You’re probably not reading this because things are going smoothly. You’re reading this because something has shifted — a fall, a close call, a night you can’t stop thinking about, or just the slow accumulation of hours that no longer feels manageable. You’ve been holding things together with in-home care, or with your own time and energy, and now you’re wondering whether there’s a better way.
This post is for families at that exact crossroads. It compares in-home care and board and care homes specifically for people with dementia — not in a vague, “it depends on your situation” way, but honestly, with real numbers and real tradeoffs. If you want to understand what the board and care services at Royal Garden actually include and how they compare to keeping your parent at home, this is a good place to start.
Neither option is right for everyone. What matters is matching the level of care to the actual stage of dementia — and being honest about what each option can and cannot deliver.
What in-home care for a parent with dementia actually looks like
Throughout this post, “in-home care” refers to paid non-medical caregivers — aides or personal care attendants hired through an agency or privately to help with daily tasks like bathing, meals, medication reminders, and supervision. This is different from home health care, which involves licensed nurses ordered by a physician for skilled medical services, and different from family caregiving, where a spouse or adult child provides care themselves. Most families managing dementia at home are doing some combination of all three — but the cost and consistency comparisons in this article focus specifically on the paid caregiver model, since that’s what families are weighing against a board and care.
In-home care sounds simple: a caregiver comes to the house and helps your parent with the things they can no longer do safely alone. In the early stages of dementia, that’s often enough. A few hours a day, someone to make meals and handle medications, a familiar face a few times a week.
But dementia is not a stable condition. It progresses. As it does, the hours required expand — gradually at first, then faster than most families expect.
Research tracking family caregivers over the last decade of a dementia patient’s life found that care hours escalate from around four hours per week ten years before death to approximately 33 hours per week in the final year. That’s nearly a part-time job — on top of whatever else a family member is already managing. For families using paid in-home care, those hours translate directly into costs.
When part-time in-home care is enough
Early-stage dementia often allows for a workable home care arrangement. Your parent can still be left alone for periods of time, follows familiar routines without significant redirection, and the primary risks are manageable with a few hours of daily supervision. In-home care preserves the familiar environment, maintains independence, and keeps your parent in a place they know.
When it stops being enough
The transition point is usually not a single moment. A caregiver who doesn’t show up and you’re scrambling. An incident during a gap in coverage. A night you couldn’t sleep because you weren’t sure your parent was safe. In-home care starts to strain when dementia reaches the stage requiring continuous supervision — not periodic check-ins, but someone present and attentive around the clock.
What a board and care home provides
A board and care home is a licensed residential home — a real house, in a real neighborhood — that provides 24-hour non-medical care for a small number of residents, typically four to six. In California, these homes hold licenses as Residential Care Facilities for the Elderly (RCFEs) and operate under the Community Care Licensing Division. The National Institute on Aging describes them as residential settings that provide personal care and meals with staff available around the clock.
What that means in practice: caregivers are present at all times, meals are prepared in-home, staff manage medications, and the environment itself supports safety. Residents aren’t navigating a large facility with long corridors and dozens of strangers — they’re living in a house with a small group of people and a consistent staff who get to know them.
What’s included in the monthly cost
Unlike large assisted living communities, which often quote a base room rate and add separate charges for care levels, medications, and activities, board and care homes typically bundle services into a single monthly rate. In the San Fernando Valley, that range runs from approximately $4,000 to $8,500 per month depending on level of care and room type. That cost generally includes:
- 24-hour supervision and caregiving
- Three home-cooked meals and snacks daily
- Medication management
- Assistance with bathing, dressing, grooming, and mobility
- Housekeeping and laundry
- In-home physician visits covered by insurance (at Royal Garden)
How board and care differs from larger assisted living
Both hold RCFE licenses in California, but the scale differs fundamentally. A board and care home has four to six residents. A larger assisted living community might have 60, 100, or more. For someone with dementia who struggles in noisy, stimulating environments — who gets disoriented by unfamiliar faces or long hallways — the smaller setting often produces meaningfully better outcomes. The home feels comprehensible. Faces become familiar. The routine becomes predictable.
The cost reality — when in-home care becomes more expensive
This is the part most families don’t run the numbers on until they’re already in crisis.
Part-time in-home care — four hours a day, five days a week — runs approximately $6,400 per month in the Los Angeles area at a median hourly rate of around $40. At that coverage level, your parent goes unsupervised for roughly 18 to 20 hours every weekday and all weekend. For early-stage dementia, that may be acceptable. For moderate to advanced dementia, it usually isn’t.
When supervision needs expand to cover evenings, overnights, and weekends, costs scale accordingly. According to Genworth and CareScout’s 2024 Cost of Care Survey, the national annual median cost for a home health aide reached $77,792 in 2024 — and that figure covers standard 40-hour-per-week care, not around-the-clock supervision. Full 24/7 in-home care in the greater Los Angeles area costs approximately $27,000 per month.
At that level, a board and care home is not the more expensive option. The monthly cost is significantly lower — and it includes continuous supervision that part-time home care cannot replicate.
The hidden costs families forget to count
The hourly rate is only part of the picture. The 2025 Alzheimer’s Disease Facts and Figures report from the Alzheimer’s Association found that 60% of dementia caregivers held jobs in the past year. Of those, 57% went in late, left early, or took time off because of caregiving. Sixteen percent had to take a leave of absence entirely.
