Most discussions of housing for adults with schizophrenia focus on apartments, group homes, or facilities. A quieter but important model exists in many states: shared living, sometimes called the host-home model, life sharing, or adult foster care. In this arrangement, an adult with serious mental illness lives with a paid host individual or family, in the host's home, with informal day-to-day support woven into family life. This guide explains how the model works, who it suits, and how it is regulated.
Shared living pairs an adult with serious mental illness or another disability with a paid host individual or family who provides a private room, meals, and informal support in the host's home — a smaller, more home-like alternative to a group home.
What shared living looks like
The arrangements vary, but a typical shared living situation includes:
- A private bedroom in the host's home
- Shared bathroom, kitchen, and living areas with the host family
- Three meals a day, eaten with or alongside the host
- Informal support with daily tasks, medication reminders, transport, and activities
- Inclusion in family life — meals, holidays, outings — to whatever extent the resident wants
- A relationship with a case manager or service coordinator from the agency that arranged the placement
- Backup respite care if the host needs time off
The host is paid a monthly stipend by the funding agency. The resident contributes part of their SSI cheque toward room and board, with a personal-needs allowance retained.
The history
Shared living has roots in two older traditions. One is adult foster care, which in many states evolved from foster care for children to similar arrangements for adults with developmental disabilities, mental illness, or age-related needs. The other is the European tradition of family care — most famously in Geel, Belgium, where the local community has taken in adults with mental illness as boarders for centuries. Modern shared-living programmes in the US borrow from both lineages.
Who tends to do well in shared living
- People who want company and family-style structure rather than solo living
- People who do not need 24-hour clinical staffing but benefit from informal supervision
- People with stable but chronic schizophrenia who have struggled with the loneliness of independent housing
- Older adults whose family caregivers can no longer provide the support
- People stepping down from a hospital, group home, or jail
Who it is harder for
- People who strongly prefer privacy and autonomy
- People with active acute symptoms or unpredictable behaviour the host cannot manage
- People with active substance use that the home cannot accommodate
- People who would not be a good match with the available host families
How shared living is regulated
Shared living is regulated at the state level under various names — adult foster care, family care home, life sharing, host home, adult family home — with rules varying significantly. Most states require:
- Licensure or certification of the host home
- Background checks and references for the host
- Training for the host (varies from a few hours to substantial mental-health-specific curriculum)
- Health and safety inspection of the home
- Limits on the number of residents per host home (often 1–3 adults)
- Ongoing case management or coordination by the licensed agency
State-level information is typically available through the department of social services, mental health, or aging.
How it is funded
Funding mechanisms vary by state, but common combinations include:
- Medicaid HCBS waivers — many states use 1915(c) waivers to fund the support component of shared living, particularly for people with developmental disabilities and increasingly for adults with serious mental illness. See Medicaid HCBS.
- State mental health authority — many states fund shared-living placements directly through the SMHA
- SSI — the resident contributes a portion toward room and board
- State SSI supplements — where they exist
Matching: the heart of the model
The single most important factor in shared living success is the match between resident and host. A good match produces a stable, often warm long-term arrangement; a poor match produces a quick breakdown. Good agencies invest heavily in matching, which typically includes:
- Detailed assessment of the resident's preferences, daily rhythms, interests, and challenges
- Detailed assessment of host families, including expectations, lifestyle, and capacity
- Multiple meetings between resident and prospective host before any decision
- A trial period (often 30 to 90 days) with explicit option to end the arrangement on either side
- Ongoing support and conflict resolution from the agency
What hosts are like
Hosts are typically individuals or families with a spare room, a stable home life, some prior caregiving experience, and an interest in this kind of work. Many are nurses, social workers, retired teachers, or people whose own family members have lived with mental illness. The pay is modest — usually not enough to be a primary household income — but for the right host, the work is meaningful and the relationships often become long term.
Rights of residents
Even though shared living is informal in feel, residents retain rights:
- The right to refuse medication outside an emergency
- The right to receive visitors
- The right to private mail and phone calls
- The right to come and go (within reasonable household norms)
- The right to file complaints without retaliation
- The right to end the placement and request a different one
The case manager or service coordinator from the agency should be a regular point of contact, not just a name on paper.
Hosts who control the resident's money or mail without authority, isolation from outside contacts, missed appointments without explanation, neglected hygiene, or signs of fear in the resident. Any of these warrant a call to the licensing agency or to the state long-term care ombudsman.
Where shared living fits
Shared living is one rung of the broader supported housing ladder. It is more home-like than a group home and provides more daily contact than PSH. For the right person and the right host, it can be a stable, warm long-term arrangement that resembles family more than institution. The right person and the right host are the whole story; the rest is logistics.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.