Last updated 2026-07-23
TL;DR
"Assisted living in my area" usually surfaces licensed residential communities that help people with daily activities like bathing, meals, and medication, but not skilled nursing care. Assisted living, group homes, and nursing homes are licensed under different rules in every state. Medicare does not pay for room and board in any of them. Opening one means meeting your state's licensing, staffing, and zoning requirements before you ever accept a resident.
What is assisted living?
Assisted living is a category of licensed residential care for people who need help with daily activities like bathing, dressing, medication reminders, and meals, but who don't need round-the-clock skilled nursing. The National Institute on Aging describes these settings as a middle ground between living fully independently and needing a nursing home, built around a philosophy of supporting independence while providing help as needed. That definition sounds simple. The regulatory reality isn't. Every state licenses assisted living under its own name and its own rulebook, so "assisted living" in Florida and "assisted living" in Ohio can mean different staffing ratios, different admission criteria, and different move-out triggers. Some states call it "residential care," some call it "personal care homes," some call it "adult foster care." If you're searching "assisted living in my area" as a consumer, you're really searching a patchwork of state licensing categories that happen to share a common marketing name. According to the National Center for Assisted Living (NCAL), the industry serves residents whose care needs span a wide spectrum, from people who need light help with errands and medication to people nearing the point where a nursing home level of care becomes necessary. That spread is exactly why the label alone doesn't tell you much. You have to look at the actual license type and the actual services included.
What is an assisted living facility?
An assisted living facility (sometimes called an assisted living community or assisted living residence) is the licensed building and program where assisted living care is delivered. It's a physical, state-licensed place, more than a service description. The license spells out how many residents it can hold, what staff must be on-site at what hours, and what level of care it's allowed to provide. The CDC's National Study of Long-Term Care Providers tracks these as "residential care communities" and has counted roughly 28,900 of them nationally in recent survey years, averaging about 33 beds per community [1]. That average masks huge variation: some assisted living facilities are 120-bed campuses with a commercial kitchen and an activities director, others are converted single-family homes with six beds and one overnight aide. Both can be legally licensed as assisted living in their state. Both will show up when someone searches assisted living facility or assisted living facilities near a given zip code.
What is a group home, and how is it different from assisted living?
A group home is a residential setting, usually a house in an ordinary neighborhood, where a small number of people (often six or fewer) live together and receive support. Group homes serve different populations depending on the state and the license type: people with intellectual and developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, and in some states, seniors who need help with daily living. The overlap with assisted living is real. In many states, a small senior group home and a small "assisted living facility" are licensed under the exact same statute once the home crosses a certain resident count or starts offering personal care services. The difference shows up mostly in scale and population focus: assisted living, as a term, leans toward older adults and larger congregate settings, while "group home" more often describes a smaller house-style setting serving IDD or behavioral health populations. Group homes for people with disabilities also get specific federal protection. The Fair Housing Act requires housing providers to make "reasonable accommodations in rules, policies, practices, or services, when such accommodations may be necessary to afford such person equal opportunity to use and enjoy a dwelling" (42 U.S.C. § 3604(f)(3)(B)) [2]. That's the legal backbone zoning attorneys cite when a city tries to block a group home from operating in a single-family zone, a topic worth understanding before you ever sign a lease. It's also why so many small group homes and small assisted living residences end up looking, from the outside, like an ordinary house on an ordinary street.
What's the difference between assisted living and a nursing home?
| Core care level | Help with ADLs, medication reminders, some nursing oversight | 24/7 skilled nursing, rehab therapy, complex medical management | |
|---|---|---|---|
| Typical staffing | Caregivers and med aides, RN/LPN oversight part of the day | RNs and LPNs on every shift, physician oversight required | |
| License type | State residential/assisted living license | State nursing facility license plus CMS certification | |
| Medicare coverage | Not covered (room and board) | Up to 100 days per benefit period after a qualifying hospital stay, with coinsurance after day 20 | |
| Typical payer mix | Private pay, long-term care insurance, some Medicaid HCBS waivers for services only | Medicare (short stays), Medicaid (long-term stays), private pay | The Centers for Medicare & Medicaid Services (CMS) oversees the certification and inspection standards nursing homes must meet to bill Medicare and Medicaid, which is a heavier regulatory lift than most assisted living licenses require. If a resident needs help remembering pills and getting to the shower, assisted living usually fits. If a resident needs wound care, IV medications, or post-hospital rehab, that's nursing home territory, at least until they recover enough to step back down. |
Assisted living and a nursing home differ mainly in the level of medical care provided and in how Medicare treats them. Assisted living is personal care; a nursing home (also called a skilled nursing facility, or SNF) is medical care, including services ordered and supervised by a physician and delivered by licensed nurses around the clock. | Feature | Assisted living | Nursing home (SNF) |
What does assisted living provide day to day?
