Last updated 2026-07-25
TL;DR
"Above the Rest Residential Assisted Living" is a business name used by facilities in some markets (Florence, AZ and similar towns show up in searches); it isn't a licensing category. This article explains what assisted living and group homes actually are, how they differ from nursing homes, what Medicare will and won't pay for, and the real steps to open a licensed group home.
What is assisted living?
Assisted living is a type of licensed residential care for adults, usually seniors, who need help with daily activities but don't need the round-the-clock skilled nursing care a hospital or nursing home provides. Residents typically have their own room or apartment and get help with things like bathing, dressing, medication reminders, and meals, plus access to staff on site. The federal government doesn't run a single national assisted living license. Each state writes its own rules, sets its own name for the category, and runs its own inspection process. Some states call it "assisted living facility," others use "residential care facility for the elderly," "personal care home," or "adult foster care." That's part of why a name like "Above the Rest Residential Assisted Living" shows up attached to specific towns like Florence: it's a business name chosen by an operator, licensed under whatever that state calls the category, not a nationwide brand or program. If you're trying to find or vet a specific facility operating under a name like this, the fastest reliable path is your state's licensing agency search tool, not a general web search. Every state that licenses assisted living publishes a facility lookup where you can check license status, capacity, and inspection history [1].
What is a group home?
A group home is a licensed residential setting, usually a single house in a regular neighborhood, where a small number of unrelated residents live together with staff support. Unlike assisted living, which almost always means seniors, "group home" covers a wider range of populations: people with intellectual or developmental disabilities (IDD), people with serious mental illness, people in addiction recovery, and in some states, seniors too. Most group homes serve somewhere between 4 and 10 residents, though the exact cap depends on state licensing rules and local zoning. States that license under the Medicaid Home and Community-Based Services (HCBS) waiver framework often tie group home capacity and services to that waiver's requirements [2]. The legal foundation that lets group homes exist in single-family neighborhoods, over local objection, mostly comes from the federal Fair Housing Act, which protects people with disabilities from zoning rules that treat a group home differently than an unrelated group of housemates would be treated. HUD's guidance states that "a local government violates the Fair Housing Act if it makes housing unavailable to persons with disabilities because of that disability," which includes many blanket bans or spacing requirements aimed at group homes [3]. That said, zoning still varies wildly by city and county, so anyone opening a home needs to check local code directly. See our zoning and property guide for how that plays out at the local level.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed building or program itself, the physical place where assisted living services happen. It's the legal entity that holds the state license, more than a marketing term. States require an ALF to hold a specific license before it can advertise, admit residents, or bill for care, and that license spells out capacity, staffing ratios, and the level of care the home can legally provide [4]. ALF licenses typically come in tiers. A basic tier might allow help with activities of daily living and medication management. A higher tier, sometimes called "limited nursing" or "extended congregate care" depending on the state, allows the facility to keep residents who need more hands-on nursing support, like wound care or tube feeding, without transferring them to a nursing home. Florida, for example, licenses standard ALFs plus optional "limited mental health," "extended congregate care," and "limited nursing services" licenses, each with its own staffing and training requirements [4]. A facility using a name like "Above the Rest Residential Assisted Living" would be licensed under whichever tier and category its state assigns, and that license (not the business name) determines what kind of care residents can legally receive there.
What is assisted living facility care actually like day to day?
Day to day, assisted living looks a lot more like an apartment building with support staff than a hospital. Residents usually have a private or semi-private room, communal dining, and a schedule of activities, plus call buttons or check-in systems so staff know if someone needs help. Core services almost every state requires include help with activities of daily living (bathing, dressing, toileting, transferring), medication management or reminders, three meals a day, housekeeping, laundry, and 24-hour staff availability for emergencies [5]. Many facilities add social and recreational programming, transportation to appointments, and on-site therapy visits, though those extras vary by operator and aren't always required by license. What assisted living does NOT typically include is skilled nursing care around the clock. If a resident's needs progress to that level (constant IV therapy, complex wound care, ventilator support), most states require either a transfer to a nursing home or, if the facility holds a higher-tier license, a documented care plan showing the ALF can legally handle it. That distinction is the single biggest source of confusion for families comparing the two settings.
