Last updated 2026-07-24
TL;DR
Illinois assisted living facilities are licensed by IDPH under the Assisted Living and Shared Housing Act (210 ILCS 9), separate from nursing homes and from unlicensed group homes run through DHS/DHFS. Assisted living provides housing, meals, and personal care but not the 24-hour skilled nursing a nursing home offers. Medicare does not pay for assisted living room and board.
What is assisted living?
Assisted living is a residential option for adults, usually older adults, who need help with daily tasks like bathing, dressing, medication reminders, and meals but who do not need the round-the-clock skilled nursing care you'd find in a nursing home. Residents typically have their own apartment or room, and staff are on-site to help as needed rather than living in a hospital-like setting. In Illinois, this level of care is formally called an "assisted living establishment" under state law, and it sits in a specific regulatory lane between independent senior housing and licensed nursing facilities. The federal government doesn't license assisted living at all. It's a state-by-state system. Illinois's version has its own rulebook, the Assisted Living and Shared Housing Act, 210 ILCS 9 [1].
What is a group home?
A group home is a small residential setting, often a single-family style house, where a handful of unrelated people live together and receive support tailored to a specific population: people with intellectual or developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, or older adults needing daily supervision (sometimes called adult foster care or sheltered care). Group homes are not the same regulatory category as "assisted living facility" in most states, including Illinois. Depending on who lives there, a group home might be licensed by the Illinois Department of Human Services (DHS) Division of Developmental Disabilities, by a community mental health authority, or it might fall under Illinois's Community Living Facilities or Sheltered Care licensing through the Illinois Department of Public Health (IDPH). The practical difference: assisted living establishments in Illinois are licensed specifically for older adults and adults needing personal care in an apartment-style setting under 210 ILCS 9, while IDD and behavioral health group homes run through separate DHS-administered rules and community care standards. If you're building a program for a specific population, start by confirming which state agency actually licenses that population's residential setting. It is genuinely not one-size-fits-all. For background on how this plays out across other states, see assisted living facilities.
What is an assisted living facility (and what is assisted living facility, exactly)?
An assisted living facility, called an "assisted living establishment" in Illinois statute, is a licensed residence that provides or coordinates personal care, 24-hour staff availability, and "sheltered care" services to adults who need help with activities of daily living but don't need continuous nursing care. Illinois law defines it under 210 ILCS 9 as an establishment that provides, at minimum, a package of services including housing, meals, and personal assistance to unrelated adults [1]. Under the Act, licensed establishments must offer a "service package" that includes three meals a day, help with activities of daily living, medication administration or oversight, laundry, housekeeping, and 24-hour staff presence able to respond to emergencies [1]. Facilities are required to use a "philosophy of aging in place," meaning residents shouldn't have to move out just because their needs increase somewhat, as long as the facility can still meet them safely. Illinois also recognizes a related but distinct license type called "shared housing establishments," which serve smaller groups in a more home-like, congregate setting, still under the same 210 ILCS 9 statute [1]. Both require licensure by IDPH, and both are inspected on a recurring basis. Confirm current licensing categories and any newer designations (Illinois has also developed "memory care" disclosure rules within assisted living) with IDPH directly, since program details get updated periodically [2].
What is assisted living vs nursing home?
| Licensing law | 210 ILCS 9 [1] | 210 ILCS 45 [3] | |
|---|---|---|---|
| Licensing agency | IDPH | IDPH | |
| Nursing staff required 24/7 | No (staff available, not necessarily licensed nurses around the clock) | Yes, licensed nursing staff required | |
| Typical setting | Private apartment/room | Semi-private or private room, hospital-like layout | |
| Level of medical care | Personal care, ADLs, med management | Skilled nursing, rehab, complex medical care | |
| Medicaid coverage | Limited, via HCBS waiver/Supportive Living Program | Yes, via Medicaid nursing facility benefit | If a family is choosing between the two, the deciding factor is almost always the resident's actual level of medical need, not preference alone. A geriatric care manager or hospital discharge planner can help make that call. |
The short version: assisted living is for people who need help with daily living tasks, and a nursing home (skilled nursing facility) is for people who need ongoing medical or nursing care. Nursing homes in Illinois are licensed separately under the Nursing Home Care Act, 210 ILCS 45, and are held to a different staffing and clinical standard than assisted living establishments [3]. Nursing homes must have licensed nurses on duty and are built around a medical model: skilled nursing, rehabilitation therapy, wound care, IV therapy, and management of complex medical conditions. Assisted living establishments in Illinois are explicitly barred from admitting or keeping residents who need continuous nursing care beyond what the law allows for aging in place. That's why residents whose needs escalate significantly sometimes have to transition to a nursing facility. Here's a side-by-side on the practical differences: | Feature | Assisted living establishment (IL) | Nursing home (IL) |
What does assisted living provide?
