Last updated 2026-07-23
TL;DR
Assisted living is licensed, non-medical housing for adults who need help with daily tasks like bathing, dressing, or medication reminders, but not hospital-level care. States, not the federal government, write the rules, so costs and services vary by location. Medicare doesn't pay for it. Medicaid may cover some services through waivers. Group homes are a related but separate license type.
What is assisted living?
Assisted living is housing for adults, most often seniors, who need help with daily activities but don't need the round-the-clock medical care a hospital or nursing home provides. Residents usually live in a private or semi-private room or apartment and pay for a package that includes housing, meals, and personal care services like bathing, dressing, and medication reminders. Staff are on site at all hours, but assisted living is not licensed as a medical facility. There's no nurse required to be on shift around the clock the way there is in a nursing home, though many communities employ nurses part time or on call. The National Center for Assisted Living, the trade group under the American Health Care Association, tracks how differently states define this level of care [1]. There is no single federal definition of assisted living. Every state writes its own rules for licensing, staffing ratios, and what services a community can legally offer, which is a big reason why a "assisted living facility" in one state looks nothing like one two states over. If you're comparing a specific building to what your state actually requires, start with the state-specific rules for assisted living licensing before you tour anywhere.
What is a group home, and how is it different from assisted living?
A group home is a small residential setting, usually a single-family style house, that provides supervised living for a specific population: people with intellectual or developmental disabilities, adults recovering from mental illness or substance use, or in some states, seniors who need a lower level of care than a licensed assisted living community provides. Group homes typically house fewer residents (often 4 to 10) and operate under a different license category than assisted living, sometimes called adult foster care, community residential facility, or personal care home depending on the state. The distinction matters for zoning too. Because group homes serve people with disabilities under federal disability law, most local governments can't simply zone them out of residential neighborhoods. The Fair Housing Act, as amended, requires local governments to make "reasonable accommodations in rules, policies, practices, or services" when needed to give a person with a disability equal access to housing, per 42 U.S.C. § 3604(f)(3)(B), as summarized by HUD's Fair Housing office [2]. Assisted living communities, especially larger ones, don't always get the same automatic protection, since they're licensed as a business serving a general senior population rather than exclusively people with disabilities. If you're weighing which license type fits your project, compare the state rules for assisted living facilities against your state's group home or adult foster care category before you sign a lease or make an offer on property.
What is an assisted living facility, exactly?
An assisted living facility is a licensed residence that provides housing plus a defined set of personal care services to adults who need help with daily living but don't require skilled nursing care. The National Institute on Aging describes this tier of housing as sitting between fully independent living and a nursing home, built for people who need some help with daily care but not the level of medical supervision a nursing home provides [3]. In practice, "licensed" is the operative word. Every state has its own licensing agency (often a department of health, aging services, or social services) that issues the license, sets minimum staffing and training requirements, and conducts inspections. There is no federal license for assisted living the way there is for Medicare-certified nursing homes. That means the name on the door, the required staff-to-resident ratio, and even whether a facility can administer injectable medications changes depending on which state you're in. Confirm the exact category and rule set with your state licensing agency before assuming a facility (or a business plan) meets requirements. If you're researching a specific building for a family member, or comparing a facility to state law before opening one, the assisted living facility licensing overview is a good next stop.
What is the difference between assisted living and a nursing home?
