Last updated 2026-07-23
TL;DR
Residential assisted living is licensed, non-medical residential care for people who need help with daily activities like bathing, dressing, and medication, but not full-time skilled nursing. It differs from a nursing home in staffing and regulation, and from a group home mainly in size and state licensing category. Medicare doesn't cover room and board; Medicaid may help through state waivers. To find one near you, start with your state's licensed facility directory or the federal Eldercare Locator.
What is assisted living?
Assisted living is a residential care option for people who need regular help with daily activities, things like bathing, dressing, medication reminders, and meals, but who don't need round-the-clock skilled nursing care. The National Institute on Aging describes it as housing for people who need some help with daily activities but still want to keep as much independence as possible. It sits between independent living and nursing home care. There's no single federal definition or license for assisted living. Each state writes its own rules, licenses its own facilities, and often uses its own name for the category (assisted living residence, residential care facility, personal care home). That's why terminology gets confusing fast, and why the assisted living category in one state can look completely different from the same phrase two states over. As of the most recent federal count, the U.S. had about 28,900 licensed residential care communities with roughly 996,100 licensed beds, according to a national survey run by the CDC's National Center for Health Statistics [1]. That range spans everything from a four-bed home in a converted single-family house to a 150-unit senior living campus with a memory care wing. Size alone doesn't tell you much about quality or licensing status, which is why the license itself matters more than the building.
What is a group home?
A group home is a licensed residential setting, usually a house rather than an institutional building, where a small number of residents (commonly somewhere between 4 and 16, depending on the state) live together and get supervision, personal care, or behavioral health support from paid staff. Group homes exist for a lot of different populations: seniors who need help with daily living, adults with intellectual or developmental disabilities, people in mental health recovery, and people in substance use recovery. In plenty of states, "group home" and "assisted living" overlap almost completely for small residential settings. In others, they're separate license categories with different staffing rules, different inspection schedules, and different funding streams. Washington calls its version an adult family home. Virginia calls it a residential care home license under a different chapter of its code. California has board and care homes. None of that is universal, so confirm the exact category name and requirements with your state licensing agency before you assume anything carries over from a neighboring state. If you're comparing options for a family member, read up on assisted living facilities generally, then ask the specific home which license category it operates under and what that license actually requires of staff.
What is an assisted living facility?
An assisted living facility is a licensed building, or set of buildings, where trained staff provide personal care services, meals, housekeeping, and supervision to residents who need help with daily activities but don't require full-time skilled nursing. Some states file this under a category literally called facility assisted living licensing, to distinguish it from nursing facility licensing, which sits under a completely different set of statutes and a different regulatory body. Unlike nursing homes, there's no federal certification process for assisted living. Nursing homes that accept Medicare or Medicaid go through a federal survey and certification process; assisted living facilities generally don't, even when a state licenses them closely. A 2018 federal watchdog report found that oversight of assisted living, particularly where Medicaid dollars pay for services inside these settings, varies widely from state to state and lacks the kind of uniform federal standard nursing homes have. Practically, that means the word "facility" on a building doesn't guarantee any particular staffing level or service list. You have to pull the actual state license type. A page like assisted living facility can walk you through what that license typically requires, but the specific statute always sits with your state licensing agency, not with any single national rulebook.
What does assisted living provide?
Assisted living typically provides help with activities of daily living (bathing, dressing, grooming, toileting, mobility), medication management or reminders, prepared meals with dietary accommodations, housekeeping and laundry, transportation to appointments, organized social and recreational activities, staff availability around the clock, and an emergency call system in each unit or room. The National Institute on Aging lists personal care and meal service as core, expected features of this level of care. What it generally does not provide is skilled nursing care, things like wound care, IV therapy, ventilator management, or complex rehabilitation. Residents whose medical needs grow past what personal care staff can safely handle usually have to transfer to a nursing home, or bring in an outside home health or hospice provider under rules that differ by state. Some assisted living licenses include a stated "level of care" ceiling written right into the admission agreement, spelling out exactly what triggers a required move. A short honest note here: activities calendars and dining menus look great in a tour brochure, but the number that actually matters is the staff-to-resident ratio during the overnight shift. Ask for that number directly, in writing, before you sign anything.
