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Small residential care settings for older adults and people with disabilities are found throughout the United States. Those with fewer than 25 residents account for half of residential care settings. Adult foster homes (AFH) are under-studied although they provide personal and health-related services to residents, including people with Alzheimer’s disease. This qualitative study collected data from 726 AFH owners over four years. Results provide a contemporary perspective on owners’ experience of the rewards and challenges of operating a small home. These results are relevant since many residents prefer small settings, and because federal regulatory changes affect AFH policies and practices.

“This ‘Family Setting’ Is Not that Anymore”: Rewards and Challenges of Adult Foster Home Owners