For families · Definitions
What is an adult family home — and what is it called in your state?
Quick answer
An adult family home is a regular house licensed by Washington State DSHS to provide housing and personal care for up to six adults (up to eight with approval). The term is Washington's; the same small residential care home is an adult foster home in Oregon and Michigan, a board and care (RCFE) in California, a personal care home in Georgia and Pennsylvania, and a family care home in North Carolina.
Reviewed September 5, 2026. State terms and capacity limits change; verify with the agency listed before relying on this table.
The adult family home model
Every state licenses some version of the same idea: a small number of adults who need daily help living together in an ordinary house, cared for by a provider who lives there or staffs it around the clock. It sits between in-home care and a facility. Residents get the supervision of assisted living without the scale, and the state inspects the home, licenses the provider, and caps how many people can live there.
In Washington that license is the adult family home, created by RCW 70.128 and regulated under WAC 388-76. DSHS locator data retrieved September 2026 shows 6,069 licensed adult family homes with 35,306 beds in 35 of Washington's 39 counties. About 81% are licensed for six residents, about 96% hold a DSHS Medicaid contract, and most carry DSHS specialty designations for dementia or mental health (full counts by county). This site's directory lists every one of them from DSHS licensing records. Many of these homes also care for residents on hospice; hospice is a service that comes to the home rather than a place of its own, which is explained in the hospice guide.
The confusion starts at the state line. Someone searching for this kind of care in Phoenix will never type "adult family home," because Arizona calls it an assisted living home. The table below maps Washington's term to what each state's regulator actually calls it.
Same model, six vocabularies
State terms cluster into a handful of families. If you know your state's word, this is the fastest way to find its row in the full table.
- "Adult family home" or "adult family care" — Washington, Wisconsin, Ohio, Florida, New Jersey, West Virginia, New Hampshire, Maine, North Dakota
- "Adult foster home" or "adult foster care" — Oregon, Michigan, Minnesota, Indiana, Montana, Wyoming, South Dakota, Virginia, Massachusetts
- "Family care home" — North Carolina, Kentucky, Idaho
- "Personal care home" — Georgia, Pennsylvania, Mississippi
- "Residential care" (home, facility, or provider) — Vermont, Missouri, Oklahoma, Arkansas, South Carolina, New Mexico, Louisiana, California, Hawaii, Tennessee
- "Assisted living" with no separate small-home license — Alaska, Arizona, Utah, Colorado, Texas, Nebraska, Maryland, Illinois, Nevada
What an adult family home is called in each state
Term as the state regulator uses it, the licensing agency, and typical capacity for the small-home category. Where a state has no separate small-home license, the row says so.
| State | Licensing term | Licensing agency | Typical capacity |
|---|---|---|---|
| Alabama | Assisted Living Facility (Family) | Alabama Department of Public Health | Family: 2–3 residents; group: 4–16 |
| Alaska | Assisted Living Home (ALH) Alaska uses one license category for homes of every size. | Alaska Department of Health, Division of Health Care Services | No fixed small-home cap; many homes serve 5 or fewer |
| Arizona | Assisted Living Home Facilities with 11 or more are "assisted living centers." | Arizona Department of Health Services | Up to 10 residents |
| Arkansas | Residential Care Facility | Arkansas Department of Human Services, Office of Long Term Care | Licensed by capacity |
| California | Residential Care Facility for the Elderly (RCFE) Everyday name is "board and care home." Homes for adults under 60 are licensed as Adult Residential Facilities (ARF). | California Department of Social Services, Community Care Licensing Division | Licensed by capacity; 6 or fewer is the small-home tier |
| Colorado | Assisted Living Residence (ALR) Medicaid "host homes" serve 1–3 adults in a caregiver's residence under a different program. | Colorado Department of Public Health and Environment | No separate small-home license |
| Florida | Adult Family-Care Home (AFCH) Provider must live in the home. Larger homes are assisted living facilities. | Florida Agency for Health Care Administration | Up to 5 residents |
| Georgia | Personal Care Home (PCH) | Georgia Department of Community Health, Healthcare Facility Regulation | Family: 2–6 residents; group: 7–15 |
| Hawaii | Adult Residential Care Home (ARCH) Expanded ARCH (E-ARCH) homes may serve residents needing nursing-facility-level care. | Hawaii Department of Health, Office of Health Care Assurance | Type I: up to 5 residents; Type II: 6 or more |