| Federal licensing | None; each state sets its own rules | Federally certified under 42 CFR Part 483 if it takes Medicare/Medicaid [4] | |
|---|---|---|---|
| Staffing | State-set minimums; 24-hour RN coverage not always required | 24-hour licensed nursing coverage required for certified facilities | |
| Level of care | Help with daily activities, medication reminders | Skilled nursing, rehab, complex medical care | |
| Typical setting | Apartment-style rooms, more independence | More clinical, hospital-adjacent room setup | |
| Who typically pays | Private pay, long-term care insurance, some Medicaid waivers | Medicare for short rehab stays, Medicaid, private pay | |
| National count | 28,900 residential care communities, 996,100 licensed beds (2020 NCHS data) [5] | About 15,600 nursing homes nationwide [6] | One practical takeaway for families: if a loved one's needs change and they start requiring daily skilled nursing (wound care, IV therapy, ventilator support), most assisted living licenses don't allow the facility to keep them, and a nursing home becomes the appropriate setting. |
The short version: assisted living is for people who need help with daily tasks, and nursing homes are for people who need ongoing medical or skilled nursing care. Nursing homes that accept Medicare or Medicaid must meet federal Conditions of Participation under 42 CFR Part 483, which include requirements for licensed nursing staff, physician oversight, and care planning [4]. Assisted living has no equivalent federal rulebook; it's state-regulated only. | Factor | Assisted living | Nursing home |
What does assisted living provide, day to day?
A typical assisted living package includes a private or shared room, three meals a day, housekeeping, laundry, help with bathing and dressing, medication management, an emergency call system, and organized social activities. Staff are present 24 hours a day for supervision and help, even if a licensed nurse isn't always on site [3]. Most states also require a written service plan for each resident, updated periodically, that spells out exactly what help that person needs and how staff will provide it. Transportation to medical appointments is common, though it's sometimes billed as an add-on rather than included in the base rate. What assisted living generally does not provide: ongoing skilled nursing care, physical therapy as a covered daily service, or hospital-level monitoring. Some states allow limited nursing tasks under a registered nurse's delegation, but that's narrower than what a nursing home is licensed to do. If a resident's care needs grow past what the license allows, the facility is required to either bring in more services (home health, hospice) or help the family transition to a higher level of care.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or personal care costs of assisted living. Medicare.gov is direct about this: long-term custodial care, which is what most assisted living provides, is generally not a covered benefit [7]. Medicare will still pay for medically necessary services a resident receives while living in assisted living, things like doctor visits, physical therapy after a fall, or a hospital stay, the same way it would if that person lived at home. This is one of the most common points of confusion for families searching "assisted livings near me" expecting Medicare to help with the monthly bill. It won't. Long-term care insurance, personal savings, home equity, veterans' benefits (like Aid and Attendance), and in some cases Medicaid are the actual funding sources people use.
Does Medicaid cover assisted living, and what won't it pay for?
Medicaid can cover some assisted living costs, but only the service portion, not room and board, and only in states that have built a specific program for it. Most states use a Home and Community-Based Services (HCBS) waiver, authorized under Section 1915(c) of the Social Security Act, or a state plan option like 1915(i), to pay for personal care, medication management, and supervision delivered inside an assisted living setting. Medicaid.gov describes HCBS as a way to let people "receive services in their own home or community rather than institutions or other similar care facilities" [8]. The room-and-board bill (rent, meals, utilities) generally has to be paid another way, often out of the resident's own Social Security income, a state supplemental payment program, or family funds. Not every assisted living community accepts Medicaid waiver residents either; many limit the number of Medicaid beds or don't participate at all. If Medicaid coverage is a deciding factor, call your state Medicaid agency and ask specifically which waiver applies to assisted living and which licensed facilities in your area are enrolled providers.
How much does assisted living cost near me?
Cost varies enormously by state, city, and even neighborhood, which is exactly why a national average is a rough guide at best. Genworth's Cost of Care Survey, one of the longest-running sources on this, has put the national median monthly cost for a private one-bedroom assisted living unit somewhere in the $5,000 to $5,900 range in recent survey years, with real numbers shifting year to year and region to region . Rural areas and smaller Southern and Midwestern markets tend to run below the national median; coastal metro areas often run well above it. Memory care add-ons, higher acuity service plans, and private (versus shared) rooms all push the price up further. The only reliable way to know the real number "near me" is to call two or three licensed communities in your specific zip code and ask for their current rate sheet, since published averages are always a year or more behind actual local pricing.
How do you find assisted living or group homes near you?
