, or are they having conversations with other residents?

— How are staff members engaging with residents?

— Do residents look comfortable, well-kempt and content?

— If it’s lunchtime, does the food smell appetizing?

— In short: How is the quality of life?


Ask about staffing levels during the day and at night, as well as nurse delegators who may provide supervision for more than one group home. Also, ask whether there is an awake caregiver in the home at night. Find out about staff turnover and consistency — homes with lower turnover rates may offer more stability for your loved one.

Safe setting

Particularly if a parent wanders, ask about how seniors are kept safe and prevented from wandering off the premises. You can see whether a group home has an outside gate or fencing, and ask about door alarms and other safety measures.

Space to move freely

If your parent likes to walk, or paces with dementia, “is there enough space in the home to pace around?” Mayfield says. “Is there a neighborhood for walking that families can take walks with their loved ones or where the caregiver might take walks?”

Consider what the surrounding neighborhood looks and feels like.

Survey/inspection results

You can access annual state inspections online to look for red flags or deficiencies.

Approach to care

“Is there a holistic approach?” is a good question, Ryan says. “I would ask: How are they honoring residents’ preferences?”

How to Find a Senior Group Home Near Me

If you’re looking for long-term care options, including group homes, these organizations can help:

U.S. News & World Report’s Senior Living Search Directory. Discover the top-rated senior living communities based on analyzed survey data from more than 250,000 residents and their family members, and learn more about what’s available locally.

Area Agency on Aging. These nonprofit agencies are designated by the state to address the needs and concerns of older people. Contact your local AAA for expert assistance with local resources.

Aging Life Care Association. Also known as geriatric care managers, aging life care professionals can help you understand and compare available choices.

Green House Project. If you’re interested in exploring Green House homes in particular, this interactive map gives their locations.

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Group Homes: Pros and Cons for Senior Care originally appeared on

Update 04/08/24: This story was previously published at an earlier date and has been updated with new information.

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