| Idaho | Certified Family Home (CFH) Certified rather than licensed. Homes serving more residents fall under residential assisted living facility rules. | Idaho Department of Health and Welfare | Typically 2 residents; up to 4 with approval |
| Illinois | Assisted Living Establishment / Shared Housing Establishment "Shared housing establishment" is the closest small-home category. | Illinois Department of Public Health | Shared housing: up to 16 residents |
| Indiana | Adult Foster Care A Medicaid waiver service in a caregiver's home; larger homes are Residential Care Facilities. | Indiana Family and Social Services Administration | Up to 4 residents |
| Iowa | Elder Group Home | Iowa Department of Inspections, Appeals, and Licensing | 3 to 5 residents |
| Kansas | Home Plus Kansas's name for the small residential care home; originally capped at 8. | Kansas Department for Aging and Disability Services | Up to 12 residents |
| Kentucky | Family Care Home Personal care homes serve larger groups. | Kentucky Cabinet for Health and Family Services | 2 to 3 residents |
| Louisiana | Adult Residential Care Provider (ARCP) | Louisiana Department of Health | Licensed by capacity |
| Maine | Adult Family Care Home | Maine Department of Health and Human Services, Division of Licensing and Certification | Licensed small residential care; larger homes are residential care facilities |
| Maryland | Assisted Living Program (small) | Maryland Department of Health, Office of Health Care Quality | Small programs serve 1–4 residents |
| Massachusetts | Adult Foster Care (AFC) A Medicaid program in a caregiver's home rather than a facility license. | MassHealth (Executive Office of Health and Human Services) | 1 to 3 residents |
| Michigan | Adult Foster Care Home (AFC) "Homes for the Aged" is a separate license for 21+ residents aged 55 and over. | Michigan Department of Licensing and Regulatory Affairs | Family home: up to 6 with the licensee living on-site; small group home: up to 12; large group home: 13–20 |
| Minnesota | Adult Foster Care / Community Residential Setting Family foster care is in the caregiver's home; corporate foster care is staffed. | Minnesota Department of Human Services | Up to 4 residents (5 with a variance) |
| Mississippi | Personal Care Home | Mississippi State Department of Health | Licensed by capacity |
| Missouri | Residential Care Facility (RCF) | Missouri Department of Health and Senior Services | Licensed by capacity; no separate small-home tier |
| Montana | Adult Foster Care Home | Montana Department of Public Health and Human Services | Up to 4 residents |
| Nebraska | Assisted-Living Facility | Nebraska Department of Health and Human Services | 4 or more residents; no separate small-home license |
| Nevada | Residential Facility for Groups (RFG) | Nevada Division of Public and Behavioral Health | Licensed by capacity; small homes commonly serve up to 10 |
| New Hampshire | Adult Family Care Residential care facilities are the larger category. | New Hampshire Department of Health and Human Services | Up to 3 residents |
| New Jersey | Adult Family Care (AFC) Delivered through a licensed sponsor agency that places residents with caregivers. | New Jersey Department of Health | Up to 3 residents |
| New Mexico | Adult Residential Care Facility | New Mexico Department of Health, Division of Health Improvement | Licensed by capacity |
| New York | Family-Type Home for Adults (FTHA) Adult homes and assisted living residences are the larger categories under the Department of Health. | New York Office of Children and Family Services | Up to 4 residents |
| North Carolina | Family Care Home (FCH) Adult care homes serve 7 or more. | North Carolina Division of Health Service Regulation | 2 to 6 residents |
| North Dakota | Adult Family Foster Care Larger homes are licensed as basic care facilities. | North Dakota Health and Human Services | Up to 4 residents |
| Ohio | Adult Family Home Uses Washington's term. "Adult group homes" serve 6–16; together they are "adult care facilities." | Ohio Department of Health | 3 to 5 residents |
| Oklahoma | Residential Care Home | Oklahoma State Department of Health | Licensed by capacity |
| Oregon | Adult Foster Home (AFH) Same abbreviation as Washington, different word. Licensed in three classes (1–3) based on the provider's training and experience. | Oregon Department of Human Services, Aging and People with Disabilities (homes for adults with developmental disabilities are licensed by ODDS; mental health homes by the Oregon Health Authority) | Up to 5 residents (ORS 443.705) |
| Pennsylvania | Personal Care Home (PCH) Domiciliary care serves up to 3 in a caregiver's home under a separate program. | Pennsylvania Department of Human Services | 4 or more residents |