Day to day, assisted living typically provides three meals, help with activities of daily living (bathing, dressing, transferring, toileting), medication management or reminders, housekeeping, laundry, social and recreational activities, and some level of on-site staff supervision. Most states require at least one staff member awake and available at all times, though the exact overnight staffing rule varies by license type. What it usually does not provide, at least not included in the base rate, is skilled nursing care, physical therapy, or hands-on medical treatment beyond basic first aid and medication administration. Facilities that want to offer more clinical services often need a higher tier of license or a separate home health agency partnership. Some operators also run assisted living at home models, where personal care services are delivered in a resident's existing house rather than in a licensed facility. Whether that arrangement needs a state license at all depends entirely on the state and the scope of services offered, so this is a call to make with your state licensing agency before you build a program around it.
How do you actually find assisted living in your area?
If you're a family searching for care, the most reliable public tool is the Eldercare Locator, a service of the federal Administration for Community Living that connects you to your local Area Agency on Aging, which maintains current lists of licensed options in your county. State health department or human services websites also publish licensed facility rosters, usually searchable by county, and these lists are the ground truth because they reflect the actual license on file, not marketing copy. The reason generic web searches for assisted living or senior assisted living facilities near me can feel inconsistent is that results mix licensed communities, unlicensed board-and-care arrangements (illegal in most states past a certain resident count), and paid referral sites that don't disclose which facilities pay to be listed. The National Conference of State Legislatures has tracked how widely assisted living regulation differs state to state, including admission and discharge criteria, staffing minimums, and medication administration rules. There is no single national assisted living standard. Always cross-check a facility's license status directly with your state licensing agency before trusting a search result.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board cost of assisted living, and it generally doesn't cover custodial personal care as a standalone benefit. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need" [3], and assisted living's core service, help with daily activities, falls squarely into that custodial category. Where Medicare can help is around the edges. If a resident of an assisted living facility needs a physician visit, physical therapy ordered by a doctor, or short-term skilled nursing after a qualifying hospital stay, Medicare Part A and Part B may cover those specific medical services, just not the housing cost itself. Some Medicare Advantage plans have added limited supplemental benefits in recent years (things like meal delivery or personal care aide hours for chronically ill enrollees), but these are narrow, plan-specific add-ons, not a general assisted living benefit. Anyone building a marketing plan around "Medicare covers our facility" is setting up a legal and ethical problem, because it simply isn't true in the general case.
Does Medicaid cover assisted living?
Sometimes, for the services, but rarely for the room and board. Federal Medicaid rules generally prohibit paying for room and board in residential settings; what states can do is use Home and Community-Based Services (HCBS) waivers to pay for the personal care, case management, and supportive services delivered inside an assisted living or group home setting. These HCBS waivers (commonly 1915(c) waivers) are optional programs each state designs and applies to CMS for, so availability, income limits, and covered services vary widely by state and sometimes by county waiting list. A facility that wants to accept Medicaid waiver residents typically has to enroll separately as a Medicaid provider through the state Medicaid agency, on top of its basic operating license. If Medicaid revenue is part of your business model, confirm the current waiver program name, waiting list status, and reimbursement rate with your state Medicaid agency before you build a pro forma around it.
How do I start a group home or assisted living business?
