Last updated 2026-07-25
TL;DR
Illinois assisted living establishments are licensed by the Illinois Department of Public Health under the Assisted Living and Shared Housing Act (210 ILCS 9). Operators need a state license before admitting residents, must follow staffing and service-plan rules, and go through IDPH inspections. Medicare doesn't pay for room and board; Medicaid covers some services through a specific waiver program.
What is assisted living in Illinois?
Assisted living in Illinois is a licensed residential care option for adults, mostly seniors, who need help with daily activities but don't need the round-the-clock medical supervision a nursing home provides. Illinois calls the license category the "assisted living establishment" and it's governed by the Assisted Living and Shared Housing Act, 210 ILCS 9 [1]. The law defines an assisted living establishment as a place that provides sleeping accommodations to at least three unrelated adults and offers or coordinates personal care services, 24-hour staff availability to meet scheduled or unscheduled needs, and support for instrumental activities of daily living [1]. That's a mouthful. But the core idea is simple: residents live in their own apartment-style unit, keep some independence, and get help layered in as needed rather than a hospital-style care model. Illinois also licenses "shared housing establishments" under the same act, which is a smaller-scale, more home-like setting, often with shared common areas. Both categories fall under IDPH oversight, and both require a license before you open your doors [1].
What is a group home, and how is it different from assisted living?
A group home usually refers to a smaller residential setting serving people with intellectual or developmental disabilities (IDD), mental illness, or in recovery from substance use, rather than seniors needing help with daily living. In Illinois, IDD group homes are typically licensed as Community Integrated Living Arrangements (CILAs) or ICF/DD facilities through the Illinois Department of Human Services, not through the assisted living statute. Assisted living establishments, by contrast, are licensed under 210 ILCS 9 and regulated by IDPH, with a target population of older adults or adults with age-related functional needs [1]. If you're planning to serve people with IDD, you're looking at a completely different licensing agency, application, and rule set than if you're opening a senior assisted living community. Confirm with your state licensing agency which category matches your intended population before you draft a floor plan or lease a building. Retrofitting a facility built for the wrong license type gets expensive fast. If your project is really a group home for adults with disabilities or in recovery, start with assisted living facilities for a broader look at how licensing categories split by population, then confirm the correct department with your state before spending money on a lease.
What is an assisted living facility (and what does the license actually require)?
An assisted living facility, called an "establishment" in Illinois statute, is a licensed building or set of units where residents get personal care, medication assistance, and supportive services while living somewhat independently. To operate one legally in Illinois you need a license from IDPH before admitting a single resident [1]. The application process generally includes: a facility license application submitted to IDPH, proof of the physical plant meeting building and life safety code requirements, a written policy and procedures manual covering resident rights, medication management, emergency procedures and staffing, disclosure of ownership and management, and a plan for background checks on staff [1] [2]. IDPH also requires facilities to maintain a written contract with each resident disclosing services, fees, and move-out criteria, a requirement spelled out in the Act's resident rights provisions [1]. Expect a site inspection before licensure and then periodic unannounced inspections after you're operating. Fees, exact application forms, and inspection frequency are set by IDPH rule and can change, so confirm current fee schedules and forms directly with the Illinois Department of Public Health rather than relying on a fixed number here [1].
What is assisted living vs nursing home in Illinois?
| Governing law | 210 ILCS 9 [1] | 210 ILCS 45 [3] | |
|---|---|---|---|
| Licensing agency | Illinois Dept. of Public Health | Illinois Dept. of Public Health | |
| Typical resident need | Help with ADLs, some medication support | Skilled nursing, rehab, complex medical needs | |
| Staffing model | 24-hr staff availability, licensed nurse involvement | Licensed nurses on duty around the clock | |
| Living unit | Private or semi-private apartment-style unit | Shared or private room, more clinical setting | |
| Medicare coverage | Not covered for room and board | Short-term skilled stays may be covered [4] | This distinction matters for your business plan too. If your target resident needs daily wound care or IV medications, you're probably describing a nursing home model, not assisted living, and licensing the wrong category will get flagged during your IDPH survey. |
The biggest difference is the level of medical care and the regulatory home. Nursing homes in Illinois are licensed under the Nursing Home Care Act (210 ILCS 45) and are built for residents who need ongoing skilled nursing care, often including IV therapy, wound care, or rehabilitation after a hospital stay [3]. Assisted living establishments, licensed under 210 ILCS 9, are for residents who need help with daily activities like bathing, dressing, or medication reminders, but not continuous skilled nursing [1]. Staffing reflects that difference. Nursing homes must have licensed nurses on site around the clock in most cases, along with a medical director and physician oversight tied to each resident's care plan. Assisted living establishments require staff availability 24 hours a day to respond to needs, but the staff mix leans toward personal care aides and a smaller number of licensed nurses for medication oversight and assessments, per IDPH's assisted living rules [1]. Here's a side-by-side that captures the practical differences: | Feature | Assisted Living Establishment | Nursing Home |
What does assisted living provide day to day?
