Shared Living Vermont — How Adult Family Care Works Under Choices for Care

Nursing homes cost $13,628 per month. Assisted living runs $8,635. For families who cannot cover those numbers and whose parent does not need the clinical intensity of either setting, Vermont offers a care model that most people have never heard of: shared living, also called adult family care.

Under this model, a trained shared living provider welcomes an older adult into their own home and provides daily personal care, meals, companionship, and supervision. Medicaid pays an authorized agency a daily tiered rate, and the home provider receives a tax-free stipend to provide services through the Choices for Care program. The older adult lives as part of the household rather than in an institutional setting.

How It Works

A shared living arrangement pairs one older adult (or occasionally two) with a provider who has been screened, trained, and approved by a designated agency. The provider is not a licensed nurse or a certified nursing assistant — they are a private individual who has completed the required training and background checks and agreed to integrate the care recipient into their daily life.

The provider handles meals, housekeeping, laundry, medication reminders, transportation, and assistance with activities of daily living like bathing, dressing, and toileting. The arrangement is closer to a family dynamic than a clinical one. The older adult eats at the family table, watches television in the living room, and participates in household routines.

A supervising agency coordinates the placement, develops the care plan, provides ongoing training, and conducts regular home visits to monitor quality. The agency also serves as the intermediary if problems arise — friction between the provider and the care recipient, changes in the recipient's health needs, or safety concerns.

Who Qualifies

Shared living is available through the Choices for Care High/Highest program. To qualify, your parent must meet the Medicaid financial eligibility requirements and the clinical criteria for the High or Highest Needs group — meaning they meet the nursing facility level-of-care threshold.

For the Highest Needs group, services are an entitlement without a waitlist, but a specific shared-living provider still depends on availability. For the High Needs group, placements are subject to available funding and provider capacity.

The financial requirements are the same as for other Choices for Care services: countable assets at or below $2,000 for a single applicant (or up to $10,000 for a single applicant who owns and resides in a primary home and chooses community-based services), with income processed through Vermont's medically needy spend-down pathway.

What Providers Are Paid

Medicaid pays the authorized agency a daily tiered rate for the arrangement, and the home provider receives a tax-free stipend to provide the authorized services. The amount varies based on the care recipient's assessed level of need; providers serving Highest Needs participants receive more than those serving High Needs participants.

Providers also receive the care recipient's Supplemental Security Income (SSI) payment and any applicable state supplement, minus a personal needs allowance that the recipient retains. The total compensation is significantly less than what a nursing home or assisted living facility charges, which is part of why the model is cost-effective for the state — and why provider recruitment is an ongoing challenge.

When Shared Living Works Well

The model works best for older adults who:

• Are reasonably social and comfortable living in someone else's home
• Need daily personal care support but not 24-hour skilled nursing
• Prefer a family environment over an institutional setting
• Have a stable, predictable care routine
• Do not exhibit aggressive behaviors or severe wandering that would make a private home unsafe

It is particularly valuable in Vermont's rural counties where residential care facilities are scarce. In the Northeast Kingdom or southern Vermont, the nearest assisted living residence may be a 45-minute drive from the parent's community. A shared living provider in the same town keeps the parent connected to their doctor, their church, and their neighbors.

When It Does Not

Shared living has real limits. If your parent needs overnight clinical monitoring, complex wound care, insulin injections, or management of a ventilator or feeding tube, the model cannot accommodate those needs. Providers are not licensed medical professionals, and the care plan cannot include tasks that require clinical licensure.

If your parent has moderate-to-advanced dementia with behavioral symptoms — aggression, nocturnal agitation, persistent exit-seeking — a private home without secured exits and dementia-trained staff around the clock is not a safe environment. A memory care unit within a licensed facility is the more appropriate setting.

And because the arrangement depends heavily on the personal relationship between provider and recipient, compatibility matters. A mismatch in personality, lifestyle, or expectations can make the arrangement unsustainable, and finding a new provider may take weeks or months.

Getting Started

Contact your parent's regional Area Agency on Aging (HelpLine: 1-800-642-5119) or the designated agency in your county that manages shared living placements. They will walk you through the Choices for Care eligibility process and help match your parent with an available provider.

If you are weighing shared living against other options — home care, residential care homes, assisted living — the Vermont care decision guide maps all of these settings side by side, with the cost comparisons, Medicaid coverage rules, and clinical capability limits that help you identify which model fits your parent's needs and your family's financial reality.

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