As the U.S. population ages, demand for long-term care services is increasing. Adult Foster Homes (AFHs), small residential care settings offering personalized support for older adults, are vital yet understudied compared to other options. This dissertation uses data from the Oregon Community-Based Care study (2017–2023) and mixed-methods research to examine AFHs comprehensively, including homes’ characteristics, residents' health status, and operators’ experiences during COVID-19. Findings highlight key trends, associations, and operators' insights, informing public health and long-term care strategies.