Before there was such a thing as "assisted living" personal care homes played a vital role in caring for older adults who couldn't live completely independently but who didn't need institutional care. They were often known as "Mrs. Smith's house, where she has two boarders she watches over." Mrs. Smith was unlicensed, unregulated and usually not formally trained.

As our aging population has increased, and many families no longer live with or near their elders, the personal care home concept has become popular as a small and homelike alternative to the larger and more formally organized assisted living residence.

Depending on where in the country you live, personal care homes can be known as board and care homes, foster homes, residential care facilities, and even - just to add to the confusion - assisted living homes.

In general, a "pc home" provides a non-medical living environment that offers a room, meals, and varying levels of supervision and help with personal care needs (toileting, bathing and grooming, dressing, eating, supervision of medications). Personal care homes are not licensed to provide medical or nursing care.

Most states have some form of licensing or certification for personal care homes, but not all such homes are licensed or certified. Small pc homes with only two or three residents are often exempt from these requirements. Some authorities believe that as many as half of all care homes are not licensed or certified.

The unlicensed/uncertified personal care homes may be difficult to locate because the regulatory agencies do not include them on their data lists. Word of mouth, local resource booklets, professional advisors, and the Internet are all means of locating personal care homes in your area.

What to Look For in a Personal Care Home:

  Are there enough caregivers? There should be at least one caregiver to three residents.

  Is the home clean and neat? Check out the kitchen and resident bathrooms.

  Are all bathrooms equipped with basic safety devices such as grab rails, hand-held shower wands and shower stools/benches? Is the home free of obstacles, throw rugs, raised thresholds and steps? Are all doorways wide enough for a wheelchair to easily pass through?

  Is the home over-decorated? Some newer homes are showplaces that could easily be featured in a home & garden magazine. That's lovely for a photo, but is it livable? If the residents must be wary of disturbing or breaking the decor, the home isn't resident-friendly.

  Who is responsible for medications and what training does this person have? Where are medications stored? Who calls the doctor or the pharmacy for refills?

  Are special diets available? Is the kitchen open to the residents at any time for snacks?

  Are there organized activities? Are the residents ever taken out for recreation?

  Are caregivers interacting with residents outside of meals or personal care activities? In a personal care home a caregiver who sits and chats with residents in the common area is providing valuable socialization, particularly if the TV is not on at the same time.

  Does the residence use a physician or nurse practitioner who makes house calls? If not, who takes the resident to the doctor and, if they do, how do they report to the family?

  Is there an evacuation plan in case of emergencies? Where will residents go if the home cannot immediately be re-entered?

Visit two or three times, if you can. When you find a residence you like, be sure to carefully review the admission agreement and any other documents. Remember that attachments, handbooks, or other documents may be just as legally binding as the "agreement."