Choosing the right long-term care option for yourself or a loved one is one of the most important decisions a family can make. In Massachusetts, families are fortunate to have a variety of care settings to choose from—including Adult Foster Care (AFC), nursing homes, and assisted living facilities. Each option offers different levels of care, environments, and financial considerations.
This guide will help you compare these three care models across key areas—level of care, living arrangements, costs, and social and emotional factors—so you can make an informed and confident decision.
What Is Adult Foster Care (AFC)?
Adult Foster Care is a state-supported program in Massachusetts that allows adults who need daily assistance to live in a private home setting with a caregiver, rather than in an institutional facility. The program is funded by MassHealth and supports older adults or individuals with disabilities who require help with activities of daily living (ADLs) like bathing, dressing, meal prep, and medication management.
Care is provided by a live-in caregiver—often a family member (excluding spouses or legal guardians) or a trained individual placed through an AFC agency. These agencies oversee care plans, train caregivers, and send Registered Nurses (RNs) and Case Managers (CMs) for monthly in-home visits to ensure safety, compliance, and personalized attention.
What Is a Nursing Home?
Nursing homes (also known as skilled nursing facilities) are licensed medical institutions offering 24/7 medical supervision for individuals with complex health conditions. Residents typically receive care from a team that includes RNs, licensed practical nurses (LPNs), therapists, and physicians.
This setting is most appropriate for people who require ongoing medical monitoring, rehabilitation after surgery, or have chronic illnesses that can’t be managed safely at home.
What Is Assisted Living?
Assisted living facilities are residential communities for older adults who need some help with daily tasks but don’t require the intensive medical care offered in a nursing home. Residents live in private apartments with access to shared amenities such as dining rooms, fitness centers, and social activities. Staff assist with personal care and medication, and some facilities offer on-site nursing services for minor health needs.
Assisted living emphasizes independence with support, making it ideal for seniors who are still mobile and socially active but need some assistance to remain safe.
Comparing Levels of Care
| Feature | Adult Foster Care (AFC) | Assisted Living | Nursing Home |
|---|---|---|---|
| Medical Oversight | Monthly RN & CM visits via agency | Limited; mostly medication reminders | 24/7 skilled nursing care |
| Daily Care (ADLs) | Provided by live-in caregiver | Staff available for scheduled assistance | Provided continuously by staff |
| Emergency Response | Caregiver on site | Staff usually available 24/7 | Full-time medical staff on site |
| Mobility & Independence | Moderate to high | Moderate to high | Often low (more dependent residents) |
AFC is best for those who require consistent help with personal care but don’t need around-the-clock medical supervision. Nursing homes are designed for individuals with serious health conditions, while assisted living works well for those who can still manage much of their day independently.
Comparing Living Arrangements
| Feature | Adult Foster Care | Assisted Living | Nursing Home |
|---|---|---|---|
| Living Environment | Private home with caregiver | Private apartment with shared facilities | Private/semi-private room in facility |
| Social Setting | Small, home-based setting | Community with social events | Institutional; less emphasis on social |
| Family Involvement | High; often family caregivers involved | Moderate | Varies; less personal interaction |
The homelike environment of AFC provides a sense of familiarity and comfort that’s especially important for individuals with dementia, PTSD, or anxiety. By contrast, assisted living emphasizes social interaction, while nursing homes can feel more clinical and institutional.
Cost Comparison (Massachusetts, 2025 Estimates)
| Care Type | Monthly Cost (Approx.) | Funding Options |
|---|---|---|
| Adult Foster Care | $0–$2,500 (covered for MassHealth-eligible) | MassHealth (Medicaid), tax-free caregiver stipend |
| Assisted Living | $5,000–$7,500 per month | Private pay, long-term care insurance |
| Nursing Home | $12,000–$15,000 per month | MassHealth (after asset spend-down), Medicare (short-term only) |
Key Notes:
- AFC is the most affordable when the care recipient qualifies for MassHealth. The state reimburses agencies, which pay caregivers a tax-free stipend ranging from $10,000–$20,000/year.
- Assisted living is entirely private pay unless it is part of a Medicaid waiver pilot, which is rare.
- Nursing homes are the most expensive, and long-term stays require spending down assets to qualify for MassHealth coverage.
Social & Emotional Considerations
Each care model offers a different emotional experience for residents and caregivers.
- AFC provides the most personalized and emotionally supportive environment. Many caregivers are family members, and the home setting allows for cultural familiarity, pets, favorite meals, and personal routines.
- Assisted living encourages social interaction and offers amenities like group outings, game nights, and fitness classes. It’s ideal for seniors who are still sociable and active.
- Nursing homes can feel isolating or clinical for some residents, especially those who don’t need constant medical supervision. However, they provide critical support for those who are bed-bound or recovering from serious illness.
Which One Is Right for You or Your Loved One?
Ask yourself the following questions:
- What level of care is truly needed?
- If daily tasks are becoming difficult but medical needs are minimal, AFC or assisted living may be ideal.
- If medical complexity is high or 24/7 supervision is necessary, consider a nursing home.
- What setting feels most comfortable?
- If your loved one values privacy and familiarity, AFC offers a home-like atmosphere.
- If they enjoy activities, meals with peers, and group settings, assisted living may be a better fit.
- What financial resources are available?
- For families eligible for MassHealth, AFC is the most cost-effective.
- Without MassHealth eligibility, be prepared for significant out-of-pocket expenses for assisted living or nursing homes.
- How involved can the family be?
- AFC allows families to remain closely involved, especially when a family member serves as the caregiver.
How OMNISTARR Supports AFC Agencies in Massachusetts
At OMNISTARR, we understand that the success of the Adult Foster Care program relies on quality, consistency, and compassion. That’s why we proudly partner with AFC agencies across Massachusetts to provide:
✔ Highly Skilled RNs and Case Managers
We recruit and place Registered Nurses and Case Managers with deep experience in community care and compliance. These professionals conduct monthly home visits, complete clinical documentation, monitor care plans, and provide critical oversight to ensure MassHealth standards are met.
✔ Compliance and Documentation Support
We understand the importance of timely and accurate reporting. OMNISTARR supports agencies with centralized scheduling, digital documentation workflows, and audit-readiness support to minimize disruptions and maintain high-quality care.
✔ Scalable Staffing Solutions
Whether you’re a growing agency or one managing high caseloads, OMNISTARR helps fill gaps quickly and efficiently with vetted professionals who are compassionate, culturally competent, and fully credentialed.
✔ A Trusted Partner in Home-Based Care
As a Massachusetts-based healthcare staffing leader, we’re committed to strengthening the AFC community. Our goal is to help agencies focus on what matters most—improving lives through dignified, home-based care.
Final Thoughts
Choosing between Adult Foster Care, assisted living, and nursing homes is not a one-size-fits-all decision. Each option has its strengths—and the right choice depends on your loved one’s health, lifestyle, financial resources, and personal preferences.
If you’re an AFC agency looking to expand your reach or improve care quality, OMNISTARR is here to support you with reliable staffing, compliance support, and a shared commitment to compassionate home-based care.
For more information on how we can help your agency thrive, connect with us today or follow us on LinkedIn.