People living with HIV or with a terminal disease face frequent health risks due to opportunistic infections which affect their way of life and dramatically increase their risk of death. Increasingly, terminally ill patients in Botswana are cared for at home, hence the need to understand their housing conditions. Despite a high volume of HIV-related studies undertaken in Botswana, little research has examined the relationship between patients’ housing conditions and quality of care at home. Using existing government data from the Botswana 2001 Population and Housing Census, we investigated the housing situation for the households in the national home-based care (HBC) programme. Data were available for 8 872 households having residents enrolled in the programme. The findings indicate that the majority of patients under HBC are faced with housing-related features that can affect their quality of care and chances of recovery. The largest proportion of households had six or more individuals sharing one or two rooms, which raises health concerns for the spread of communicable diseases. In rural areas, few of the HBC households had indoor piped water, proper waste disposal or flush toilets. The lack of basic amenities such as these creates problems for patients as well as for caregivers. We advocate for policy that will address and cater to housing as part of a comprehensive and effective HBC programme. Housing determines where, how and when homecare is provided for sick individuals; therefore, achieving healthy living environments and housing assistance for HBC patients must be addressed by the government. It is recommended that an evaluation of a patient's home should be a first step in their enrolment in the HBC programme. Thereafter, HIV-infected or affected household members should be advised and assisted to make the necessary housing changes to maintain quality of life or accelerate the homecare patient's recovery.