What does assisted living provide that a group home for other populations might not?
Assisted living for seniors is built around the aging process: mobility loss, memory decline, and chronic disease management layered onto otherwise independent adults. A group home for IDD or mental health populations is built around a different set of goals, often habilitation, skill-building, community integration, or psychiatric stability, rather than managing decline. That difference shows up in staffing and training. Senior assisted living staff need training in fall prevention, medication administration, and often dementia care. IDD group home staff need training in behavior support plans, communication techniques, and person-centered planning under each state's developmental disabilities agency rules. Mental health group homes typically require staff trained in crisis de-escalation and psychiatric medication protocols. Recovery residences add substance use relapse prevention and, in many states, certification through a recognized recovery housing standard [6]. Anyone planning to operate should figure out the population first, because it drives every other decision: which state agency licenses you, what staffing ratios apply, what the physical building needs (grab bars and wander-management for dementia vs. secured storage and behavior-plan space for IDD), and what Medicaid waiver, if any, will pay for services. Our populations served content breaks down staffing and training differences by population if you're still deciding.
What is the difference between assisted living and a nursing home?
| Primary regulator | State health/social services agency, license varies by state | State health department + federal Medicare/Medicaid Certification (42 CFR Part 483) | |
|---|---|---|---|
| Staffing | Aides, some nurses; no federal RN-hour minimum | Federal rule requires RN coverage; CMS finalized minimum staffing standards in 2024 | |
| Medical care level | ADLs, medication management, limited nursing (state dependent) | Skilled nursing, rehab therapy, complex medical care | |
| Typical setting | Private/semi-private room, apartment-style | Semi-private or private room, more clinical | |
| Medicare coverage | Generally not covered | Short-term skilled stays covered under specific conditions | |
| Medicaid coverage | Often covers services (not room/board) via HCBS waiver | Covers long-term nursing home care in all states | Because of that staffing and licensing gap, nursing homes are the appropriate setting for residents needing daily skilled nursing, IV therapy, or complex wound care, while assisted living fits people who need daily support but not medical treatment. Residents sometimes move between the two as needs change, which is why many senior campuses offer both levels under one roof. |
The core difference is the level and type of medical care provided, more than the building. Assisted living is a supportive, mostly non-medical setting; a nursing home (also called a skilled nursing facility, or SNF) provides medical and rehabilitative care ordered and supervised by physicians and delivered largely by licensed nurses, around the clock. | Feature | Assisted Living | Nursing Home (SNF) |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of assisted living, including room, board, and personal care services. CMS states plainly that "Medicare doesn't cover long-term care (also called custodial care)" if that's the only care needed, and assisted living is considered custodial, not skilled, care . Medicare Part A can cover a short-term stay in a Medicare-certified skilled nursing facility, but only under specific conditions: a qualifying 3-day inpatient hospital stay, admission to the SNF within 30 days of that discharge, and a doctor-certified need for skilled nursing or rehab . That coverage is capped at 100 days per benefit period, with a daily copay kicking in after day 20, and it does not extend to assisted living at all . Medicaid is a different story. Most states offer Medicaid coverage for some assisted living services through a Home and Community-Based Services (HCBS) waiver, but even then, Medicaid generally pays for the care services, not room and board, which residents or their families must cover separately [2]. Coverage, waiver availability, and waiting lists vary enormously by state, so anyone planning to rely on Medicaid needs to check their specific state's waiver program directly rather than assume coverage exists.
