Medical foster homes, also called adult foster care, have long served as community-based alternatives to moving an older loved one who needs ongoing assistance, nursing support or medical care into an institution such as a nursing home.
This model can be especially helpful for veterans, who often benefit from living with peers in a more intimate setting than a nursing home. In fact, the U.S. Department of Veterans Affairs’ Medical Foster Homes program inspects, approves and manages private homes designed to serve veterans in their later years when they need help because of serious, chronic or disabling conditions. These homes typically provide the same level of care that nursing homes provide, but can be a great nursing home alternative for seniors.
If you’re considering long-term care options for yourself or a loved one, here’s what to know about medical foster homes, the VA medical foster home program, who lives and works in these facilities, the type of care they offer and what medical foster homes cost.
[READ: Resources for Caregivers of Military Veterans]
What Are Medical Foster Homes?
Medical foster homes for veterans and other adults are private residences where a trained caregiver provides room, board and personal care to a small number of residents. Other family members of residents also sometimes live in the home as well.
The caregiver provides assistance with the activities of daily living including bathing, toileting, dressing and eating, and the small group environment offers companionship and connection for residents who are often in the same peer group.
VA Medical Foster Homes
For example, the VA’s Medical Foster Home program matches veterans who require nursing-home-level care with a community-based caregiver supervised by a home-based primary care team affiliated with the VA.
Christen Bergeron, a New Hampshire-based senior living expert and founder of Navigating Senior Living, a consultancy that helps adult children navigate aging parent care, says, “VA Medical Foster Homes are limited to three residents, each with their own private bedroom.”
These homes, which are located in residential neighborhoods across the country, emphasize providing a home-like environment, which many older adults find more comfortable than the institutional feel of a nursing home.
Adult foster homes/residential care homes
Some adult foster homes offer less intensive care levels. Often referred to as residential care homes, adult family homes, board-and-care homes or personal care homes, these less medically focused homes provide an alternative to an assisted living community for older adults who need assistance and care, but don’t require more intensive medical care.
Residential care homes not affiliated with the VA are typically designed to care for up to 10 residents, Bergeron says. “Just like a VA Medical Foster Home, all meals, housekeeping and laundry, along with medication reminders and management, are provided.”
These homes have caregivers on staff, but they also sometimes partner with outside agencies for nursing needs, she adds.
Some adult foster homes cater specifically to people with Alzheimer’s or dementia while others provide care for younger adults with physical disabilities. There’s a spectrum of care homes that offer a variety of options, but all of these are designed to support older or disabled individuals who might benefit from a quieter, smaller-scale setting than they would find in a larger assisted living or nursing home environment.
[READ: What Is a Skilled Nursing Facility vs. a Nursing Home?]
Who Is Eligible for VA Medical Foster Homes?
As of May 2025, about 700 veterans were participating in the VA’s Medical Foster Home program, according to a report from the U.S. Government Accountability Office.
Eligibility for this voluntary program is restricted to veterans who:
— Cannot live independently
— Require nursing home care
— Enroll to receive primary care at home from the VA
— Are located near an approved home that has availability
— Have the resources to pay for this care privately
The GAO reports that as of May 2025, 483 homes were aligned with 150 VA medical centers around the country.
Efforts to expand the reach and utility of medical foster homes got a boost in recent years with the passage of the Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022. Better known as the Cleland-Dole Act, this bill was signed into law in December 2022 to help address homelessness, telehealth and long-term care needs among veterans.
Key provisions in the law established a five-year pilot program intended to improve access to medical foster homes for veterans by paying for medical foster care for qualified veterans. However, the GAO reported that as of May 2025, such payments had not yet been started as the VA was not able to update its payment systems because of competing priorities. At the time, officials were exploring manual payment options until the system could be updated, and as of this writing, those payments have not started yet.
[READ: Using VA Benefits to Pay for Long-Term Care.]
