Group homes are small residential facilities where people who need daily support live together in a home-like setting rather than in a large institution or hospital. They typically house 20 or fewer residents and serve a wide range of people, including adults with intellectual and developmental disabilities, children in foster care, older adults who need help with daily tasks, and people recovering from mental health crises. The common thread is that residents need more support than they can get living alone but don’t require the round-the-clock medical care of a hospital or nursing home.
Who Lives in Group Homes
Group homes serve several distinct populations, and the experience inside one varies significantly depending on who it’s designed for.
Adults with intellectual or developmental disabilities make up one of the largest groups. These homes provide supervision, help with daily routines, and opportunities to participate in community life. Residents often live with just one or two housemates and have an agency responsible for meeting their daily care and medical needs. The goal is integration: helping residents interact with people in their community, hold jobs, pursue hobbies, and make their own social choices rather than being isolated in a facility.
Children and teenagers may be placed in group homes through the foster care system when a traditional family placement isn’t available or appropriate. Some of these are therapeutic group homes, staffed under a licensed clinician, that specialize in children with significant emotional or behavioral needs. These settings provide individual and group counseling, educational services, case management, and safety planning. The federal Administration for Children and Families defines group homes as housing 12 or fewer youth, distinguishing them from larger institutions.
Older adults use what are sometimes called board and care homes or residential care facilities. The National Institute on Aging describes these as small private facilities with 20 or fewer residents. Unlike assisted living facilities, which can house 100 or more people, group homes for seniors are smaller and more personal. They generally don’t provide nursing or medical care on-site, focusing instead on supervision, meals, and help with daily activities.
Adults with mental health conditions may live in transitional group homes designed to bridge the gap between a psychiatric facility and independent living. Colorado’s mental health transitional living homes, for example, offer 24/7 supervision along with life skills training, job connections, meditation and social activities, help with medication routines, and discharge planning with the explicit goal of moving residents back into the community.
What Services Group Homes Provide
The specific services depend on the population, but most group homes share a core set of supports. Residents receive help with daily living tasks like bathing, dressing, cooking, cleaning, and laundry. Medication management is common, ranging from simple reminders to take pills on schedule to more hands-on assistance. Meals are typically prepared on-site, and many homes provide transportation to appointments, jobs, or community activities.
Beyond the basics, many group homes connect residents with outside services. These can include nursing visits, personal care aides, individual counseling, peer mentorship from someone with lived experience of disability, and help finding longer-term housing. For children, services often extend to educational support, vocational training, legal assistance, and access to dental and medical care.
One important distinction: group homes generally provide supervision and accommodations, but clinical treatment is delivered separately. A resident might see a therapist who visits the home or travel to an outside clinic. The home itself is meant to feel like a home, not a treatment center.
How Group Homes Differ From Larger Facilities
The defining feature of a group home is its small scale. Board and care homes for seniors typically have 20 or fewer residents, compared to assisted living facilities that house 25 to over 100. Youth group homes cap at 12. This smaller size allows for more individualized attention, a quieter environment, and a setting that more closely resembles a regular household.
Assisted living facilities offer more medical infrastructure, including 24-hour on-site staff, help with medications, and housekeeping services built into the facility. Nursing homes go further still, providing skilled medical care. Group homes sit at the lower end of this spectrum. They’re less expensive than assisted living or nursing homes, but they also offer less medical oversight. For many residents, that tradeoff is the point: they need support with daily life, not clinical care.
The community integration philosophy also sets group homes apart. Federal guidelines under the Americans with Disabilities Act emphasize that community-based settings should let people with disabilities interact with non-disabled people, choose their own activities, and come and go freely. Larger or more institutional settings tend to limit community access, offer mainly group activities, restrict visitors, and impose rigid schedules for eating, bathing, and leaving the building.
Staffing and Oversight
Group homes are licensed by state agencies, and requirements vary by state. In Michigan, for example, small group homes must maintain at least one direct care staff member for every 12 residents, though the state can require higher ratios based on residents’ needs. Staff must be trained in first aid, CPR, fire safety, resident rights, communicable disease prevention, and the specific needs of the population they serve. Administrators complete 16 hours of approved training annually or equivalent college coursework. Crisis intervention requires separate, state-approved certification.
These are minimums. Many group homes, particularly therapeutic ones serving children or people with serious mental health needs, maintain much higher staffing levels and more specialized training. The quality of a group home depends heavily on the training, experience, and attentiveness of its staff.
How Group Homes Are Paid For
Funding sources vary by the type of home and the resident’s situation. For people with disabilities, Medicaid’s Home and Community-Based Services (HCBS) waivers are one of the most common funding mechanisms. These waivers let states provide Medicaid coverage to people who would otherwise only qualify for institutional care, effectively redirecting funds from large facilities to community-based settings like group homes. States can target these waivers to specific populations by age or diagnosis, including autism, cerebral palsy, traumatic brain injury, and epilepsy. Eligibility requires demonstrating a need for the same level of care that an institution would provide.
For seniors in board and care homes, Medicare does not cover costs. Medicaid may provide partial coverage depending on the state and the individual’s eligibility, but most residents pay out of pocket. Assisted living follows a similar pattern: it’s generally self-funded, though Medicaid may cover some aspects in certain states.
Children placed in group homes through foster care are typically funded through state child welfare agencies, with federal support through programs like Title IV-E.
Outcomes and Limitations
For adults with disabilities and mental health conditions, group homes represent a significant improvement over institutionalization. They offer more autonomy, more community contact, and a more dignified daily life. Transitional mental health homes have shown particular promise by combining structured support with a clear path toward independence, using intensive case management and discharge planning to move residents toward self-sufficiency.
For children and youth, the picture is more complicated. Research compiled by Casey Family Programs found that young people placed in group settings are almost 2.5 times more likely than peers in family foster care to become involved in the juvenile justice system. They also have lower test scores in English and math, are less likely to graduate high school, and are less likely to achieve permanent family placement. Many youth describe group placements as punitive or prison-like. Children placed in family foster homes, by comparison, experience fewer placements, spend less time in out-of-home care, and are more likely to stay near their community of origin and with their siblings.
This doesn’t mean group homes for youth serve no purpose. For children with intensive behavioral or emotional needs, a well-run therapeutic group home with clinical oversight can provide stability that a family setting cannot. But the research strongly suggests group placement should be a last resort for children, not a default, and that the quality of the individual home matters enormously.