Assisted living provides a bundled package of housing, meals, personal care assistance, and light health oversight, all delivered in a residential (not clinical) setting. Under Illinois's Assisted Living and Shared Housing Act, licensed establishments must provide at least: three meals daily, housekeeping and laundry, social and recreational programming, assistance with activities of daily living (bathing, dressing, toileting, mobility), medication administration or reminders, and 24-hour staff on-site who can respond to emergencies [1]. Beyond the required minimum, many Illinois assisted living communities also offer transportation to appointments, memory care programming for residents with dementia, wellness checks, and coordination with outside home health or hospice providers. What they generally do not provide, by design, is IV therapy, ventilator care, or skilled nursing beyond limited nursing tasks allowed under the aging-in-place provisions. One thing operators and families both get wrong: assisted living is not automatically medical care. It's supportive care. If a resident's needs cross into needing daily wound care or IV medication, the facility either needs to bring in licensed home health support under Illinois's rules, or the resident may need to move to a higher level of care.
How to start a group home (and how do I start a group home) in Illinois
Starting a group home in Illinois means first figuring out which population you intend to serve, because that decision determines your licensing agency, your building code requirements, your staffing ratios, and your funding path. There is no single "group home license" in Illinois; the process branches early. Here's the general sequence most operators follow: 1. Pick your population and license type. IDD group homes usually go through DHS's Division of Developmental Disabilities (community integrated living arrangements, or CILAs). Mental health and recovery residences often work with community mental health authorities and may need Community Integrated Living Arrangement or supportive living certification. Senior assisted living or sheltered care goes through IDPH under 210 ILCS 9 [1]. 2. Confirm zoning and building code fit with your local municipality; group homes for people with disabilities have some protection under the federal Fair Housing Act (42 U.S.C. § 3604) against exclusionary zoning, but local fire and life-safety codes still apply [4]. 3. Write your policy and procedure manual. Every licensing agency wants to see admission criteria, medication management protocols, staffing plans, emergency procedures, resident rights policies, and grievance processes before they'll issue a license. 4. Build your staffing plan. Ratios and required credentials (CNA, med aide certification, background checks under the Health Care Worker Background Check Act, 225 ILCS 46) vary by license type; confirm current ratio requirements with the specific licensing agency for your population. 5. Apply for licensure, which typically includes a facility application, floor plans, a fire marshal inspection, and a criminal background check on owners and key staff. 6. Pass your pre-licensure inspection. IDPH (or DHS, depending on your license type) will inspect the physical plant and review your policies before issuing a license. 7. Apply for Medicaid enrollment or waiver participation if you plan to serve Medicaid-eligible residents, which is a separate process from state licensure entirely. Because the steps and exact fee amounts differ by license type and change periodically, confirm current application forms, fee schedules, and inspection checklists directly with IDPH or DHS before you budget your startup timeline [2][5]. Trying to guess at fees from an old PDF is how operators end up resubmitting paperwork twice. If you want a structured starting point instead of hunting through statute PDFs on your own, our licensing kit builder walks through state-specific application checklists, policy manual templates, and staffing plan frameworks. It's a $299 one-time tool, not a subscription, and it does not promise approval speed since that's entirely up to your state agency.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room, board, or personal care in an assisted living facility, in Illinois or anywhere else. CMS is direct about this: Medicare covers medically necessary services like doctor visits, short-term skilled nursing after a qualifying hospital stay, and certain home health services, but it does not pay for custodial or personal care, and it does not pay for the cost of living in an assisted living residence [6]. What Medicare might cover for someone living in assisted living is the same as what it covers for anyone: Medicare Part A hospital care, Part B doctor visits and outpatient services, and in some cases a limited home health benefit if a physician certifies the person is homebound and needs skilled care. None of that touches the facility's monthly rent-and-care fee. Medicaid is a different story, but still limited. Illinois offers the Supportive Living Program (SLP), a Medicaid-funded assisted living alternative for low-income older adults and younger adults with disabilities, which can help cover the cost of care (not room and board) for people who qualify financially and functionally [7]. Regular Illinois Medicaid does not pay for private-pay assisted living the way it pays for nursing home care under the nursing facility benefit. Families budgeting for assisted living should plan around private pay, long-term care insurance if the resident has a policy, and, for those who qualify, the Supportive Living Program, rather than assuming Medicare will step in.