Assisted living in Illinois typically provides housing, meals, housekeeping, laundry, medication management or reminders, help with bathing and dressing, social and recreational activities, and 24-hour staff availability for emergencies [1]. It is not a medical model. Residents generally keep their own physician and arrange outside home health or hospice services as needed, though the facility must coordinate and document those services under its service plan requirements [1]. Each resident is supposed to have a written service plan developed after an assessment, describing what help they need and how often. IDPH's assisted living rules require this assessment to happen before or at admission and to be updated when a resident's needs change [1]. If your facility markets itself as providing memory care or a higher level of service, Illinois has a separate "supportive living" designation and additional requirements for memory care disclosures, so don't assume a base assisted living license automatically covers dementia-specific programming without checking the specific rule against your program design [1]. A quick, quotable summary: assisted living establishments in Illinois must provide "a range of services, including but not limited to housing, meals, personal care, and health-related services" tailored to resident needs, per the framework laid out in the Assisted Living and Shared Housing Act [1].
How do I start a group home or assisted living business in Illinois?
Starting an assisted living establishment (or a group home under a different license type) in Illinois generally follows this sequence, though you should confirm each step and its current requirements with the relevant state agency before committing money: 1. Decide your population and correct license category. Seniors needing ADL help point toward IDPH's assisted living license. IDD, mental health, or recovery populations usually point toward Illinois Department of Human Services licensing categories instead [1]. 2. Form your business entity and get an EIN. Most operators use an LLC or corporation, both for liability protection and because state licenses are usually issued to a legal entity, not an individual. 3. Secure a location that can pass life safety code review. Zoning matters here too. Group homes serving people with disabilities have federal Fair Housing Act protections around reasonable accommodation in residential zoning, which can affect how local zoning boards must treat your application [5]. 4. Write your policy and procedures manual. IDPH and other licensing agencies expect written policies covering admission and discharge criteria, medication management, staffing plans, emergency and disaster procedures, resident rights, grievance procedures, and infection control [1] [2]. 5. Submit your license application with required fees, floor plans, staffing plan, and background check documentation. Confirm exact fee amounts and forms with IDPH, since these change periodically and vary by facility size. 6. Pass your pre-licensure inspection. IDPH surveys the physical plant and reviews your policies before issuing the license [1]. 7. Hire and train staff, including required background checks under the Health Care Worker Background Check Act, which applies to workers with resident access in licensed facilities [6]. 8. Open, then maintain compliance through ongoing unannounced inspections and any required continuing education for administrators. Building this paperwork from scratch, especially the policy manual and staffing plan, is where most first-time operators lose weeks. A licensing kit builder that gives you state-specific templates for the policy manual, staffing plan, and application checklist can shortcut a lot of that drafting work; GroupHomePath's $299 State Group Home Licensing Kit is built around exactly this gap, though you'll still need to submit everything through your state's own portal and pass its inspection.
How do I start a group home step by step?
If your project is specifically a group home (IDD, mental health, or recovery population) rather than senior assisted living, the process runs through a different Illinois agency but the shape is similar. You'll typically need to identify the correct program type (CILA, ICF/DD, or a behavioral health licensed setting), work with the Illinois Department of Human Services or Illinois Department of Human Services' Division of Developmental Disabilities on provider enrollment, meet physical plant and staffing ratio requirements specific to that program, and complete required staff training, including mandated reporter and behavior intervention training where applicable. Funding sources differ too. Many IDD group homes are funded through Illinois Medicaid Home and Community-Based Services waivers rather than private pay, which means you'll also need a Medicaid provider agreement and to meet CMS home and community-based settings rules if you want to bill Medicaid for services . Don't skip the zoning research. Local municipalities sometimes try to restrict group homes through occupancy limits or special use permits, but the federal Fair Housing Act limits how far a city can go in restricting housing for people with disabilities, and courts have applied this to group home siting disputes [5]. Get a local land use attorney's read on your specific parcel before signing a lease.
