The past decade has seen the development of regulation for assisted living across the United States (Mollica, 2002), forcing policy makers to consider whether and how to draw the boundaries for this category of housing with services. This article presents the approaches of two states to defining, licensing, and monitoring small board-and-care settings for older people. Oregon has a designated adult fostercare program and regulations, while Maryland regulates small homes under the broader category of "assisted living." The two case-study states represent very different policy responses to small board-and-care homes, demonstrating some of the diversity that is taking place nationally. This article reviews how the current age of assisted living affects small board-and-care homes.

For decades, small board-and-care settings have served an important, albeit at times overlooked and at other times scandalous, role in community-based care for older people who have physical and cognitive impairments. With the recent increase in assisted living residences and changes in regulatory requirements, now is a good time to review the role of small settings. Historically, these "mom and pop" homes have served a diverse group of clients, but they have taken a disproportionate number of very frail and low-income older people.

Information on small board-and-care homes is at best incomplete and at worst anecdotal and prejudicial. A review of published literature reveals a decrease in studies since the late 19905, with a 1996 AARP study (Folkemer et al., 1996) representing the last national review of regulatory issues. Have researchers answered all of the important questions about this setting type? More likely, this lack of attention is due to the increasing dominance of assisted living and to the "invisibility" (Sherman and Newman, 1988) and "social marginality" (Morgan, Eckert, and Lyon, 1995) of small board-and-care homes. Added to these shifts are the public policy choices some states have made to include board-and care under the newer assisted-living category.

Following is a brief review of board-and-care literature and demographics of the two case study states. The primary focus of the literature compares the regulatory approaches, with Oregon representing states with distinct adult-care home regulations and Maryland representing those that define small homes as assisted living. Because the purpose here is to draw lessons, neither state's approach is held up as better; each has pros and cons. We suggest that (1) the different regulatory approaches result in different responses from the operators of small board and-care homes, and (2) despite distinct approaches to defining and monitoring small settings for older people, the essential nature of small group homes (i.e., personalized, family-style care) persists.