Start with your state's licensing agency, since every licensed assisted living community and most group homes are required to be on a public list, often searchable by county with inspection history attached (confirm with your state licensing agency for the exact database name and URL). The federal Eldercare Locator, run by the Administration for Community Living, is a free tool that connects callers to their local Area Agency on Aging, which maintains referral lists and can flag options by budget and care level . Local long-term care ombudsman programs are another underused resource: they track complaints and inspection results and can tell you, off the record, which facilities in your area have a track record of problems. For a broader look at how to compare listings and licensing status side by side, see senior assisted living facilities near me and the general directory guide for assisted living facilities.
How do you 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 project second. The rough sequence, in most states: pick your population and license type (adult foster care, group home, or assisted living, since each has a different rule set and confirm the exact category name with your state licensing agency), find a property that already meets or can be renovated to meet occupancy and zoning requirements, write your policy and procedure manual, build a staffing plan with job descriptions and required training hours, and then file the license application with supporting documents like fire inspection sign-off, background check results, and proof of financial capacity. Most states require an on-site inspection before they'll issue the license, and many require another inspection within the first year of operation. None of this happens fast; expect the paperwork and inspection cycle to take a few months at minimum, and longer if your property needs work to meet fire and life-safety code. A lot of first-time operators underestimate how much of this is repeatable paperwork, not custom writing. A state-specific policy manual and application checklist, like the $299 one-time State Group Home Licensing Kit, can save real time by giving you a starting template instead of a blank page, but it doesn't replace your state's own forms and it doesn't guarantee approval. You still have to meet every requirement your specific agency lists, and those requirements change, so always confirm current forms and fees directly with your state licensing agency before you submit anything.
What licenses, zoning approvals, and inspections do you need before opening?
At minimum, expect to need: a license from your state's health, aging, or social services department (the exact agency name varies by state), local zoning approval or a conditional use permit for the property, a fire marshal or life-safety inspection, background checks on owners and staff (state and often FBI-level), general and professional liability insurance, and a standard local business license. Some states also require a Certificate of Need before a new facility can open, particularly for larger assisted living projects. Zoning is where a lot of new operators get stuck, especially for smaller group homes trying to open in single-family residential zones. Under the Fair Housing Act, local governments generally can't use zoning to exclude group homes serving people with disabilities, and courts have repeatedly required cities to grant reasonable accommodations under 42 U.S.C. § 3604(f)(3)(B) [2]. That protection doesn't automatically extend to every larger assisted living project, so check your local zoning code and talk to the planning department early, before you're under contract on a property. For more detail on matching a property to your specific license category, see facility assisted living and assisted living at home for smaller-scale, in-home models some states license separately.
Frequently asked questions
What is assisted living?
Assisted living is licensed housing for adults, usually seniors, who need help with daily activities like bathing, dressing, and medication reminders but don't need hospital-level medical care. Residents live in private or shared rooms and pay for a package of housing plus personal care services. States, not the federal government, set the licensing rules, so the exact definition and services vary depending on where you are.
What is a group home?
A group home is a small licensed residential setting, often a single-family style house with 4 to 10 residents, that provides supervised living for a specific population such as people with intellectual or developmental disabilities, adults in mental health or substance use recovery, or seniors needing a lower level of care. It's usually licensed under a different category than assisted living, like adult foster care or a community residential facility.
What is an assisted living facility?
An assisted living facility is a licensed residence providing housing plus a defined set of personal care services (help with daily activities, medication management, meals, supervision) to adults who don't need skilled nursing care. Each state's licensing agency sets the specific rules for staffing, training, and services, so there's no single national standard defining what an assisted living facility must include.
What is the difference between assisted living and a nursing home?
Assisted living is for people who need help with daily tasks but not ongoing medical care; nursing homes are for people who need skilled nursing, rehabilitation, or complex medical supervision. Nursing homes that take Medicare or Medicaid must meet federal Conditions of Participation under 42 CFR Part 483, including 24-hour licensed nursing coverage. Assisted living has no equivalent federal rulebook and is regulated state by state only.
What does assisted living provide?
