Columbia Senior AdvisorBy Columbia Senior Advisor Care Team · September 26, 2026
About 25 of the Midlands' 64 senior-serving CRCFs have 16 or fewer licensed beds, while 17 have more than 60. Small homes are more likely to accept OSS and feel like a household; large communities offer more activities and usually a secured dementia unit.
One license, very different buildings
South Carolina does not tier its assisted living licenses. A community residential care facility is a CRCF whether it has five beds or 170, and the same Regulation 60-84 applies: one staff member per eight residents at peak hours, one per 30 off-peak, a licensed administrator, written care plans and the same admission limits.
What differs is everything a family notices on a tour: how many residents share a dining table, whether there is a chapel or a hair salon, how many different aides a resident sees in a week, and what it costs.
How Midlands CRCFs break down by size
Counting senior-serving CRCFs in the six counties by licensed beds:
| Licensed beds | Number of CRCFs | With a secured Alzheimer's unit |
|---|---|---|
| Up to 16 beds | 25 | 0 |
| 17 to 60 beds | 22 | 9 |
| 61 to 100 beds | 13 | 6 |
| More than 100 beds | 4 | 4 |
Source: S.C. DPH Find a Facility license data as of November 6, 2026. The median senior CRCF has 39 licensed beds.
What small residential homes do well
Small homes, common in North Columbia, Northeast Richland, Blythewood and Lower Richland, can feel like living in a house: a handful of residents, home cooking and an owner who is often on site. Residents who are overwhelmed by crowds or noise may do better there, and staff get to know each person's routine quickly.
Small homes are also more likely to participate in Optional State Supplementation, which in 2026 pays a participating CRCF up to $1,719 a month for a low-income resident. For families with limited savings, that can decide the question.
What large communities do well
Larger communities in Lexington, Harbison, Northeast Columbia and Elgin usually offer a full activity calendar, transportation, on-site therapy partners and, most importantly for many families, a secured Alzheimer's unit under the same roof. A resident whose dementia progresses can move down the hall instead of across town.
They also tend to cost more and to change operators more often. Our facility pages show the licensee's legal name, which is the name to search when ownership changes.
Questions to ask at either size
Ask how staffing compares with the legal minimum at peak and overnight, because in a small home one person on duty may be both cook and caregiver. Ask who covers when the owner is away, how medications are handled, and whether the home has served residents with your parent's conditions.
At a large community, ask how many different aides a resident sees each week and how the dementia unit is staffed at night. At both, ask for the latest DPH inspection report, which is public on written request.
Matching the setting to the person
Think about the parent, not the brochure. A retired schoolteacher who loves company, lectures and a busy dining room may thrive in a large Lexington or Harbison community. A shy farmer from Calhoun County who has never lived among strangers may settle faster in a small home with six residents and the same aide every morning. A parent with advancing dementia needs a secured unit, which in the Midlands almost always means a larger building.
Health needs matter too. Small homes may have fewer staff on duty at once, so a resident who needs two people to transfer can be harder to serve well. Ask each home, large or small, how many current residents need two-person help and how they cover it at night.
Visiting a small home well
Small residential homes rarely have marketing staff, so call ahead and ask for a time when the owner or administrator can talk. Look at bedrooms, bathrooms and the kitchen, ask to see the posted DPH license, and ask how many residents are there now. Stay for a meal if you can.
Ask, too, who works the overnight shift and whether that person ever sleeps on duty; Regulation 60-84 requires a staff member awake and dressed at all times.
Frequently asked questions
Is a small care home licensed the same as a large assisted living community?
Yes. Both hold a DPH community residential care facility license under Regulation 60-84.
Are small care homes cheaper?
Often, and they are more likely to accept Optional State Supplementation, but prices vary by home.
Do small homes have memory care units?
Rarely. Most secured Alzheimer's units in the Midlands are in buildings with more than 50 licensed beds.
How do I check a small home's license?
Search DPH's Find a Facility map or our directory, which lists every licensed CRCF in the six counties.
What is the smallest licensed assisted living home in the Midlands?
Several CRCFs on DPH's roster have five licensed beds, mostly in North Columbia, Blythewood and the rural edges of Richland County.
Do small homes have to follow the same staffing rules?
Yes. The one-per-eight peak and one-per-30 off-peak minimums, with someone awake at all times, apply to every CRCF.
Is a large community safer than a small home?
Not by itself; safety depends on staffing, training and the match between residents' needs and the building, which you can judge from the record and from visits.