Starting a group home or assisted living business is a licensing project first and a real estate or hospitality project second. Skip the licensing homework and you'll be redoing your floor plan, your staffing plan, or your entire business structure after the state tells you no. Here's the rough sequence most states follow, though the order and exact requirements always need confirming with your state licensing agency: 1. Decide your population and license category: adult foster care, IDD group home, assisted living/residential care, mental health residential, or recovery residence. This choice drives every rule that follows. 2. Check zoning before you sign a lease or mortgage. Many states protect small group homes as a permitted single-family use under fair housing law [2], but larger assisted living communities often need commercial or institutional zoning. 3. Form your business entity, get an EIN, and line up general liability and professional liability insurance. 4. Write your policies and procedures manual. Nearly every state licensing application requires one covering admissions, medication management, emergency procedures, abuse reporting, and resident rights. 5. Build a staffing plan that meets your state's ratio and qualification rules (awake overnight staff, medication aide certification, background check requirements). 6. Submit your license application with the required fee (amount varies by state, confirm with your state licensing agency) and complete state and FBI background checks for owners and staff. 7. Pass your pre-licensing inspections: fire marshal, building/health department, and life safety code review. 8. If you plan to accept Medicaid waiver residents, enroll separately as a Medicaid provider through your state Medicaid agency. 9. Once licensed, keep up with ongoing requirements: annual or unannounced inspections, incident reporting, and staff training renewals. The U.S. Small Business Administration's general business planning guidance is a decent starting framework for the entity and financial-planning side of this, but it won't touch the state-specific licensing rules, which is where most first-time applicants lose months.
What licensing, staffing, and zoning rules should I actually expect?
Expect three separate approval processes running in parallel: your state health or human services licensing agency (the actual operating license), your local zoning or planning department (whether this use is allowed at this address), and your local fire marshal or building department (life safety and occupancy). Missing any one of the three can stall your opening date even if the other two are done. Staffing rules typically specify a minimum staff-to-resident ratio, a requirement for an awake staff member overnight above a certain resident count, medication administration training or certification, and CPR/first aid certification for direct care staff. These numbers differ by state and often by license tier within a state, so a six-bed home and a 40-bed community under the same broad license category can carry very different staffing minimums. Zoning is where the Fair Housing Act protections matter most. Group homes for people with disabilities, up to a state-defined resident cap, generally can't be excluded from single-family residential zones through use restrictions that single them out [2]. Larger assisted living communities, especially ones built as new construction, more often need commercial, institutional, or planned-development zoning, plus a certificate of occupancy that matches the intended use. The National Conference of State Legislatures' tracking of state assisted living statutes is a useful starting map for seeing how these categories are structured before you call your state agency, but the agency's current rulebook is always the final word.
What does it cost to start and run one, and where does the money come from?
On the resident-facing side, the Genworth Cost of Care Survey has put the national median monthly cost of assisted living at roughly $5,350 as of its 2023 survey, though local costs swing hard based on region, staffing model, and level of care included. That figure is a useful benchmark for underwriting a private-pay rate, not a promise of what any specific market will support; costs in a rural county and costs in a major metro can differ by thousands of dollars a month. On the startup side, costs break into two buckets: property and build-out (renovation, fire suppression, accessibility upgrades) and licensing and compliance (application fees, background checks, policy manual development, staff training, insurance). None of those numbers are standard nationally, and anyone quoting you a flat "it costs $X to open a group home" is guessing. Confirm actual license fees and required documentation with your state licensing agency; they're the only source with current, binding numbers. This is exactly the kind of paperwork bottleneck the $299 State Group Home Licensing Kit was built to shortcut. It's a one-time purchase covering the policy manual templates, staffing plan structure, and application checklist most state agencies expect, so you're not starting your policy manual from a blank page. It doesn't replace your state's application or guarantee approval; nothing legitimately can. What it does is save the weeks most first-time applicants spend reverse-engineering what a licensing reviewer wants to see.
Where to start if you're serious about opening a facility
If you're past the research stage and actually planning to open, the order of operations matters more than the order of enthusiasm. Get your license category confirmed with your state agency first, your zoning confirmed second, and your staffing and policy documents drafted third, before you commit to a property or a lease term. Read your state's specific rules on assisted living facility and facility assisted living licensing categories side by side with the group home statute for your target population; in a surprising number of states, the smaller home-style option is both cheaper to open and faster to license than the large-community option. If you want a structured starting point instead of assembling policy manuals and staffing plans from scratch, the /licensing-kit-builder walks through the same document set most state licensing agencies ask for, built once and reusable as you expand into additional homes.
Frequently asked questions
What is assisted living?
Assisted living is licensed residential care for people who need help with daily activities like bathing, dressing, and medication, but don't need round-the-clock skilled nursing. It's a middle tier between independent living and a nursing home. Every state licenses it under its own rules and sometimes its own name, so services and staffing minimums vary by state, more than by facility.
What is a group home?
A group home is a small residential setting, often a regular house, where a limited number of people (often six or fewer) live together and receive support. Group homes serve seniors, people with intellectual or developmental disabilities, and people in mental health or substance use recovery, depending on the license category in that state.
What is an assisted living facility?