How to start a group home
Starting a licensed group home is a multi-step regulatory project, not a real estate purchase. The exact steps and agency names differ by state, but the sequence is consistent across almost every jurisdiction: 1. Pick your population and license category (senior ALF, IDD group home, mental health residential, adult foster care, recovery residence) with your state licensing agency, since this decision drives everything downstream. 2. Check zoning and land use for the specific property before signing a lease or purchase agreement; confirm with your state licensing agency and your local planning department whether a conditional use permit or special exception is required. 3. Write your policy and procedure manual covering admissions, medication management, emergency preparedness, resident rights, staffing plans, and incident reporting, all matched to your state's specific regulation numbers. 4. Complete any required background checks, fire marshal inspection, and building/health department sign-off before the state will schedule a licensing survey. 5. Submit the license application with required fees; confirm current fee amounts with your state licensing agency, since they range widely and change periodically. 6. Pass the pre-licensing inspection, which typically checks physical plant safety (exits, sprinklers, ADA-relevant features), staffing documentation, and policy compliance. 7. Hire and train staff to the ratios your license category requires, then complete any orientation or new-provider training your state mandates before intake. Building the paperwork correctly the first time is where most delays happen; states routinely bounce applications back for incomplete policy manuals or missing staffing plans rather than deny them outright. If you want a structured starting point instead of assembling this from scratch, the $299 State Group Home Licensing Kit gives you a state-matched set of application checklists and policy manual templates to adapt, though your state agency's own application and current fee schedule always control what actually gets filed.
How do I start a group home if I have no experience in senior care or healthcare?
Lack of clinical experience isn't automatically disqualifying, but most states do require either a licensed administrator on staff or a credentialed administrator overseeing the home, and some require the owner-operator to pass a state exam or complete an approved training course before a license is issued. Florida, for instance, requires ALF administrators to complete a state-approved core training course and pass a competency test administered through the Department of Elder Affairs before they can be listed as the facility's administrator of record . Other states run similar administrator certification programs through their aging or health department. Check your specific state's requirement before assuming a bachelor's degree or nursing license is mandatory; many states accept a combination of business management background plus the required state training course. What you can't skip regardless of background: a clean criminal background check (for you and every staff member), a facility that meets fire and life-safety code, and a policy manual that demonstrates you understand resident rights, medication handling, and emergency procedures. If you're weak on the operations side, partnering with or hiring an experienced administrator to hold the license credential while you handle business operations is a common, legitimate structure in several states.
What licenses, permits, and inspections does a new group home need?
Beyond the core state facility license, expect to coordinate three or four separate approval processes that often run in parallel, not sequence. Zoning and building: your local planning or zoning department confirms the property's use classification allows a group home, and the building department confirms the structure meets residential (or in some states, institutional) building code for the resident count you're proposing. See our zoning and property coverage for how conditional use permits typically work. Fire and life safety: a fire marshal inspection is standard before licensing, checking smoke detectors, sprinkler requirements (which often kick in at specific resident thresholds), egress width, and emergency lighting. Requirements escalate with resident capacity and mobility level, so a home serving non-ambulatory residents usually faces stricter code than one serving independent seniors. Health and sanitation: many states require a health department inspection covering food service, water supply, and infection control, especially if the home prepares meals on site. Background checks: owners, administrators, and direct care staff typically need state and sometimes federal background checks (FBI fingerprinting), and some states also check the abuse/neglect registry specific to the population you serve. See our inspections guide for what inspectors actually look for during pre-licensing and annual renewal visits.
How much does it cost to license and open a group home?
Costs break into two buckets: government fees and everything else. Government fees (application, license, background check processing) are usually the smallest line item, often a few hundred to a few thousand dollars depending on state and capacity, though you should confirm current amounts with your state licensing agency since fee schedules change and vary by facility size [1][4]. The much larger costs are property (purchase, lease, or renovation to meet ADA and fire code), staffing during the pre-licensing period, insurance (general liability and professional liability specific to residential care), and furnishings/equipment matched to your resident population. None of these are numbers this article can responsibly quote as a national average, because they swing enormously by state, market, and whether you're buying a house or building new. Any source that gives you a single flat national startup number without asking your state and population first isn't giving you a real estimate.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care setting for adults, usually seniors, who need help with daily activities like bathing, dressing, and medication but don't need round-the-clock skilled nursing. Residents typically have their own room, get meals and housekeeping, and have staff available 24 hours a day. Each state licenses and regulates it separately under its own name and rules.
What is a group home?
