Guides

Small care home or big senior community: which is right for her?

By Jordan Green, Founder

Arizona gives you a real choice that most states don't. Assisted living here comes in two licensed forms: a home, which is an ordinary house with ten or fewer residents, and a center, the larger community with apartments and a dining room. The Phoenix area has about 1,330 licensed homes and 208 communities. Families rarely know the small homes exist, and they're often the better fit.

What a small home is actually like

Picture a house in a neighborhood. Five to ten residents, each with a bedroom (private or shared), a living room everyone uses, a kitchen where meals are cooked. One or two caregivers during the day, one overnight, often the owner on site. It feels like a household because it is one. The care is hands-on and personal; the day is quieter. Many quote a single monthly price that includes care.

Who tends to do well: someone who needs a lot of physical help, who's anxious in crowds, who's further along with dementia, or who simply wants a calm, familiar-feeling place. Who doesn't: someone who's still social and active and would be bored by lunch.

What a larger community is actually like

An apartment, a dining room with a menu, activities on a calendar, a van to appointments, a nurse on staff, a salon, sometimes a pool. Dozens to a couple hundred residents. Care is delivered by aides on a schedule, and priced in levels on top of the rent. There is more life in the building and more independence.

Who tends to do well: someone mostly steady on her feet who wants people, purpose, and choices. Someone who'd find a ten-person house too small. Couples, often. Who doesn't: someone who needs help every time she moves, and will wait for it at 2 a.m. when an aide is covering a whole wing.

The honest trade-offs

• Attention. Small homes usually win on caregiver-to-resident ratio. Ask any place for the number, day and night.
• Overnight. In a small home, ask whether the overnight caregiver is awake. In a community, ask how many aides cover how many residents after 10 p.m.
• Things to do. Communities win. A small home's day might be the TV, the patio, and a visit from the music lady.
• Medical coverage. Communities more often have a nurse on site or on call. Small homes rely on visiting providers and hospice when it's time.
• Aging in place. Ask both: "What happens when her needs grow?" Some homes keep people through hospice; some communities require a move to a memory-care wing or out.
• Price. Small homes often come in lower for someone who needs a lot of care, because the price is all-in and there's no ladder of add-ons. Communities are often cheaper for someone who needs little care. The starting price is a poor guide either way.
• Who's in charge. In a small home, the owner sets the tone and may be there daily. In a community, it's a manager and a corporate operator; turnover matters more.

What our price data shows

We read every community's website and listing, and we're working through the small homes the same way. Among the Phoenix-area communities that publish a starting price, the median is $4,000 a month, which is the lowest room at the lowest care level, not what families pay. Among the small homes that state a price online (182 of the 1223 we've researched so far), the median starting figure is $3,800 a month, and that one is usually closer to the real bill because it's all-inclusive.For what families actually pay after move-in, and what adds to the bill, read what assisted living costs in the Phoenix area.

How I'd decide

1. Be honest about how much help she needs, day and night. More help tilts toward a small home.
2. Be honest about her personality. Social and busy tilts toward a community.
3. Tour one of each, even if you think you know. People change their minds in the first five minutes of a tour.
4. Ask the overnight question and the "what happens when needs grow" question at both.
5. Get the all-in price for her level of care from each, in writing. We do this for you.

Every licensed place is in our directory: the communities and the small homes, by city, with the license facts and what we've confirmed. When you've got two or three names, take the tour questions with you, or let us set the tours up and prep both sides.

Questions families ask

• Is a small home safer than a big community?

  Neither is safer as a category. A good small home has more eyes per resident; a good community has more staff on site at any hour and a nurse on the schedule. The specific place and the specific people matter far more than the license type.

• Why don't small homes list prices?

  Most are small businesses run by the owner. Many quote one all-inclusive rate set after meeting the resident. We confirm the number by phone for you, with the date, so you're comparing real figures.

• Can she move from one to the other later?

  Yes, and people do in both directions. Someone might start in a community and move to a small home as needs grow; someone might leave a home for a community that offers more to do. Plan for the next two years, not the next ten.

• Which one do you usually recommend?

  It depends on the person, and we'll tell you which way the picture leans after a short conversation. We get paid the same referral fee either way, so we have no reason to steer you.