| South Carolina | Community Residential Care Facility (CRCF) | South Carolina Department of Public Health | Licensed by capacity |
| South Dakota | Adult Foster Care Home | South Dakota Department of Health | Up to 4 residents |
| Tennessee | Residential Home for the Aged (RHA) Assisted-care living facilities are the higher-care category. | Tennessee Department of Health | Licensed by capacity; non-medical care |
| Texas | Assisted Living Facility, Type A or Type B Adult foster care (Type C, 3–4 residents) exists as a Medicaid program in a caregiver's home. | Texas Health and Human Services Commission | Small facilities serve 16 or fewer; no separate small-home license |
| Utah | Assisted Living Facility, Type I or Type II Utah distinguishes by level of care, not by size. | Utah Department of Health and Human Services | Small facilities serve 5 or fewer; no separate small-home license |
| Vermont | Residential Care Home Adult family care (1–2 residents in a caregiver's home) is a Medicaid Choices for Care option. | Vermont Department of Disabilities, Aging and Independent Living | 3 or more residents |
| Virginia | Adult Foster Care Assisted living facilities are licensed at 4 or more. | Virginia Department of Social Services (local departments approve homes) | Up to 3 residents |
| Washington | Adult Family Home (AFH) The term this site is built around. Licensed under RCW 70.128 and WAC 388-76. | Department of Social and Health Services (DSHS), Residential Care Services (part of the Home and Community Living Administration since 2025) | Up to 6 residents; DSHS may approve up to 8 |
| West Virginia | Adult Family Care Home Residential care communities are the larger category. | West Virginia Bureau for Social Services | Up to 3 residents |
| Wisconsin | Adult Family Home (AFH) One of the few states that uses Washington's exact term. | Wisconsin Department of Health Services (3–4 beds); counties certify 1–2 bed homes | 1–2 residents (certified) or 3–4 residents (licensed) |
| Wyoming | Adult Foster Care Home | Wyoming Department of Health | Small homes in a caregiver's residence |
47 states listed. States not shown either fold small homes into their general assisted living license or have not yet been reviewed. Corrections are welcome — the agency named in each row is the authority.
Common questions
What is an adult family home?
An adult family home (AFH) is a regular residential house licensed by Washington State DSHS to provide room, board, and personal care to two to six adults who are not related to the provider. DSHS may approve seven or eight for experienced providers who meet added requirements (WAC 388-76-10031). The provider, entity representative, or a resident manager lives in the home, unless the home has 24-hour staffing with a decision-maker always present (WAC 388-76-10040). Residents receive help with daily activities, medication, and, in homes with specialty designations, dementia, mental health, or developmental disability care.
Is "adult family home" a national term?
No. It is Washington's licensing term, defined in RCW 70.128. Wisconsin and Ohio also use it, and Florida, New Jersey, West Virginia, New Hampshire, and Maine use "adult family care" or "adult family-care home." Most other states license the same kind of small residential care home under a different name, such as adult foster home, personal care home, family care home, or residential care home.
What is the difference between an adult family home and assisted living?
Scale and setting. An adult family home is a private house serving up to six (occasionally eight) residents with a live-in or round-the-clock caregiver. An assisted living facility is a licensed building, often with dozens to hundreds of apartments, shift staff, and communal dining. In Washington the two are licensed under different laws (RCW 70.128 for adult family homes, RCW 18.20 for assisted living), have different building requirements, and are inspected under different rules.
What is an adult family home called in Oregon?
An adult foster home, also abbreviated AFH. Oregon adult foster homes are licensed by the Oregon Department of Human Services for up to five residents and are classified by level of care.
What is an adult family home called in California?
A Residential Care Facility for the Elderly (RCFE), commonly called a board and care home. Small RCFEs serving six or fewer residents are the closest equivalent to a Washington adult family home. Homes for adults under 60 are licensed as Adult Residential Facilities.
Does Medicaid pay for adult family home care?
In Washington, yes, for residents who qualify. Most adult family homes hold a DSHS Medicaid contract (96% in DSHS locator data retrieved September 2026); the site's directory shows which homes accept Medicaid and which are private pay only. Other states have their own Medicaid waiver programs for small residential care, and eligibility and rates differ by state.