What does assisted living cost in Illinois?
Costs vary a lot by region, unit size, and level of care, and no single number captures it well. Genworth's Cost of Care Survey, one of the most widely cited industry sources, put the 2023 national median monthly cost for assisted living at $5,350, though state and metro-level numbers differ meaningfully from that figure and change annually [8]. Illinois-specific figures move around depending on the source and year. Because there isn't a single authoritative state government dataset publishing monthly assisted living rates the way there is for nursing home Medicaid rates, the honest answer is: get current quotes from facilities in your specific metro area (Chicago-area pricing tends to run higher than downstate) rather than relying on any single national survey number for your particular county. What's more reliably documented is the funding overlay: Illinois's Supportive Living Program uses a Medicaid per-diem rate structure set by the Illinois Department of Healthcare and Family Services for participating facilities, distinct from private-pay market rates [7]. If you're modeling a business plan around SLP participation, get the current per-diem schedule directly from HFS rather than estimating from private-pay averages, since they're calculated on entirely different bases.
How is assisted living licensed and inspected in Illinois?
IDPH licenses and inspects assisted living establishments and shared housing establishments under 210 ILCS 9, and facilities are subject to periodic on-site surveys similar in spirit (though not identical in scope) to nursing home surveys [1][2]. Inspectors check compliance with staffing requirements, resident service plans, medication management practices, life-safety code items, and resident rights protections. Illinois law requires assisted living establishments to develop an individual service plan for each resident and to reassess residents periodically to make sure the facility can still meet their needs safely, part of the aging-in-place framework built into the statute [1]. Facilities found out of compliance can face plans of correction, fines, or in serious cases, license revocation. Because survey frequency, specific checklist items, and current fee schedules are updated by IDPH periodically, always pull the current inspection checklist and licensing fee schedule from IDPH's own published forms rather than relying on older summaries, including this one, for exact dollar figures [2].
What rights do assisted living residents have in Illinois?
Illinois assisted living residents have statutory rights spelled out in 210 ILCS 9, including the right to privacy, the right to manage their own financial affairs unless a guardian is appointed, the right to be free from abuse and neglect, and the right to receive visitors [1]. Facilities are required to provide residents with a written resident's rights statement at admission. Residents also have a right to a written contract disclosing the services included in their base rate, what costs extra, and the conditions under which the facility can raise rates, discharge a resident, or end the tenancy. Illinois requires advance written notice before an involuntary discharge or transfer, with specific exceptions for emergencies [1]. Families who believe a facility isn't meeting these obligations can file a complaint with IDPH, which has statutory authority to investigate licensed assisted living establishments.
Frequently asked questions
What is assisted living?
Assisted living is residential care for adults, usually seniors, who need help with daily activities like bathing, dressing, and medication management but not full-time skilled nursing. Residents live in private or semi-private units and receive meals, housekeeping, and personal care support from on-site staff, typically in an apartment-style rather than hospital-style setting.
What is a group home?
A group home is a small residential setting where several unrelated people live together and receive support suited to a specific population, such as people with developmental disabilities, mental health conditions, or substance use recovery needs. Licensing agency, staffing rules, and building requirements depend entirely on which population the home serves.
