Group home house rules: what every policy manual needs

Last updated 2026-07-24

What is a group home, exactly?

A group home is a licensed residence where a small number of unrelated people, usually people with intellectual or developmental disabilities, mental illness, substance use disorders, or seniors who need help with daily living, live together with paid staff support. Most states cap group homes at somewhere between 4 and 16 residents, with many landing at 6 or fewer to stay classified as a "family-style" home rather than an institutional one. The term covers a lot of ground. Adult foster care homes, IDD group homes, mental health residential facilities, recovery residences, and residential assisted living (RAL) homes for seniors all fall under some flavor of "group home" depending on the state's licensing category. Each category has its own agency, its own rule chapter, and its own definition of what services staff can legally provide (medication reminders vs. medication administration is a common dividing line). If you're comparing models before you pick one, it helps to look at how assisted living facilities are licensed and staffed differently than a small IDD group home in the same state. What all group homes share is this: someone other than the resident (a state agency, usually) sets minimum standards for safety, staffing, and resident rights, and the operator has to run the home inside those lines every single day, more than on inspection day.

What is assisted living, and how is it different from a group home?

Assisted living is a licensed care model for people, mostly seniors, who need help with activities of daily living (bathing, dressing, medication management, mobility) but don't need the 24-hour skilled nursing care of a nursing home. It's a service model, not a building size. A big assisted living facility with 80 units and a small residential assisted living home with 6 beds can both be licensed under the same state assisted living statute. A group home, by contrast, is often defined by population and structure rather than service intensity alone. A 6-bed group home for adults with IDD and a 6-bed residential assisted living home for seniors can look identical from the curb, but they answer to completely different licensing chapters, staffing ratios, and training requirements. Confirm with your state licensing agency which category actually applies to the population you plan to serve, because guessing wrong here derails an application fast. If you want the fuller breakdown of what assisted living covers, see assisted living and assisted living facility licensing basics.

What is an assisted living facility (and what does it actually provide)?

An assisted living facility (ALF) is the licensed building or program itself, the physical home or campus where assisted living services are delivered under state supervision. States use different names for the same basic concept: Residential Care Facility for the Elderly (RCFE) in California, Assisted Living Residence in Florida, Personal Care Home in Georgia, and so on. What it provides typically includes: help with bathing, dressing, toileting, and mobility; medication management or reminders (the exact legal line varies a lot by state); three meals a day plus snacks; housekeeping and laundry; 24-hour staff awareness (not always awake overnight staff, depending on license type); and social or recreational activities. Medicaid.gov's overview of institutional long-term care confirms that assisted living and similar residential care categories are defined and licensed by each state, not by a single federal standard ^[1], which is why service lists and terminology shift so much state to state. What it does not typically provide: skilled nursing care, IV therapy, ventilator management, or complex wound care, unless the state license specifically allows a higher tier of care (some states have "enhanced" or "limited nursing" ALF tiers for exactly this reason).

What's the difference between assisted living and a nursing home?

Medical staffing	Varies by state, often no RN required on-site	RN required 8 hrs/day min., licensed nurse 24/7 [2]
Federal oversight	None (state-regulated only) [1]	Medicare/Medicaid Conditions of Participation
Typical resident	Needs help with ADLs, largely independent	Needs skilled nursing or rehab care
Room setup	Private or semi-private apartment-style	Semi-private common, hospital-style beds
Medicare coverage	Not covered as room and board	Covered short-term post-hospital under conditions	Getting this distinction right in your policy manual matters. If your license is assisted living or a residential care license, your house rules and admission agreement need to make clear you are not a nursing facility and don't accept residents whose needs exceed your license tier.

The core difference is medical intensity and staffing. Assisted living is built for people who are largely independent but need support with daily tasks. A nursing home (skilled nursing facility) is built for people who need ongoing medical care, rehabilitation after surgery or illness, or supervision from licensed nurses around the clock. Nursing homes are required to have a registered nurse on duty at least 8 consecutive hours a day, 7 days a week, and licensed nursing coverage 24 hours a day, under federal nursing home requirements at 42 CFR 483.35 ^[2]. Assisted living has no equivalent federal nursing-hour mandate; staffing minimums are set state by state and vary widely, from ratio-based rules to vague "sufficient staff to meet resident needs" language. | Feature | Assisted living | Nursing home |

Does Medicare cover assisted living facilities?

