Birmingham and Bloomfield Hills sit at the top of Oakland County's price range for senior care, but the two communities don't offer the same thing - here is how families weigh Homes for the Aged, Adult Foster Care, and staying in a longtime home across both cities.
By Detroit Senior Advisor Care Team · August 21, 2026
Birmingham and Bloomfield Hills sit side by side in southeastern Oakland County, and it's easy to assume they offer interchangeable options for senior living. They don't. Birmingham is a compact, walkable downtown built on a tight street grid, with condos, small apartment buildings, and Adult Foster Care (AFC) homes woven into established neighborhoods like Poppleton Park, Quarton Lake, and the Rail District. Bloomfield Hills, by contrast, is almost entirely low-density and lot-based, with large private homes on wooded acreage and a handful of larger licensed communities operating as Homes for the Aged (HFA) set back from the road. A family searching for senior living in Birmingham is often looking at a small AFC home inside a converted single-family house within walking distance of Shain Park or Booth Park. A family searching in Bloomfield Hills is more often looking at a larger HFA campus with its own dining room and activity calendar, because the lot sizes and zoning simply support a different scale of building.
Neither Birmingham nor Bloomfield Hills has its own senior-care licensing category - both fall under the same Michigan Department of Licensing and Regulatory Affairs (LARA) framework as every other city in the state. What changes is the density of AFC homes versus HFA campuses, the price point, and how close a resident can stay to the life they already had. Beaumont Royal Oak (now Corewell Health William Beaumont University Hospital) and Ascension Providence Hospital in Southfield both serve this corridor for hospital discharges, and proximity to one of those campuses is a real factor in how quickly a family needs to decide.
Because Birmingham's residential streets are dense and its lots are small, most licensed senior care inside the city itself operates as small or family-scale AFC homes - typically six or fewer residents, licensed by LARA's Bureau of Community and Health Systems (BCHS) as a family or small group home. These homes tend to sit on quiet side streets rather than main corridors, and from the curb they look like any other house in the neighborhood. Families who want their parent to stay recognizably "in Birmingham" - close to a longtime church, the Baldwin Public Library, or grandchildren at Birmingham Public Schools - often end up choosing one of these smaller AFC homes precisely because the alternative means leaving the city limits.
The tradeoff is availability. Small AFC homes have few beds, turnover is unpredictable, and a family that starts looking only after a hospital discharge often finds every home in the immediate downtown area full. It's common for a Birmingham search to expand into neighboring Bloomfield Township or Beverly Hills within the first few calls - not because the family wanted a different city, but because that's where the next open bed happens to be. Building a short list before a crisis, rather than during one, matters more in a tight market like Birmingham's than almost anywhere else in the metro.
Bloomfield Hills works in the opposite direction. Large, wooded lots and low-density zoning mean the city supports fewer total licensed homes, but the ones that exist tend to be bigger - congregate-style Homes for the Aged with 21 or more residents, on-site dining, and a broader activity calendar than a six-bed AFC home can offer. These campuses are often set back from Long Lake Road, Lahser Road, or Woodward, screened by mature trees, and easy to drive past without noticing. For families who want a larger community with more built-in socialization and staffing depth, Bloomfield Hills' HFA campuses are usually the closer option compared to searching all the way into Rochester Hills or Novi.
That scale comes at a price. Bloomfield Hills consistently sits at or near the top of Oakland County's private-pay range, and a bigger HFA campus generally costs more per month than a small AFC home in a converted house, even a few miles away in Birmingham or Troy. Families touring in Bloomfield Hills should ask directly what's included in the base rate versus billed as a separate care-level add-on - memory-support staffing, medication management, and higher personal-care tiers are frequently priced outside the advertised base rate, and the gap between the two numbers can be substantial by the time a resident needs more hands-on help.
Michigan doesn't license "assisted living" as its own category anywhere in the state, and that includes Birmingham and Bloomfield Hills. What residents and families call assisted living is delivered either through an AFC home under the Adult Foster Care Facility Licensing Act (1979 PA 218) or a Home for the Aged under Part 213 of the Public Health Code (1978 PA 368), both inspected by LARA's BCHS. There is also no separate Michigan memory-care license - dementia care in either city is delivered inside an AFC or HFA license, with the facility disclosing what dementia-specific training and staffing it provides. Before touring anywhere in this corridor, it's worth pulling the license record directly from LARA's AFC/HFA licensing search to confirm the facility's current license type, capacity, and any recent citation history - marketing language on a website doesn't always match what's on file with the state.
Medicaid's MI Choice Waiver, the state's home- and community-based services waiver, can help cover personal-care supports for eligible residents inside an AFC home, but it does not cover the room-and-board portion of either an AFC or HFA placement - families in Birmingham and Bloomfield Hills should expect private pay, long-term-care insurance, or VA Aid & Attendance (for eligible veterans) to cover the base rate itself, with MI Choice layered in only for the care-services piece where it applies.
In practice, most families in this corridor aren't choosing between Birmingham and Bloomfield Hills in the abstract - they're choosing based on which parent's life was already anchored where, and which type of building actually has an open bed. A parent who spent decades walking to downtown Birmingham for church, the farmers market, or a regular restaurant table often does better staying inside the city in a small AFC home, even if it means a longer wait for an opening. A parent who values a larger social calendar, more staff on site around the clock, and doesn't have the same downtown attachment often settles into Bloomfield Hills more easily, budget allowing.
The Detroit Area Agency on Aging 1-B (covering Oakland, Macomb, Washtenaw, Livingston, and Monroe counties) and Michigan's MMAP program (Michigan Medicare/Medicaid Assistance Program) both offer free, unbiased benefits counseling that can help a family compare the true out-of-pocket cost of an AFC home in Birmingham against an HFA campus in Bloomfield Hills before committing. Touring at least one option in each city - rather than assuming the closer or more familiar name is automatically the better fit - is the single most useful step families skip when they're moving quickly after a hospital discharge.
Free and no pressure. We answer to families, not facilities.
Or call (313) 513-4054