Next Avenue: Why small, residential assisted living facilities are growing in popularity

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Smaller residential facilities offer a more intimate setting that feels like a home.


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As so many epic journeys do, mine began with a 2:17 a.m. phone call. Gary — my stepfather and my mother’s primary caretaker —had a heart attack. He was almost certainly going to survive, but that left no one to take care of mom. A year prior, my mom had a massive stroke that did severe damage to her cognitive processing.

After a few weeks with us, she ended up in the hospital. It was clear she’d need to go to assisted living after a short stay in a nursing home for rehab. The rehab didn’t help, and what we thought was a great place turned out to be a horrible experience. After three days, we knew we needed to get her out of there.

I am an expert in senior living, founding and publishing a leadership blog for senior living owners and operators. Yet even I naively believed that finding the right assisted living community in my own backyard would be a snap. It was not. After visiting several large traditional senior living communities, none seemed quite right.

What small assisted living communities are

Our last stop, however, was a very different kind of assisted living community.

It was a lovely single-family home that had been converted into a six-bed residential care home and with never more than six residents at a time. At least two staff members were around 24 hours a day. They got to know my mom and took great care of her until she died, eight months later. They also took great care of Gary, who went to visit every afternoon.

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The small assisted-living model, sometimes known as residential care or board and care facilities, has evolved tremendously over the past 20 years and more of these homes are opening every week. Concerns about the health and safety of residents during the pandemic in traditional, larger assisted living facilities, is one reason interest has been growing.

One of the leaders of this movement is Gene Guarino, founder of the Residential Assisted Living Academy, which helps individuals and companies open and operate small assisted living communities across the country. Guarino’s facilities house five to 21 people.

Read: How to find a nursing home in a pandemic: What to look for and critical questions to ask

He notes that their residents “may not have the same access to some larger group activities but, now more than ever, people are realizing that a smaller home environment may be a safer and more convenient option.”

Some of the typical benefits of small assisted living communities vs. large ones:

  • A more intimate setting that feels like a home
  • A deeper relationship with caregivers
  • A higher level of staffing with faster response times
  • The ability to live in a residential neighborhood
  • Easier control of viruses
  • Easier to accommodate visits from family members
  • Home-cooked meals

Historically, these home-based assisted living communities were seen as being sort of the Motel 6, low-cost version of assisted living. But these days, small residential assisted can sometimes be as luxurious as 5-star hotels. When my mom was in hers, the cost was about $6,000 a month, about the same as she would’ve paid in a large community. Some other luxury versions cost $10,000 a month or more.

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You can also find small assisted living homes in the $2,500 a month to $4,500 a month range where rooms are bigger than the Motel 6 kind, the food fancier, and staffing a bit better.

Some small residential assisted living communities take residents who are on government support, reducing the cost.

Who might not want a small assisted living community

Residential assisted living is likely not a great choice, however, for:

  • Very active older people, who need or want just a little bit of assistance
  • Very social people
  • Anyone expecting a wide menu of food choices; here, food is like at home, just one item per meal
  • People needing 24-hour nurses on duty

To find a small assisted living facility, start by asking friends and family member if they’ve had any experience with one. Or begin a web search of assisted living facilities; you may have to scroll to the second or third page to find these small homes. Most online senior living directory services include some residential assisted living homes, too.

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Before you or a loved one moves into a small assisted living community, be sure to visit one and ask essential questions to see if it’s a good fit and up to your standards.

Steve Moran is the founder and publisher of Senior Living FORESIGHT (formerly Senior Housing Forum).

This article is reprinted by permission from, © 2020 Twin Cities Public Television, Inc. All rights reserved.

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