Assisted living typically provides a private or shared room, meals, housekeeping, laundry, help with bathing and dressing, medication management, an emergency call system, transportation to appointments, and organized social activities, with staff present 24 hours a day. It does not generally include skilled nursing care, complex wound care, or hospital-level monitoring; residents needing that level of care usually transition to a nursing home.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or personal care costs of assisted living, since it classifies this as long-term custodial care rather than a covered medical benefit. Medicare will still pay for medically necessary services a resident receives while living there, such as doctor visits or physical therapy, the same way it would cover those services anywhere else.
Does Medicaid cover assisted living?
Medicaid can cover the service portion of assisted living (personal care, supervision, medication management) in states that use an HCBS waiver or a state plan option like 1915(i), but federal Medicaid rules generally prohibit paying for room and board directly. Residents typically pay room and board separately from their own income or family funds. Coverage and participating facilities vary by state, so check with your state Medicaid agency.
How do you start a group home?
Pick your population and confirm the exact license category with your state licensing agency, find or renovate a property that meets zoning and fire/life-safety code, write a policy and procedure manual, build a staffing plan, complete background checks, and file your license application with the required inspections. Expect the full process to take months, and confirm current fees and forms directly with your state agency since they change and vary widely.
How do I start a group home if I've never run one before?
Start by reading your specific state's group home or adult foster care licensing statute and requesting the current application packet from the licensing agency; don't rely on generic national advice for statute numbers or fees. Build your policy manual, staffing plan, and zoning approval before you sign a lease. Many first-time operators use a template kit to speed up the paperwork, but every final requirement still has to match your state's current rules.
How much does assisted living cost near me?
Genworth's Cost of Care Survey has placed the national median monthly cost for a private one-bedroom assisted living unit roughly in the $5,000 to $5,900 range in recent survey years, but real local pricing varies a lot by state and even by neighborhood. Memory care and private rooms cost more. The only reliable way to know the current local price is to call facilities directly and ask for their current rate sheet.
How do I find assisted living facilities near me?
Check your state licensing agency's public facility search or database (most states publish one with inspection history), call the federal Eldercare Locator to reach your local Area Agency on Aging, or contact your area's long-term care ombudsman program for referral help and complaint history on specific facilities. Touring at least two or three licensed options before deciding is standard advice from most Area Agencies on Aging.
Do group homes need a different license than assisted living facilities?
Usually yes. Most states license group homes under a separate category, often adult foster care, community residential facility, or a disability-services license, with different rules on resident count, staffing, and services than assisted living. Confirm the exact category names and requirements with your state licensing agency, since terminology and the dividing line between categories differ from state to state.
How long does it take to get an assisted living or group home license?
There's no single national timeline; it depends on your state, how complete your application is, and how quickly the property passes fire and zoning inspections. Many operators report the process, from application submission to license issuance, taking a few months at minimum, longer if the property needs renovation. Confirm the expected timeline with your state licensing agency before setting an opening date.
Sources
- HUD, Fair Housing Act and reasonable accommodation: Fair Housing Act requires reasonable accommodations for group homes serving people with disabilities, 42 U.S.C. § 3604(f)(3)(B)
- National Institute on Aging, residential facilities and assisted living: Assisted living serves people who need help with daily care but not the medical supervision a nursing home provides
- Electronic Code of Federal Regulations, Title 42 Part 483: Federal Conditions of Participation apply to Medicare/Medicaid-certified nursing homes, including 24-hour licensed nursing requirements
- CDC/NCHS FastStats, Residential Care Communities: About 28,900 residential care communities with 996,100 licensed beds nationwide
- CDC/NCHS FastStats, Nursing Home Care: About 15,600 nursing homes operate nationwide
- Medicare.gov, long-term care coverage: Medicare does not cover long-term custodial care such as assisted living room and board
- Medicaid.gov, Home and Community-Based Services: Medicaid HCBS waivers let beneficiaries receive services in the community rather than institutions, and can cover assisted living services but generally not room and board
- Genworth, Cost of Care Survey: National median monthly cost figures for assisted living, updated periodically by survey year