No. Medicare does not cover the room and board costs of assisted living, and it does not pay for custodial personal care in a residential setting. Medicare.gov states plainly that Medicare "doesn't cover long-term care (also called custodial care)" for daily activities like bathing, dressing, and using the bathroom when that's the only care needed ^[3]. Medicare Part A can cover a short-term skilled nursing facility stay after a qualifying hospital stay, and Medicare Part B can cover medical services a resident receives while living in assisted living (a doctor visit, physical therapy, durable medical equipment), but the facility's monthly fee itself isn't a Medicare-covered expense. Medicaid is the more common public payer for residential care, though coverage varies enormously by state and usually flows through a Home and Community-Based Services (HCBS) waiver rather than a straight assisted living benefit. CMS's HCBS 1915(c) waiver page explains that states can request waivers under section 1915(c) of the Social Security Act to cover home and community-based services as an alternative to institutional care ^[4]. If Medicaid revenue is part of your plan, budget the 6 to 18 months many states take to get a provider enrolled and a waiver slot assigned, and don't promise anything to families before that's confirmed.

How do I start a group home?

Starting a group home follows a similar arc in almost every state, even though the agency names and forms differ. Here's the realistic sequence: 1. Pick your population and license category (IDD, mental health, adult foster care, senior RAL) and confirm which state agency licenses it. This decision drives everything downstream, so don't skip it to save time. 2. Check zoning first, before you sign a lease or make an offer on a house. Many states protect small group homes under fair housing law, but zoning fights still happen and can sink a project for months. 3. Write your policy and procedure manual: admission criteria, medication management, emergency procedures, resident rights, grievance process, staff training, and house rules (the topic of this article) all typically need to be in there. 4. Build your staffing plan against your state's required ratios and background check rules. Most states require FBI and state criminal background checks plus a check of abuse/neglect registries for anyone with resident contact. 5. Prepare the physical building to code: fire marshal sign-off, health department sign-off, and physical plant requirements (room sizes, number of bathrooms, ADA-type accessibility in many cases) are usually all separate inspections from the licensing inspection itself. 6. Submit the license application with your fee, manuals, floor plan, and staffing plan, then schedule and pass your pre-licensure inspection. None of this happens overnight. Depending on the state and the completeness of your paperwork, expect a real timeline measured in months, not weeks. Building a full assisted living at home model or a small residential setting has extra layers around home modification and neighborhood notice in some states, so budget time for that too.

What exactly are "house rules" in a group home (and how are they different from the policy manual)?

House rules are the day-to-day behavioral expectations residents live under: quiet hours, chore assignments, visitor policy, curfew (if any), smoking areas, pet policy, and how disputes between roommates get handled. The policy and procedure manual is the operator's internal rulebook for staff: how medication gets documented, how incidents get reported to the state, how staff get trained, how records get retained. House rules should be a short, plain-language document residents (and often their guardians or case managers) sign at admission. It sits downstream of, and never contradicts, the state's resident rights statute or your policy manual. If your house rules say lights-out at 9pm for every adult resident regardless of ability or preference, and your state's resident bill of rights guarantees the right to reasonable self-determination, your house rules lose that fight every time. A clean house rules document usually covers: daily schedule and meal times, chores and shared responsibilities, visitor hours and sign-in procedure, phone and internet use, curfew (if applicable to the population and legally permissible), smoking/vaping policy and location, pet policy, quiet hours, laundry and personal property rules, and the consequences process for rule violations, including what triggers a behavior plan versus what triggers discharge review. Keep the tone respectful and adult. Rules written like a summer camp code of conduct for adult residents tend to draw negative attention from surveyors and families both.

What house rules cross the line into illegal or unlicensable territory?

The most common problem areas: blanket curfews for adults with full legal capacity, restrictions on visitors based on protected characteristics, mail or phone monitoring without a documented clinical or legal basis, mandatory religious participation, and rules that function as a disguised eviction shortcut (like "three rule violations equals immediate discharge with no notice"). Under the federal Fair Housing Act (42 U.S.C. 3601 et seq.), group homes serving people with disabilities are protected from rules and municipal restrictions that treat them differently than an unrelated group of housemates would be treated. HUD's own Fair Housing Act regulations, at 24 CFR 100.201-100.204, define reasonable accommodation obligations that apply directly to group living arrangements for people with disabilities ^[5]. State resident rights statutes for licensed facilities typically go further, spelling out specific protected rights: the right to visitors at reasonable times, the right to privacy in communication, the right to participate in one's own care plan, and the right to a grievance process before any involuntary discharge. Discharge (or "termination of residency") is the single riskiest house-rule area from a liability standpoint. Most states require written notice periods, a documented reason tied to specific criteria (danger to self/others, non-payment, needs exceeding the license level), and in many states a right to appeal before discharge, especially for Medicaid-funded residents. Don't let a house rules document promise "immediate removal" for infractions your state's regulations don't actually allow as grounds for emergency discharge; confirm the exact discharge criteria and notice period with your state licensing agency before you finalize that section.

What should a house rules document include, section by section?