An assisted living facility is the actual licensed building and program delivering assisted living care, more than the service description. Its state license specifies resident capacity, required staffing, and allowed care level. The CDC's National Study of Long-Term Care Providers has counted roughly 28,900 residential care communities nationally in recent survey years.
What is assisted living vs nursing home?
Assisted living provides personal care and daily living support with limited nursing oversight. A nursing home (skilled nursing facility) provides 24/7 licensed nursing care, physician-ordered treatment, and rehabilitation. Medicare can cover up to 100 days of nursing home care per benefit period after a qualifying hospital stay; it doesn't cover assisted living room and board at all.
What does assisted living provide?
Typical assisted living services include meals, help with bathing and dressing, medication reminders or administration, housekeeping and laundry, social activities, and on-site staff supervision, usually with someone awake overnight. It generally doesn't include skilled nursing, IV medications, or rehab therapy unless arranged through a separate home health provider.
Does Medicare cover assisted living facilities?
No. Medicare.gov states that Medicare doesn't cover long-term custodial care when that's the only care needed, and assisted living's core service is custodial personal care. Medicare may still cover specific medical services delivered to a resident there, like doctor visits or short-term therapy, just not the housing or personal care cost itself.
Does Medicaid cover assisted living?
Sometimes, for services, rarely for room and board. States can use Home and Community-Based Services (HCBS) waivers to pay for personal care and case management delivered in assisted living settings, but federal rules generally block Medicaid from paying room and board. Availability and eligibility rules vary by state, so confirm current waiver programs with your state Medicaid agency.
How do I start a group home?
Pick your license category and population, confirm zoning before signing a lease, form your business entity, write your policies and procedures manual, build a compliant staffing plan, then submit your license application to your state licensing agency along with required background checks. Pass fire, building, and health inspections before you can legally admit residents.
How do I start an assisted living business specifically?
Follow the same core sequence as a group home, but expect a heavier build-out: commercial-grade kitchen and life safety systems, higher staffing ratios for larger resident counts, and often a separate zoning category (institutional or commercial rather than single-family). Confirm your specific tier's requirements directly with your state licensing agency before committing to a property.
How much does assisted living cost?
The Genworth Cost of Care Survey put the national median monthly cost of assisted living at roughly $5,350 as of its 2023 survey, but actual local costs vary widely by region, staffing model, and level of care. Use this as a rough benchmark for market research, not a fixed price for any specific location.
How do I find assisted living in my area?
Use the federal Eldercare Locator (run by the Administration for Community Living) to reach your local Area Agency on Aging, or check your state health or human services department's licensed facility roster directly. These sources reflect actual license status, unlike many paid referral websites that mix licensed and unlicensed options.
What's the difference between an assisted living facility and a group home?
The main differences are scale and population focus. Group homes are typically smaller, house-style settings often serving IDD or behavioral health populations, while assisted living leans toward larger congregate communities serving older adults. In many states, small senior group homes and small assisted living residences fall under the exact same license category.
Can Medicare Advantage plans cover any assisted living costs?
Some Medicare Advantage plans have added limited supplemental benefits for chronically ill enrollees, like meal delivery or a set number of personal care aide hours, since CMS expanded allowable supplemental benefits in recent years. These are narrow, plan-specific add-ons, not general coverage of assisted living room and board, and vary plan by plan.
Sources
- CDC National Center for Health Statistics, National Study of Long-Term Care Providers (NSLTCP): Roughly 28,900 residential care communities operate nationally, averaging about 33 beds per community.
- Cornell Law School Legal Information Institute, 42 U.S.C. § 3604(f): Statutory text requiring reasonable accommodations in rules or policies necessary for people with disabilities to use and enjoy a dwelling.
- Medicare.gov, Long-term care coverage information: Medicare doesn't cover long-term custodial care, including assisted living room and board, when that's the only care needed.
- Medicaid.gov: Medicaid covers assisted living services in many states through Home and Community-Based Services (HCBS) waivers rather than covering room and board.
- U.S. Small Business Administration: Starting an assisted living or group home business requires obtaining specific state and local licenses and permits before operating.
- Medicaid.gov: States can use 1915(c) HCBS waivers to fund assisted living services for eligible seniors and people with disabilities as an alternative to nursing home care.
- Centers for Medicare & Medicaid Services (CMS): CMS oversees health and safety quality standards that distinguish licensed nursing homes from assisted living facilities, which are regulated at the state level.