Board and care vs. nursing home: what's the difference?

Families searching for senior care often type “nursing home” when what their loved one needs is something different — or the reverse. In California these are two distinct, separately licensed types of care. Here's how they differ, and how to tell which one actually fits.

What each one is

Board and care home

“Board and care” is the everyday name for a small residential care facility for the elderly (RCFE), licensed by the California Department of Social Services. Many are ordinary houses on residential streets with six or fewer residents. Caregivers help with daily living — bathing, dressing, meals, medication management — and keep an eye on residents around the clock. It's a home where people live, not a clinical setting where they're treated.

Nursing home

A nursing home is a skilled nursing facility, licensed as a healthcare facility (in California, by the Department of Public Health). Licensed nurses are on staff around the clock, and the focus is medical: rehabilitation after a hospital stay, complex wound care, IV therapy, tube feeding, and other services that need skilled nursing.

The differences that matter most

Level of medical care

This is the real dividing line. A skilled nursing facility is built for ongoing medical needs. A board and care home is built for help with daily life, and coordinates with your family member's doctors, outside home health nurses, or hospice when medical needs arise. Penda Homes is a licensed residential care home, not a skilled nursing facility — if someone needs daily skilled nursing, we'll tell you plainly rather than promise something we can't provide.

Size and setting

Nursing homes are larger, often with dozens or hundreds of beds, and are organized like a medical facility. A small home means a living room, a kitchen, a backyard, and a handful of neighbors. We wrote more about this tradeoff in Small Board-and-Care Homes vs. Large Facilities.

Cost

Because skilled nursing is staffed and regulated as medical care, nursing homes typically cost considerably more per month than assisted living. Our own rates start at $4,500/month, all-inclusive — see What Assisted Living Actually Costs in Menifee for the broader picture.

Who pays

Medicare may cover a limited period of skilled nursing or rehabilitation after a qualifying hospital stay, but it does not pay for long-term custodial care. Board and care is generally paid privately or through long-term care insurance, and Medi-Cal has its own separate eligibility rules. Our payment options page covers what we see families use.

How to tell which one your family member needs

• Mostly needs help with daily activities and supervision, and is medically stable: a board and care home is usually the right level.
• Needs daily skilled nursing, or is recovering from surgery, a stroke, or a fall and needs intensive rehab: skilled nursing, at least for a period of time.
• Not sure: ask the doctor or hospital discharge planner for a recommendation on level of care. Many people move from hospital, to a short rehab stay, to a residential home.

Care needs can also change over time. Hospice and comfort care can often be delivered inside a residential home — we explain how in Hospice vs. Palliative Care.

Ask what happens if needs grow

Every residential care home operates within state licensing rules and its own admission and retention policies. Ask directly: what level of care can you provide, and what changes would mean a move? It's one of the questions on our tour checklist, and a good home will answer it specifically rather than promising they can handle everything.