Here's a workable structure operators actually use, adapted to whatever population you serve: - Daily schedule: wake times, meal times, medication times, activity blocks

• Chores and shared living responsibilities, matched to each resident's care plan and ability level
• Visitor policy: hours, sign-in log, areas of the home open to visitors, overnight guest policy
• Curfew, if applicable: many states restrict curfews for adult residents with capacity to make their own decisions, so tie this to your population and state rules rather than a blanket house standard
• Substance use policy: zero-tolerance vs. harm-reduction approach (recovery residences in particular need this spelled out precisely, since it drives admission and discharge decisions)
• Smoking, vaping, and alcohol policy, with designated locations if allowed
• Phone, internet, and personal electronics use
• Personal property and room search policy (search policies need real legal grounding, more than "staff discretion")
• Laundry, hygiene, and personal care expectations
• Pet policy
• Behavior expectations and the escalation ladder: verbal reminder, written warning, behavior plan review, and only then discharge review with the notice period your state requires
• Grievance and complaint process, including the state's complaint hotline number so residents know they can go outside the home if needed Every item on that list should map back to something in your formal policy manual and, ideally, to a specific line in your state's licensing regulation. A house rules sheet that reads like a landlord's move-in packet, disconnected from your actual regulatory obligations, is a common finding during inspections.

How do house rules affect inspections and licensing renewal?

Surveyors typically ask to see your posted or provided house rules during a licensing inspection, and they'll cross-check them against the resident rights section of your state code. If your rules restrict something the code protects (visitation, communication, participation in care planning), that's a citable finding, sometimes a serious one if it suggests a pattern of restricting resident autonomy. Inspectors also check whether house rules are actually followed as written, and whether residents (or their guardians) signed an acknowledgment of them at admission. A rules document that exists on paper but isn't part of the admission packet, or isn't reflected in daily practice, tends to raise more questions than having no document at all. Keep house rules updated whenever your state revises its resident rights regulations, and review them at every license renewal cycle even if nothing else about your operation changed. Regulations get amended more often than most operators expect, and a house rules document written for a 2019 rule chapter can quietly become non-compliant by 2024 without anyone noticing until survey day.

How do house rules differ across populations (IDD, mental health, recovery, and senior RAL)?

The bones are similar, but the emphasis shifts hard by population. IDD group homes usually build house rules around each resident's individual support plan (ISP), so "rules" are often personalized rather than blanket, tied to goals like increasing independence in specific ADLs. Mental health residential facilities tend to need more explicit crisis and de-escalation language baked into the rules, plus clear boundaries around peer conflict and medication self-administration where allowed. Recovery residences (sober living) usually have the strictest and most explicit substance use rules of any category, often including mandatory drug testing schedules, curfew tied to program phase, and a clearly defined relapse policy. The National Alliance for Recovery Residences (NARR) publishes a national standard that many states now reference directly in their certification requirements for recovery housing. Senior residential assisted living homes lean toward rules that support dignity and routine: meal schedules, visiting hours for family, fall-prevention related property rules (no throw rugs, clear walkways), and how staff handle a resident's right to accept or decline care. If you're weighing which senior model fits your market, assisted living facility and senior assisted living facilities near me cover the demand side of that decision.

How do house rules connect to the rest of your licensing paperwork?

Think of house rules as one spoke on a wheel where the hub is your full policy and procedure manual. Admission agreements reference the house rules. Staff training covers how to enforce them consistently and document violations. Your grievance procedure explains what a resident does if they think a rule was applied unfairly. Your discharge policy explains what happens when a rule violation becomes a safety issue. If you're building this paperwork from scratch, a lot of operators underestimate how many individual documents a state application actually wants: policy manual, staffing plan, emergency preparedness plan, medication management policy, house rules, admission agreement, grievance procedure, and often a separate abuse-reporting protocol, each cross-referenced to a specific regulation number. GroupHomePath's $299 State Group Home Licensing Kit bundles these documents into state-specific templates so you're not starting the house rules section, or any of the others, from a blank page. It's a starting template, not a substitute for your state's actual regulation text, so pair it with a direct read of your state's current rule chapter before you submit anything. Whatever tools you use, the test that matters is simple: can a surveyor open your house rules, flip to your state's resident rights section, and find no conflict between the two? If yes, you're in good shape. If no, fix it before inspection day finds it for you.

Where to go from here

House rules are a small document that touches almost every other part of your operation: admissions, staffing, discharge, and inspections all reference them in some way. Get the structure right early and you'll spend a lot less time rewriting it under pressure during a survey correction plan. If you're still deciding which license category and service model fits the population you want to serve, start with assisted living and facility assisted living for the senior care side, and confirm the IDD, mental health, or recovery equivalents directly with your state licensing agency, since those categories often live under a different department entirely. Whatever path you pick, the State Group Home Licensing Kit has state-specific starting templates for house rules and the rest of the manual, so you're editing instead of inventing from zero.

Frequently asked questions

What is assisted living?