What is an assisted living facility?
An assisted living facility, called an assisted living establishment under Illinois law (210 ILCS 9), is a licensed residence providing housing, meals, and personal care assistance to adults who need help with daily activities but not continuous nursing care. It's licensed and inspected by the Illinois Department of Public Health.
What is assisted living facility vs nursing home?
Assisted living provides help with daily activities like bathing and medication reminders in a home-like setting, while a nursing home provides 24-hour skilled nursing care for people with significant medical needs. Illinois licenses them under different statutes: 210 ILCS 9 for assisted living and 210 ILCS 45 for nursing homes.
What is assisted living vs nursing home in terms of cost?
Assisted living is typically paid privately or through Illinois's Supportive Living Program (a Medicaid alternative), while nursing home care is more commonly covered by Medicaid's nursing facility benefit for those who qualify financially and medically. Neither is covered by Medicare for room and board, though Medicare covers short-term skilled nursing after qualifying hospital stays.
What does assisted living provide?
Illinois law requires licensed assisted living establishments to provide three daily meals, housekeeping and laundry, help with activities of daily living, medication administration or reminders, social programming, and 24-hour on-site staff able to respond to emergencies. Facilities are not required to provide skilled nursing or complex medical care.
How do I start a group home in Illinois?
Start by identifying which population you'll serve, since that determines your licensing agency (IDPH for assisted living/sheltered care, DHS for IDD group homes, community mental health authorities for behavioral health residences). Then confirm zoning, write your policy manual, build a staffing plan, and apply for licensure with the correct agency.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care in assisted living. It covers medically necessary services like short-term skilled nursing after a qualifying hospital stay and certain home health visits, but not the cost of living in an assisted living residence, according to CMS guidance.
Does Medicaid pay for assisted living in Illinois?
Illinois's Supportive Living Program is a Medicaid-funded alternative that can help cover care costs (not room and board) for financially and functionally eligible older adults and adults with disabilities in participating assisted living settings. Regular Illinois Medicaid does not pay for private-pay assisted living the way it covers nursing home care.
What license does an assisted living facility need in Illinois?
Assisted living establishments and shared housing establishments in Illinois are licensed by the Illinois Department of Public Health under the Assisted Living and Shared Housing Act, 210 ILCS 9. This is separate from the license required for nursing homes and separate from licensing for IDD or behavioral health group homes.
How much does assisted living cost in Illinois?
Costs vary widely by region and level of care. National surveys like Genworth's Cost of Care report put the 2023 median monthly assisted living cost at $5,350, but Illinois figures differ by metro area and change annually, so get current facility quotes for your county rather than relying on a national average.
Can a group home be located anywhere in Illinois?
Not automatically. Local zoning and building codes still apply, though group homes serving people with disabilities get some protection from exclusionary zoning under the federal Fair Housing Act (42 U.S.C. § 3604). Always confirm zoning fit with the local municipality before signing a lease or purchase agreement.
Sources
- Illinois General Assembly, Assisted Living and Shared Housing Act (210 ILCS 9): Illinois assisted living/shared housing establishment definitions, service package requirements, and resident rights
- Illinois Department of Public Health, Assisted Living program page: IDPH licenses and inspects assisted living establishments
- Illinois General Assembly, Nursing Home Care Act (210 ILCS 45): Nursing homes are licensed under a separate statute, 210 ILCS 45
- U.S. Department of Justice, Fair Housing Act text: Federal Fair Housing Act protections against exclusionary zoning for group homes serving people with disabilities
- Illinois Department of Human Services, Division of Developmental Disabilities: DHS administers licensing pathways for IDD community living arrangements
- Medicare.gov, Nursing home care coverage: Medicare does not cover long-term custodial or assisted living room and board costs
- Illinois Department of Healthcare and Family Services, Supportive Living Program overview: Illinois Supportive Living Program is a Medicaid-funded assisted living alternative with its own eligibility and rate structure
- Genworth, Cost of Care Survey 2023: National median monthly assisted living cost figure for 2023