A group home is a licensed residential setting, often a single house, where a small number of unrelated residents live with staff support. It covers seniors, people with intellectual or developmental disabilities, people with mental illness, and people in addiction recovery, depending on the state's licensing categories and the operator's chosen population.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed building or program that provides assisted living services. It holds a state-issued license specifying its capacity, staffing requirements, and level of care allowed, ranging from basic personal care to higher tiers that permit limited nursing services depending on the state.
What does assisted living provide?
Assisted living typically provides help with activities of daily living, medication management or reminders, three daily meals, housekeeping, laundry, 24-hour staff availability, and social or recreational activities. It generally does not provide skilled nursing care around the clock; residents needing that level of care usually move to a nursing home.
What is the difference between assisted living and a nursing home?
Assisted living is a supportive, mostly non-medical setting for people who need help with daily tasks. A nursing home provides skilled, physician-directed medical care with required RN coverage under federal rules (42 CFR Part 483). Nursing homes fit residents needing daily medical treatment; assisted living fits those needing support, not treatment.
Does Medicare cover assisted living facilities?
No. Medicare does not cover assisted living room, board, or custodial care costs. CMS states that Medicare doesn't cover long-term custodial care when that's the only care a person needs. Medicare Part A may cover a short skilled nursing facility stay under specific conditions, but that's separate from assisted living.
How do I start a group home?
Pick your population and license category, confirm local zoning allows the use, write a compliant policy and procedure manual, pass background checks and fire/health inspections, submit your state license application with required fees, and hire staff meeting your license category's ratios. Every state runs this process differently, so start with your state licensing agency's specific application guide.
Is 'Above the Rest Residential Assisted Living' a specific licensed facility?
It's a business name used by some assisted living operators, and names like this appear attached to specific towns (Florence included) in search results. It is not a licensing category or national brand. To verify any specific facility using this name, search your state's official assisted living facility license lookup tool directly.
What's the difference between assisted living and independent living?
Independent living is unlicensed senior housing for people who need no daily personal care help, essentially an apartment community with amenities. Assisted living is licensed and provides hands-on help with activities of daily living plus medication management. Many senior campuses offer both, letting residents transition as needs increase.
Does Medicaid pay for assisted living?
In most states, yes, but only for care services through a Home and Community-Based Services (HCBS) waiver, not for room and board, which the resident or family typically still pays out of pocket. Waiver availability, income limits, and waiting lists vary significantly by state, so confirm directly with your state Medicaid agency.
How many residents can a group home have?
It depends entirely on the state and license category, commonly ranging from a handful of residents in a small residential home up to a larger capacity in a licensed facility building. Local zoning classification also affects the cap, since many jurisdictions treat homes above a certain resident count as a commercial or institutional use.
Do I need a nursing background to open a group home?
Not necessarily. Most states require a licensed or certified administrator overseeing the home rather than requiring the owner personally hold a nursing license. Many states run their own administrator training and competency exam program that owners without clinical backgrounds can complete, though a clean background check is required regardless of your professional history.
What inspections happen before a group home can open?
Expect a fire marshal life-safety inspection, a building code inspection matched to your resident capacity, a health department review if you serve meals on site, and the state licensing agency's own pre-licensing survey covering staffing, policies, and physical plant safety. Requirements and inspection order vary by state and county.
Sources
- Administration for Community Living, Eldercare Locator: States operate their own licensing and facility lookup systems for assisted living
- Medicaid.gov, Home & Community-Based Services 1915(c): Medicaid HCBS waivers can fund group home and assisted living services, tied to waiver-specific rules
- eCFR, 42 CFR Part 483, Requirements for States and Long Term Care Facilities: Nursing homes are federally regulated under 42 CFR Part 483 requirements
- CMS, Minimum Staffing Standards for Long-Term Care Facilities final rule: CMS finalized minimum nurse staffing standards for nursing homes in 2024
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care, including assisted living
- Medicare.gov, Skilled nursing facility (SNF) care: Medicare Part A covers SNF stays only under specific conditions including a qualifying 3-day hospital stay, capped at 100 days per benefit period