In Ghana, family caregiving for older adult’s manifests in co-residential, non-residential and multigenerational household caregiving, although composited under the umbrella of family care. Due to this compositing, the nuances surrounding the decision to take up co-residential family care and the associated challenges are unknown. The goal of this study is to understand the factors that make families co-opt for co-residential elderly caregiving arrangements. Evidence from the study thereof is to help stakeholders preserve a favourable living environment for elderly people and their caregivers in co-residential family care settings. This study employed a qualitative research design using an interpretive approach, with purposive sampling to select family caregivers and care recipients as participants. Data were collected through semi-structured interviews and analysed using thematic analysis. Two themes emerged, bordering 1) Factors Shaping Co-Residential Care: a) cultural and relational expectations, b) economic and structural constraints, c) practicality and accessibility of care; and 2) Challenges of Co-Residential Care: a) burden, exhaustion and role conflict, b) economic and social constraints, c) interpersonal tensions and risk of abuse or neglect. In essence, the finding highlights that co residential care is both a cultural value and a survival strategy but exposes caregivers and recipients to vulnerabilities. It therefore requires systemic recognition and support: policies, training, and advocacy to protect care recipients and caregivers. Government and social work must expand infrastructure, empower families, and challenge cultural norms that normalise caregiver sacrifice.