What's the difference between assisted living and a nursing home?
| Federal certification | None (state-licensed only) | Required if accepting Medicare/Medicaid | |
|---|---|---|---|
| Nurse staffing | Set by state, varies widely | RN 8 hrs/day min., licensed nurse 24/7 | |
| Level of medical need | ADL help, not skilled nursing | Skilled nursing, rehab, chronic medical care | |
| Typical setting | Apartment-style unit or home | Hospital-adjacent, clinical setting | |
| Medicare coverage | Not covered | Short-term stay may be covered | Neither setting is automatically "better." A person who needs help remembering pills and getting dressed doesn't need a nursing home. A person recovering from a stroke who needs daily physical therapy and wound checks does. The assisted living facility label tells you the category; it doesn't tell you whether the specific home can actually meet a specific person's medical needs, so ask directly. |
The core difference is medical staffing. Nursing homes (also called skilled nursing facilities) are required under federal Medicare and Medicaid certification rules to have a registered nurse on site at least 8 consecutive hours a day, 7 days a week, and a licensed nurse (RN or LPN) on duty 24 hours a day. Assisted living facilities have no comparable federal staffing rule; staffing minimums, where they exist at all, come entirely from state regulation and vary a lot. | | Assisted living | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the monthly cost of room, board, or personal care services in assisted living. Medicare.gov is direct about this: original Medicare doesn't pay for most long-term care or custodial care, the kind of help with daily activities that assisted living provides. What Medicare can cover is a short skilled nursing facility stay after a qualifying hospital stay, and separate medical services (doctor visits, physical therapy, durable medical equipment) delivered to someone who happens to live in assisted living. It does not pay the facility's rent-like monthly rate. Medicaid is different, but still limited. Most states don't let Medicaid pay for room and board in assisted living either. What many states do instead is use a Medicaid Home and Community-Based Services waiver, authorized under Section 1915(c) of the Social Security Act, to pay for the personal care services portion of assisted living or a group home for eligible low-income residents. Medicaid.gov describes these waivers as a way to let states "furnish an array of home and community-based services" as an alternative to institutional care. Room and board is typically covered separately, often from the resident's own Social Security or Supplemental Security Income payment. Waiver names, income limits, and covered services differ by state, so confirm the specific program with your state Medicaid agency directly.
How do I find residential assisted living near me?
A basic map search will show you paid listings and reviews, but it won't tell you whether a home is currently licensed, in good standing, or under a correction order. Start somewhere more reliable. First, check your state's official licensed facility search tool, usually run through the state health department, aging department, or department of human services (confirm the exact agency name with your state licensing agency, since it varies). Second, use the Eldercare Locator, a free public service run by the federal Administration for Community Living that connects people to local aging and disability resources in every state. Third, if your state posts inspection or survey history online, pull the last two years of records for any home you're seriously considering. Fourth, tour in person, more than one home if you can, and ask about staffing ratios and any open corrective action. If you're weighing whether a loved one even needs to move at all, it's worth reading about assisted living at home as an alternative model before committing to relocation. And for a deeper comparison guide built around specific local options, see senior assisted living facilities near me.
How do I start a group home?
Starting a licensed group home or residential assisted living home is a state-by-state process, and there's no shortcut that skips your state's actual licensing statute. The general sequence looks like this in most states: 1. Pick a population and license category (senior residential assisted living, IDD, mental health, or recovery), because staffing rules, training requirements, and inspection standards differ by population. 2. Pull your specific state's licensing application and statute directly from your state licensing agency; don't rely on a neighboring state's rules. 3. Address zoning and property compliance early. Group homes serving people with disabilities are protected under the Fair Housing Act, and local governments must, in some circumstances, provide a reasonable accommodation to their zoning rules to allow the home, according to a joint statement from HUD and the Department of Justice. Occupancy limits and fire code still apply. 4. Write the required policy and procedure manuals: medication administration, emergency and disaster planning, resident rights, grievance procedures. Almost no state issues a license without these on file. 5. Build a staffing plan that meets state minimum ratios, training hours, and background check requirements. 6. Budget for renovation to meet fire and life safety code, insurance, and licensing fees (fees range widely, commonly a few hundred to a few thousand dollars; confirm the exact figure with your state licensing agency). 7. Pass the pre-licensing inspection, which usually includes the fire marshal and the health department. Writing a state-compliant policy manual from a blank page is where most first-time operators lose weeks they didn't budget for. That's the specific gap our $299 one-time State Group Home Licensing Kit is built to close: state-specific application checklists and policy templates so you're working from a draft instead of a blank document. It doesn't replace your state's application or guarantee approval; only your licensing agency can approve a license.
What licenses, staffing, and zoning does a group home need before it opens?
Licenses: every state requires a specific residential care or group home license before you can operate, tied to the population you serve. Some states also require a separate food service permit if meals are prepared on site, and a fire safety inspection sign-off is nearly universal. Staffing: expect state rules to set a minimum staff-to-resident ratio during waking hours, a (usually lower) overnight ratio, required background checks (state fingerprint checks and checks against state abuse or neglect registries), and a minimum number of training hours covering medication administration, CPR and first aid, and sometimes population-specific training like dementia care or crisis de-escalation. Zoning: group homes for people with disabilities generally get treated as a residential use, not a commercial one, and the Fair Housing Act's reasonable accommodation doctrine backs that up in most jurisdictions. Still, local occupancy caps, spacing rules between group homes, and building/fire code requirements (sprinklers, egress width, smoke compartments) apply on top of that protection and vary block to block. Call your city or county planning department before you sign a lease, not after.