Assisted living is a licensed care model, mostly for seniors, that provides help with daily activities like bathing, dressing, and medication management while allowing residents to live somewhat independently. It's regulated at the state level with no single federal definition, so services, staffing, and terminology vary by state ^[1].

What is a group home?

A group home is a licensed residence, usually housing between 4 and 16 people, where residents with shared support needs (IDD, mental illness, recovery, or seniors needing care) live together with paid staff. Each state defines the license category, staffing ratios, and services allowed separately, so the exact rules depend on your state and population.

What is an assisted living facility?

An assisted living facility is the licensed building or program where assisted living services are delivered, regulated by the state rather than the federal government. States use different names for it, such as Residential Care Facility for the Elderly in California or Personal Care Home in Georgia, but the core service model is similar across states.

What does assisted living provide?

Assisted living typically provides help with bathing, dressing, toileting, and mobility, medication management or reminders, meals, housekeeping, laundry, 24-hour staff awareness, and social activities. It generally does not provide skilled nursing care, IV therapy, or complex wound care unless the state license includes an enhanced or specialized care tier.

What is the difference between assisted living and a nursing home?

Assisted living serves people who need help with daily tasks but not medical care, with staffing rules set entirely by the state. Nursing homes serve people needing skilled medical or rehab care and must have an RN on duty at least 8 hours a day and licensed nursing coverage 24/7 under federal rules (42 CFR 483.35) ^[2].

Does Medicare cover assisted living facilities?

No. Medicare does not cover the room-and-board or custodial care costs of assisted living. Medicare.gov states Medicare "doesn't cover long-term care" for help with daily activities alone ^[3]. Medicare can cover medical services a resident receives while living there, and Part A can cover short skilled nursing stays after a qualifying hospitalization.

How do I start a group home?

Pick your population and license category, confirm zoning before signing a lease, write a full policy manual including house rules, build a staffing plan meeting your state's ratios and background check rules, get your building code-compliant, and submit the license application with your fee and required documents for a pre-licensure inspection.

What should be in a group home's house rules document?

A solid house rules document covers daily schedule, chores, visitor policy, curfew (if legally applicable), substance use and smoking policy, phone and personal property rules, pet policy, quiet hours, and a clear escalation process from warning to behavior plan to discharge review, tied to your state's actual discharge notice requirements.

Can a group home set a curfew for adult residents?

It depends on the population and the state's resident rights statute. Many states protect adult residents' right to reasonable self-determination and free movement, which limits blanket curfews for people with full legal capacity. Recovery residences and some structured programs can build phase-based curfews into a treatment plan; confirm your state's specific rules before writing one into house rules.

Can house rules override a resident's legal rights?

No. House rules sit below state resident rights statutes and federal fair housing protections. A rule that restricts visitation, communication, or participation in care planning beyond what the state's resident bill of rights allows is not enforceable and can be cited as a violation during a licensing inspection.

What happens if a resident breaks a house rule?

Most states require a documented, graduated response rather than immediate discharge: a warning, then a behavior plan or care conference, then formal discharge review only for serious or repeated violations tied to specific criteria in state regulation. Discharge typically requires written notice and, for many Medicaid-funded residents, an appeal right before removal.

Do house rules need to be part of the licensing application?

Most states require a policy and procedure manual as part of licensing, and house rules are typically a component or attachment to that manual, plus part of the resident admission packet. Confirm the exact submission requirement with your state licensing agency, since some states review house rules during the pre-licensure inspection rather than at application.

How is a recovery residence's house rules different from a senior group home's?

Recovery residences usually have stricter, more explicit rules: mandatory drug testing schedules, phase-based curfews, and a defined relapse policy, often aligned to standards like those published by the National Alliance for Recovery Residences. Senior group homes focus more on routine, dignity, and safety, like meal schedules, visiting hours, and fall-prevention property rules.

Sources

1. Medicaid.gov, Institutional Long Term Care: Assisted living facility terminology and standards are set at the state level with no single federal definition
2. Electronic Code of Federal Regulations, 42 CFR 483.35: Nursing homes must have an RN on duty at least 8 consecutive hours a day and licensed nursing coverage 24 hours a day
3. Medicare.gov: Medicare doesn't cover long-term custodial care such as help with daily activities alone
4. Centers for Medicare & Medicaid Services, Home & Community-Based Services 1915(c): States can request 1915(c) waivers to cover home and community-based services as an alternative to institutional care
5. Electronic Code of Federal Regulations, 24 CFR 100.201-100.204: HUD's Fair Housing Act regulations define reasonable accommodation obligations that apply to group living arrangements for people with disabilities
6. 42 U.S.C. 3601 et seq., Fair Housing Act: The Fair Housing Act protects group homes serving people with disabilities from discriminatory rules and restrictions