What's the difference between assisted living and nursing home care, in plain terms?
Assisted living is for people who can manage most of their own care with support; nursing home care is for people who need hands-on medical care most of the day. Think of it as a spectrum: independent living, then assisted living, then skilled nursing, with increasing medical intensity and increasing regulatory oversight at each step. In Illinois, that spectrum maps to different statutes. Assisted living falls under 210 ILCS 9 [1]. Nursing homes fall under 210 ILCS 45 [3]. Supportive living, a Medicaid-eligible variant that sits between the two, has its own program rules administered jointly by the Illinois Department of Healthcare and Family Services and IDPH . Cost also differs sharply, though Illinois doesn't publish a single statewide rate. National surveys give a rough sense of scale: Genworth's 2023 Cost of Care Survey found the median monthly cost of assisted living nationally was $5,350, compared to $9,733 for a private nursing home room . Illinois-specific costs vary by region and facility type, so treat national medians as a starting reference point, not a quote for your local market.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board or personal care costs of assisted living. Medicare's own guidance is direct about this: assisted living is considered non-medical, custodial care rather than skilled nursing or rehabilitative care, and Medicare does not pay for long-term custodial stays [4]. Medicare will pay for specific medical services a resident receives while living in assisted living, such as doctor visits, physical therapy ordered by a physician, or a short skilled nursing facility stay after a qualifying hospital admission, but it won't pay the facility's monthly rent-like fee for housing and personal care [4]. Medicaid is a different story, though coverage rules vary a lot by state. Illinois offers a Supportive Living Program that uses Medicaid HCBS funding to help cover services (not room and board) for lower-income seniors and adults with disabilities in qualifying supportive living facilities . Separately, Illinois Medicaid HCBS waivers can help fund services for people with IDD living in licensed community settings . If your business model depends on Medicaid revenue, work through Illinois' Department of Healthcare and Family Services provider enrollment process early, since it can take longer than the facility license itself.
What are Illinois' staffing requirements for assisted living?
Illinois assisted living establishments must have staff available 24 hours a day to meet resident needs, plus a licensed health care professional involved in resident assessments and medication oversight, under the Assisted Living and Shared Housing Act framework [1]. The exact staff-to-resident ratio isn't fixed as a single statewide number in the statute; instead IDPH rules tie staffing levels to the acuity and number of residents, assessed through each facility's staffing plan submitted at licensure [1]. That means your staffing plan needs to show, in writing, how you'll cover direct care hours across all shifts, who supervises medication administration, and how you handle call-offs and emergencies without dropping below safe coverage. IDPH reviewers look at this plan during licensure and can cite you during inspection if actual staffing doesn't match what you documented. Background checks are non-negotiable. Illinois requires criminal history checks for employees with access to residents under the Health Care Worker Background Check Act, and facilities need a documented process for running and tracking these checks before an employee has unsupervised resident contact [6].
What happens during an Illinois assisted living inspection?
IDPH conducts an initial licensure survey before you can open, then periodic unannounced inspections afterward, typically checking life safety code compliance, resident records, medication management practices, staffing documentation, and resident rights compliance [1] [2]. Surveyors also investigate complaints, which can trigger an inspection outside the normal cycle. Common citation areas nationally, and reasonably assumed relevant in Illinois too, include incomplete resident service plans, medication administration records that don't match physician orders, staff files missing background check documentation, and fire drill or life safety code gaps. Keep your policy manual, staff training records, and resident files organized and current, because that's what a surveyor asks for first. If you get cited, IDPH will issue a statement of deficiencies and require a plan of correction with a timeline. Repeated or serious violations can lead to fines, admission holds, or license revocation under the enforcement provisions of 210 ILCS 9 [1]. Confirm current inspection frequency and fee schedules directly with IDPH, since these details are set by administrative rule and get updated periodically.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care option for adults who need help with daily activities like bathing, dressing, or medication management but don't need full-time skilled nursing care. Residents typically live in private or semi-private apartment-style units and get support layered in based on an individual assessment and service plan.
