Board and Care Homes

The legal definition of what constitutes a board and care home depends on local, state, and national statutes, and is related to the health and welfare agencies that monitor homes. Nomenclature varies widely. As noted by Robert Rubinstein, the middle range of care settings includes such alternatives as sheltered housing, domiciliary care, adult foster care, small congregate homes, and assisted living. The same name may be used for different types of settings in different states, making it hard to distinguish board and care facilities (McCoy and Conley). However, the term "board and care" is often used to describe the range of non-nursing home care arrangements, including many of those listed above.

Distinctions between board and care and "assisted living" are blurred. Assisted living is the name given to a consumer-focused residential model emphasizing privacy, independence, decision making, and autonomy. Moreover, the label "assisted living" has been used to differentiate this type of housing from conventional board and care housing and the negative connotations that some people associate with it (GAO, 1992; Kane et al.). In many states considerable overlap exists between board and care and assisted living, and the terms may be used interchangeably (Mollica).

Size is often a distinguishing feature in board and care settings. In particular, small board and care homes are often distinguished from larger, multiunit, purpose-built facilities. Both size and coresidence of the operator differentiate small, family-type homes from larger, more institutional, staffed homes. Studies of small board and care homes have found them to be much like extended family settings in single-family homes. The majority of small home operators are middle-aged women, many of whom have limited education (Morgan et al., 1995). Living spaces and meals are often shared in these small homes, which are believed to serve a more vulnerable adult population who are poor, have inadequate kin and other support, and suffer from long-term disabilities, mental illness, mental retardation, and chronic physical conditions (Eckert and Lyon).