Residential care homes are a step between living independently and a nursing home. Also known as board-and-care homes and personal care homes, they provide services such as housekeeping, medication management and social activities. It's a valuable service, but it's a competitive market.


Research residential care options in your local area: Are their enough potential customers to make your business viable? How can you stand out competing with established homes? Learn the regulations you are required to follow. Figure out how many employees you need and what the state requirements for staff are.

Look at the Market

The difference between residential care homes and nursing homes or assisted living facilities is that residential care homes don't have the same level of on-site medical care. They're designed for seniors who can function with some degree of independence but are unable to live alone. The services may include laundry, housekeeping, hot meals, transportation and medication management, as well as opportunities for residents to socialize.

Before opening a residential care facility, look around your community and see if there's a viable market. Monthly fees for residential care typically run $3,000 to $4,000, and there's little government support available to cover the costs. In most locations, there's a small pool of potential customers with enough money to move in and a lot of competition for their dollars.

Starting a residential care home won't do any good if the competition's too stiff. Look at established homes in your community. What services do they offer, and what's the quality of life there? Start thinking of ways to make your residential care home stand out from the pack, such as better services, better food, a nicer environment or free Wi-Fi.

Residential Care Home Requirements

Residential care home requirements are imposed state by state, rather than nationally. As part of your research before opening a residential care facility, look up the requirements for your state. They're usually lighter than nursing home regulations, but you have to abide by them.

To take one example, North Carolina guarantees certain rights to every adult care home resident that you're legally required to respect:

  • Residents must be treated with dignity and respect for their privacy.

  • Adequate care and services must be provided.

  • When you admit new residents, you have to provide a written statement of the services you provide and the cost.

  • No abuse, neglect or exploitation is tolerated.

  • You can't use drugs or physical restraints on residents unless a physician authorizes it for a specific period.

  • Resident records must be kept confidential and only disclosed with the resident's consent.

  • If a resident makes a request, you and your staff must provide a reasonable response.

  • Residents are free to talk privately and hang out with each other.

  • Residents are free to make private phone calls and send mail without staff opening it.

  • If residents have complaints or suggestions, they must be free to make them without fear of retaliation.

  • Residents must have a lockable space to secure their valuables.

  • Residents can manage their own money unless they delegate that responsibility. If they delegate it to the facility, they have a right to examine their accounts at any time.
  • They have the right to participate in community activities or not to participate.

  • If you discharge a resident, it must be for reasons such as nonpayment or medical reasons. Residents are typically entitled to a 30-day notice, and they can appeal a discharge decision.

That's only a fraction of the residential care home requirements you may have to deal with.

Finding Staff

The right staffing is essential for any business, but particularly when starting a residential care home. The staff has to deal with residents who may not be happy they've had to leave their homes and may eventually exhibit problems such as Alzheimer's or a broken hip. Depending on the services you offer, you may need cooks and waitstaff, laundry services, housekeepers, transportation and someone on call during the night shift.

Your state may have residential care home requirements for staff. In California, for example, staff members need 40 hours of training at your facility in the first year and 20 hours before they work with patients. Administrators must complete an 80-hour certification program and pass a state exam. All staff members need dementia care training. Residents who help residents take their meds need additional training.

Residential care home requirements may set a minimum staff to patient ratio. California doesn't have a specific number, but the state requires you have sufficient staff to care for patients properly.