Residential Care Homes vs. Other Types of Senior Care Options
Residential care homes are another form of senior care option that lies on a spectrum ranging from aging in place with occasional help from a family member to intensive, long-term nursing home care.
| Senior Care Option | Setting / Size | Typical Monthly Cost | Key Audience |
| VA Medical Foster Home | Private home (max 3 residents) | $1,500 to $6,000 | Veterans needing 24/7 care |
| Residential Care Home | Private home (up to 10 residents) | $5,000 to $8,500 | Seniors wanting a small home setting |
| Assisted Living Community | Large facility/apartment complex | $6,200 (national median) | Active seniors wanting community |
| Nursing Home | Medical facility | $9,581 (semi-private room) | Individuals with intensive medical needs |
What’s more, residential care homes often provide more tailored care and support for residents. “Residential care homes recognize that older adults aren’t one-size-fits-all,” Donnally says.
For example, “some people need clinical oversight every day, while others need only occasional help. The challenge is that our care system still tends to offer solutions at the extremes. That’s why we’re seeing more interest in a broader continuum of care.”
In short, she says the residential approach to caring for an older or disabled loved one allows families to find just the right level of care for the individual.
“The important distinction is that many older adults are not yet at the point where they need medical care,” Donnally notes. They may be healthy enough to live independently but would benefit from nonmedical support with household tasks, errands and having a trusted person nearby. “Addressing those needs earlier can help people remain independent longer and delay the need for more intensive care,” she explains.
[READ: Why Activities of Daily Living Are Important for Living Independently]
Who Provides Care in Medical Foster Homes?
Staffing can vary significantly from home to home and depending on the type of resident they serve. For example, VA medical foster homes are licensed by the VA and run by a primary caregiver who’s been vetted, trained and inspected by the VA. This individual lives in the home alongside the people they’re caring for, and additional caregivers may cycle in to relieve the primary caregiver as needed.
Caregivers working in adult foster homes typically have training in:
— CPR and first aid
— Medication management
— Abuse prevention
Some caregivers may have more advanced nursing training, but visiting licensed nurses, home health agencies or hospice workers typically provide additional services to augment the regular staff’s caregiving work.
Caregivers who are interested in becoming an approved medical foster home caregiver for the VA can apply at your local VA facility. You must meet certain age and experience requirements, pass a background check and rent or own a home that meets VA standards and passes inspection. The approval process can take four months or more, and you’ll be subject to ongoing, unannounced visits from VA staff to check on the home from time to time.
What Services Are Available in Medical Foster Homes?
“What’s interesting is how the definition of ‘support’ is expanding,” Donnally says, adding that not every challenge older adults face is medical. “Loneliness, transportation, household responsibilities and having someone dependable nearby are often just as important to whether someone can remain at home,” she points out.
People with these needs don’t always require the services of a clinician, but they do require connection and trust, she adds.
The services available in medical foster homes varies by home and the needs of the individual, but common supports include:
— Meal planning and preparation
— Assistance with eating
— Medication management or reminders
— Housekeeping and laundry
— Transportation
— Coordination of other services such as medical appointments outside the home
— 24-hour supervision
— Social engagement and activities
“Care and connection are different things,” Donnally underscores. “One addresses health needs; the other supports quality of life. The strongest aging models recognize that both matter.”
How Much Do Medical Foster Homes Cost?
The cost of medical foster homes can vary significantly depending on geographic location and services provided. However, these options may be a more affordable alternative to some traditional care settings, but it depends on the situation.
For example, the VA reports that their Medical foster homes generally run roughly $1,500 to $3,000 or more per month based on your income, depending on the region and care level. However, Bergeron says she’s seen VA Medical Foster Homes typically costing between $3,000 and $6,000 per month, while board-and-care homes or residential home care can cost between $5,000 and $8,500 per month.
Compare these estimates to CareScout‘s median monthly cost of an assisted living community, which is $6,200 per month, while a semi-private room in a nursing home averages $9,581 per month.
Bergeron notes that some of the variables that make the difference in cost include:
— Whether the room is private or semi-private
— Where in the country the home is located
— The range and complexity of care or services needed
— Whether additional fees are charged for transportation and other services
“Overall, these smaller residential care homes will typically be at a lower price point than a larger assisted living community. Larger assisted living communities may come with additional amenities, more robust activity programs and features such as restaurant-style dining,” Bergeron notes. But some older adults just feel more comfortable in a smaller residential care home.