The lifetime cost of caring for someone with dementia exceeds $405,000, with 70% of that total falling on families through unpaid caregiving and out-of-pocket expenses. Much of it never appears on a bill. It shows up in missed promotions, depleted savings, and years of compounded exhaustion.
The caregiver consistency problem — and why it matters more with dementia
For someone without dementia, a new caregiver is an inconvenience. For someone with dementia, it can be genuinely destabilizing.
People with dementia rely on pattern and familiarity to navigate daily life. When the face across the breakfast table keeps changing, when the routine shifts with each new aide, when the person who knew how to redirect a difficult moment has been replaced by someone who hasn’t learned that yet — the behavioral effects are real.
Why home care turnover is a structural problem
Home care agencies work to match clients with consistent caregivers. The structural reality of the industry makes that consistency hard to sustain. Home care workers earn a median wage of $16.13 per hour nationally — lower than virtually any other occupation requiring comparable responsibility. Low pay drives high turnover. The caregiver who knows your parent’s triggers and preferences today may not be there next month.
What consistency looks like in a board and care home
In a home with six or fewer residents, the caregiver-to-resident ratio changes the dynamic entirely. Staff get to know each resident in a way that isn’t possible when an aide cycles through multiple clients on rotating shifts. That familiarity is not incidental to good dementia care — it is the foundation of it. The same person who helped your parent through a difficult morning last Tuesday will be there next Tuesday too.
Safety at home with dementia: what the research shows
The home environment presents specific hazards that most families significantly underestimate — not because they’re careless, but because the risks accumulate gradually and are easy to rationalize one at a time.
Research involving older adults with moderate to severe dementia found that those living at home faced more than twice the fall risk compared to those in supervised residential settings. A separate national study found that nearly half of all community-living people with dementia fall in any given 12-month period — substantially more than their peers without dementia.
The risks go beyond falls
Falls are the most visible danger, but not the only one. Researchers have identified five distinct categories of home care safety risk for people with dementia: the person’s health status, dementia symptoms themselves, the physical home environment, the caregiving capacity of family members, and their awareness of safety risks. A board and care home addresses most of these by design — the environment supports safety, supervision is continuous, and staff train specifically in dementia care.
The risks at home are not a reflection of how much you care. They reflect what the home environment can and cannot provide as dementia progresses.
When in-home care still makes sense
In-home care is the right choice across a meaningful range of situations — and it’s worth being clear about that.
Early-stage dementia often works well with home-based support. Your parent retains significant independence, the primary needs are companionship and help with daily tasks for part of the day, and a family member living nearby provides backup supervision. A strong preference for staying home, when safety risks are currently manageable, deserves real weight in the decision.
The right time to start thinking seriously about alternatives is not when things become impossible. A useful signal is when the trajectory is clearly pointing that direction — when coverage gaps are growing, when needs are outpacing what home care can provide, and when the people doing the caregiving are showing signs of strain that won’t ease on their own.
Signs it may be time to consider a board and care home
Most families make this decision later than they should have. Not because they don’t care — because they do. The guilt of moving a parent into a residential setting, even a warm and genuinely home-like one, is real. That guilt doesn’t mean the decision is wrong.
Signs in your parent’s situation:
- Wandering, exit-seeking behavior, or getting disoriented in familiar spaces
- Falls, near-falls, or injuries at home
- Medication errors — missed doses, double doses, or inability to manage a regimen
- Behavioral changes — aggression, agitation, or nighttime confusion that’s difficult to manage
- Significant gaps in supervision that feel increasingly unsafe
- Hygiene or nutrition declining despite in-home support
Signs in your own:
Between 40% and 70% of family members providing dementia care develop clinically significant symptoms of depression. Research published in JAMA Neurology found that caregiver depression nearly doubles the rate of emergency room visits for the person being cared for. Burnout is not a personal failing — and it doesn’t stay contained to the caregiver. It becomes a patient safety issue.
Watch for these patterns in yourself:
- Chronic sleep deprivation or inability to take a break without anxiety
- Your own health declining because caregiving leaves no time to address it
- A persistent sense that no level of in-home support actually feels like enough
- Dreading what you’ll find when you call or visit
What to look for when evaluating a board and care home
Not all board and care homes deliver the same standard of care. Licensing sets a baseline, but it doesn’t guarantee the kind of environment that makes a real difference for someone with dementia.
Pay attention to how staff interact with current residents — not with you. Notice whether the environment feels calm and predictable or understaffed and rushed. Ask specifically about dementia training, caregiver-to-resident ratios, and how staff handle behavioral changes. Ask what happens if your parent’s needs increase significantly — whether the home can continue caring for them or whether a future move would be required.
The Royal Garden guide to touring a board and care home covers the specific questions worth raising at every visit, including the ones most families forget to ask until it’s too late.
This decision is harder than it looks — and you don’t have to figure it out alone
There is no version of this conversation that doesn’t involve grief, guilt, and uncertainty. That’s true whether you keep your parent at home or move them into a board and care home. What changes is the level of safety, the sustainability of the arrangement, and whether the people providing care — including you — can continue without being worn down to nothing.
Royal Garden is glad to talk this through with you. No pressure, no sales pitch — just an honest conversation about what your parent actually needs and whether we can provide it.
Schedule a visit with Royal Garden and see what this kind of care looks like in person.