What should I ask when I tour a home near me?
A tour answers different questions than a phone call. Ask to see the current license, and check that it hasn't lapsed. Ask for the most recent inspection or survey report and whether any correction orders are still open. Ask for the staff-to-resident ratio by shift, especially overnight, since that's when incidents most often happen with the least oversight. Ask who administers medication (a nurse, a certified medication aide, or unlicensed staff depends entirely on your state's rules) and what happens if a resident's needs increase past what the home is licensed to provide, meaning would they have to move to a higher level of care. Ask for a full monthly cost breakdown, since base rate plus level-of-care add-ons can double the advertised price. Ask how often the fire evacuation plan gets tested, and ask how grievances get filed and resolved. None of these questions are unreasonable, and a home that gets defensive about any of them is telling you something.
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 not full-time skilled nursing care. It sits between independent living and a nursing home on the long-term care spectrum, and each state licenses and defines it separately rather than under one federal standard.
What is a group home?
A group home is a licensed residential setting, usually house-style, where a small number of residents (often 4 to 16, depending on the state) live together with paid staff providing supervision, personal care, or behavioral health support. Group homes serve seniors, people with intellectual or developmental disabilities, and people in mental health or recovery programs.
What is an assisted living facility?
An assisted living facility is a licensed building where staff provide personal care, meals, and supervision to residents who need daily living help but not skilled nursing. There's no federal certification for these facilities, unlike nursing homes, so oversight and specific requirements come entirely from state licensing law.
What is the difference between assisted living and a nursing home?
The main difference is medical staffing. Nursing homes must have an RN on site at least 8 hours a day, 7 days a week, plus a licensed nurse 24/7, under federal certification rules. Assisted living has no comparable federal staffing rule; requirements are set entirely by the state and vary widely.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care in assisted living. It can cover a short skilled nursing facility stay after a qualifying hospital admission, and separate medical services like doctor visits or physical therapy, but not the facility's monthly rate.
Does Medicaid pay for assisted living or a group home?
Usually not for room and board directly. Most states use a Medicaid Home and Community-Based Services waiver to pay for the personal care services portion for eligible low-income residents, while room and board is typically paid from the resident's own income, such as Social Security. Waiver names and eligibility vary by state.
How do I start a group home?
Pick a population and license category, get the exact application and statute from your state licensing agency, confirm zoning and fire code compliance for the property, write required policy manuals covering medication, emergency planning, and resident rights, build a compliant staffing plan, and pass the pre-licensing inspection. No state skips this process.
How long does it take to get a group home license?
There's no single national timeline. It depends on how quickly your policy manuals, staffing plan, and property meet your state's requirements, and how backed up your state licensing agency is. Some operators move through the process in a few months; others take longer because of zoning disputes or renovation delays. Confirm expected timelines directly with your agency.
What's the difference between assisted living and independent living?
Independent living is housing for people who don't need regular help with daily activities, often with meals and light housekeeping included but no personal care staff. Assisted living adds licensed staff who help with bathing, dressing, medication, and other daily activities for residents who need that support.
Can Social Security or SSI be used to pay for assisted living?
Yes, in most cases residents use their Social Security or Supplemental Security Income (SSI) payments toward room and board, since Medicaid waivers typically cover services rather than housing costs. The Social Security Administration outlines SSI eligibility and payment rules on ssa.gov, but exact use varies by state program design.
Is there a national database of licensed assisted living facilities?
No single federal database lists every licensed assisted living facility, since licensing is a state function. The closest federal tool is the Eldercare Locator (eldercare.acl.gov), a referral service that connects people to state and local aging resources, including licensed facility information for their area.
What's the difference between memory care and regular assisted living?
Memory care is a specialized assisted living license or wing for residents with dementia or Alzheimer's, typically with secured entrances/exits, higher staff-to-resident ratios, and staff trained specifically in dementia care. Regular assisted living doesn't require that specialized training or physical security unless a state mandates it for that unit.
Sources
- CDC/NCHS, Long-Term Care Providers and Services Users in the United States, 2015-2016: About 28,900 residential care communities with 996,100 licensed beds nationally
- Medicaid.gov: Medicaid Home and Community-Based Services (HCBS) waivers can help cover the cost of assisted living services for eligible individuals.
- Medicare.gov: Medicare does not cover the room and board costs of assisted living facilities, though it may cover certain medical services provided there.
- National Conference of State Legislatures: States regulate and license assisted living facilities differently, leading to variation in staffing and care requirements across the country.
- Centers for Medicare & Medicaid Services: Nursing homes are subject to federal quality and safety oversight standards that differ from those governing assisted living facilities.
- National Institute on Aging (NIH): Assisted living facilities provide help with daily activities such as bathing, dressing, and medication management for older adults who do not need intensive medical care.