Because Medicare does not cover custodial care in any setting, it won’t cover the cost of most of the care provided in medical foster homes. However, it may cover certain medical and healthcare services provided to the individual living in a residential care home. The VA also does not currently provide payment for this type of care, so most people must pay out of the pocket for a medical foster home.
How to Find and Apply for a Medical Foster Home
You can search for medical foster homes in your area online or by contacting your local senior center or Area Agency on Aging for assistance. “Both the regulation and supervision of these homes are managed at the state level, so there is quite a bit of variation state to state,” Bergeron explains.
For example, “not all states require that caregivers be certified or licensed as caregivers to work in these homes, though the states will outline training requirements for someone to work in the home and provide care.” Some board-and-care homes are owned by nurses or others with a background in care, she says, but not always.
Eligibility for medical foster homes not affiliated with the VA varies by state, so contact the body that oversees these facilities in your state for more details.
Veterans can apply for residence in a VA foster home via the VA’s Medical Foster Homes website. Remember, residents must be veterans who are enrolled in the VA’s Home Based Primary Care program and require nursing-home-level care. To qualify for the HBPC program, you must have a complex medical condition that makes it difficult or impossible to visit the doctor or otherwise obtain care outside the home.
Ask your VA social worker for help in determining whether a medical foster home is a good option for you and how to find one that has space available.
Selecting the Right Medical Foster Care Home
When considering a specific facility, Bergeron recommends asking a lot of questions, including:
— How staff are trained and how much experience they have
— How long staff have been working in the home
— Who will be overseeing or supervising the care
— How backup coverage is managed
— The home’s licensing and inspection history
— What emergency protocols are in place
“Additionally, not all states require that staff be awake at night in a small residential care home, so be sure to ask about this,” Bergeron points out.
Tour the home
Touring a home can help you get a better sense of whether it might be a good option for your loved one. “I always ask families to always pay attention to the caregivers and staff when touring,” Bergeron says, and note how they interact with the residents and each other. “Because they will have the most contact with your mom or dad day to day, you want to come away feeling good about what you saw on the tour.”
She also recommends touring the care home more than once or at different times of day if you can. “Each tour represents a snapshot in time, so visiting more than once can be very helpful.”
Understand the financial side
Because payment is largely private with possible help from VA benefits,Medicaid waivers in some states or long-term care insurance, planning the financial side early is crucial.
Bergeron recommends asking for a detailed rate sheet up front. She also notes that you need to understand that the rate you’re quoted at move-in can change over time. Ask:
— What is the highest rate my mom or dad could pay to live here?
— What would it take to get them there?
— When and how are rate increases applied?
Another point families should consider is how the home manages a resident who has run out of private funds, Bergeron says. “Some homes do participate in Medicaid waiver programs that cover the care cost if your loved one runs out of money, though not all do. If the home does not participate in the Medicaid program, your loved one may have to move to another community if their money runs out.”
Should I Move My Loved One Into a Residential or Medical Foster Home?
Making the move to a medical foster home is a big decision, but Donnally says medical foster homes can provide important support for older adults before a crisis arises.
“Most older adults don’t wake up one day needing a medical foster home. The transition usually starts with smaller changes: They stop driving, grocery shopping becomes harder, a spouse passes away, the house feels quieter or their adult children live across the country,” she explains.
But solutions that help older adults stay at home with dignity, independence and connection are increasingly important for families navigating those moments.
“We’re seeing growing interest in solutions that come earlier in the aging journey, helping older adults remain independent while they are still able to live safely at home,” Donnally explains. Providing support with everyday needs, household tasks, transportation and connection can all play an important role in preserving quality of life and helping families plan ahead.
“Medical foster homes become incredibly important when healthcare needs increase, but aging well requires a continuum of options that meet people where they are,” she adds.
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What Is a Medical Foster Home? VA Eligibility, Costs and Care Options originally appeared on usnews.com