What is a group home?
A group home is a residential setting, usually smaller than an institutional facility, that houses people with intellectual or developmental disabilities, mental illness, or substance use recovery needs. In Illinois these are licensed separately from senior assisted living, typically through the Illinois Department of Human Services rather than IDPH [2].
What is an assisted living facility?
An assisted living facility, called an assisted living establishment under Illinois law, is a licensed building providing housing plus personal care services, medication assistance, and 24-hour staff availability for at least three unrelated adult residents [1]. It requires an IDPH license before opening and follows the Assisted Living and Shared Housing Act.
What is the difference between assisted living and a nursing home?
Assisted living serves residents who need help with daily activities but not continuous medical care, while nursing homes serve residents needing skilled nursing, rehabilitation, or complex medical management. In Illinois they're licensed under different statutes, 210 ILCS 9 for assisted living and 210 ILCS 45 for nursing homes [1][4], with different staffing and inspection standards.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for assisted living room and board or personal care because it's classified as custodial, non-medical care [5]. Medicare may still cover specific medical services a resident receives, like doctor visits or physician-ordered therapy, but not the facility's monthly housing and care fee.
How do I start a group home?
Start by confirming which population you'll serve and which state agency licenses that category, since Illinois splits senior assisted living (IDPH) from IDD or behavioral health group homes (Illinois Department of Human Services) [1][2]. Then secure a compliant location, write your policy manual and staffing plan, and submit a license application with required documentation and fees.
How much does it cost to get an assisted living license in Illinois?
Illinois sets license fees by administrative rule under IDPH, and the amount depends on facility size and category, so there's no single statewide number to quote reliably. Confirm current fee schedules directly with the Illinois Department of Public Health before budgeting for your application [1].
What's the difference between assisted living and independent living?
Independent living is unlicensed senior housing with minimal or no personal care services, essentially an apartment community for older adults who don't need daily assistance. Assisted living is a licensed care model that adds help with bathing, dressing, medication, and 24-hour staff availability, governed in Illinois by 210 ILCS 9 [1].
Can Medicaid pay for assisted living in Illinois?
Illinois' Supportive Living Program uses Medicaid HCBS funding to cover services, not room and board, for qualifying lower-income residents in approved supportive living facilities [9]. Separate Medicaid HCBS waivers help fund services for people with IDD in licensed community settings [8]. Coverage details and eligibility should be confirmed with Illinois Department of Healthcare and Family Services.
What staff-to-resident ratio does Illinois require for assisted living?
Illinois doesn't set one fixed statewide ratio in statute; instead IDPH requires facilities to submit a staffing plan tied to resident acuity and census, then reviews that plan at licensure and during inspections [1]. Confirm current staffing rule details with IDPH since acuity-based standards can be interpreted differently across facility sizes.
Do I need a background check to work in an Illinois assisted living facility?
Yes. The Health Care Worker Background Check Act requires criminal history checks for employees with resident access in licensed facilities, including assisted living establishments [7]. Facilities must document this process and complete checks before staff have unsupervised contact with residents.
What's the difference between a shared housing establishment and an assisted living establishment in Illinois?
Both are licensed under the same Assisted Living and Shared Housing Act (210 ILCS 9), but shared housing is typically a smaller, more home-like setting with shared common spaces, while assisted living establishments usually offer private or semi-private apartment-style units [1]. Licensing requirements overlap but application details differ by category.
Sources
- Illinois General Assembly, Assisted Living and Shared Housing Act (210 ILCS 9): Illinois assisted living establishments are licensed under 210 ILCS 9, including definitions, resident rights, and service requirements
- Illinois General Assembly, Nursing Home Care Act (210 ILCS 45): Nursing homes in Illinois are licensed under 210 ILCS 45, a separate statute from assisted living
- Medicare.gov, Long-term care coverage: Medicare does not cover custodial long-term care such as assisted living room and board
- Illinois General Assembly, Health Care Worker Background Check Act (225 ILCS 46): Illinois requires criminal background checks for health care workers with resident access in licensed facilities
- Medicaid.gov, Home and Community-Based Services 1915(c) waivers: Medicaid HCBS waivers can fund services for people with IDD living in licensed community settings
- Genworth, Cost of Care Survey 2023: National median monthly cost of assisted living was $5,350 versus $9,733 for a private nursing home room in 2023