Last updated 2026-07-26
TL;DR
A licensed assisted living facility in Derry, NH operates under New Hampshire's Residential Care and Health Facility Licensing rules (He-P 804), overseen by the NH Department of Health and Human Services. Facilities provide housing, meals, personal care, and medication assistance, but not the skilled nursing care a nursing home offers. Medicare generally does not cover the room and board portion.
What is assisted living?
Assisted living is a residential setting where people who need help with daily tasks, bathing, dressing, medication reminders, meals, get that support while living in something closer to an apartment or private room than a hospital ward. It's not medical care in the nursing-home sense. It's supportive housing with services layered on top. In New Hampshire, this level of care sits under a specific license category. The state's Residential Care and Health Facility Licensing rules, found in the New Hampshire Administrative Code chapter He-P 804, define "assisted living residence" as a facility licensed to provide personal care services, medication management, and supervision to residents who need help with activities of daily living but don't require the round-the-clock skilled nursing a nursing home provides [1]. A facility in Derry operating under this license has to meet the same statewide rules as one in Manchester or Concord. There's no separate "Derry version" of the license. What varies locally is zoning, fire code interpretation by the local fire marshal, and sometimes the town's own health inspections, which layer on top of the state license, not instead of it.
What is a group home?
A group home is a smaller residential setting, usually a single-family style house, where a small number of residents (often four to eight, though the exact number depends on the state and license type) live together and receive support staff who work shifts. Group homes serve a range of populations: adults with intellectual or developmental disabilities, people in mental health recovery, older adults who need less support than a full assisted living residence but more than living alone. The term gets used loosely. Some people mean any small residential care setting, others mean specifically a licensed adult foster care or intermediate care facility for people with developmental disabilities. In New Hampshire, the closest formal category to what most people picture as a "group home" for adults with disabilities falls under the Department of Health and Human Services' Bureau of Developmental Services licensing, separate from the He-P 804 assisted living rules [1]. If you're planning a home in Derry that serves seniors needing personal care, you'll likely be looking at the assisted living residence license. If you're planning a home for adults with IDD, you're in a different regulatory lane entirely, and you should confirm which one applies with assisted living facility licensing guidance and directly with the state agency before you sign a lease.
What is an assisted living facility (and what is assisted living facility, exactly)?
An assisted living facility is the licensed building and program together: the physical property that meets fire, life-safety, and building code requirements for this use, plus the staffing, service plans, and policies that let it legally provide personal care to residents. You can't just buy a big house and call it an assisted living facility. The license attaches to both the physical space (room size, exits, sprinkler systems) and the operational plan (staffing ratios, medication management policy, resident agreements). New Hampshire's licensing rule spells out categories within this umbrella, including "Residential Care Facilities" and "Supported Residential Health Care Facilities," each with different resident acuity levels and staffing expectations under He-P 804 [1]. A facility that wants to serve residents who need more hands-on help with mobility or have moderate cognitive decline will need to meet a higher standard than one that only offers meals and light supervision. This matters for anyone comparing a specific Derry property. Ask the operator, or ask yourself if you're the one applying, which sub-category of license the facility holds or is applying for. That determines what kind of resident the facility can legally accept.
What is assisted living vs nursing home?
The core difference is medical acuity and staffing. Assisted living is for people who need help with daily activities but don't require ongoing skilled nursing care. A nursing home (also called a skilled nursing facility) is for people who need 24-hour licensed nursing care, often after a hospital stay or with a chronic condition that needs regular clinical management. Nursing homes are licensed under an entirely different federal and state framework tied to Medicare and Medicaid certification requirements (42 CFR Part 483) [2]. They must have registered nurses on site and meet federal minimum staffing standards that CMS finalized in 2024, requiring at least 3.48 hours of nursing care per resident per day in most facilities, including a registered nurse on site 24/7 [3]. Assisted living facilities have no equivalent federal staffing mandate. Staffing there is set by state rule and by the facility's own service plan. Cost also differs sharply. The median annual cost of a semi-private nursing home room nationally was $104,025 in 2023 per Genworth's Cost of Care Survey, compared to $64,200 for assisted living [4]. If a resident's needs escalate past what an assisted living residence is licensed to handle (needing a ventilator, complex wound care, or continuous skilled nursing), the facility is generally required to help transition that resident to a higher level of care, which is one reason admission agreements always include a discharge or transfer policy.
What does assisted living provide?
At minimum, a licensed assisted living residence provides a private or shared room, meals, housekeeping, laundry, help with activities of daily living (bathing, dressing, toileting, mobility), medication management or reminders, and 24-hour staff availability for emergencies. Beyond that baseline, services vary a lot by facility and by license sub-type. Under New Hampshire's He-P 804 rules, licensed facilities must maintain a written service plan for each resident, updated periodically, that documents the specific personal care and health-related services that resident needs [1]. Facilities are also required to have emergency procedures, staff training standards, and a system for managing resident medications, whether that's self-administration with reminders or staff-administered medication depending on the resident's assessed needs and the facility's license category. What assisted living does not typically provide: ongoing IV therapy, ventilator care, or the kind of intensive rehabilitation therapy you'd get in a skilled nursing facility after surgery. Some facilities contract with outside home health or hospice agencies to bring in additional medical services, but that's an add-on, not baseline. If you're touring a facility in Derry, ask specifically what's included in the base rate and what triggers an additional charge; assisted living billing is notoriously tiered, with add-on fees for higher levels of care that aren't always obvious from the published rate sheet.
Does Medicare cover assisted living facilities?
No, not for room and board. Medicare does not pay for the custodial, non-medical care that makes up the bulk of assisted living cost: help with bathing, dressing, meals, and supervision. CMS is explicit about this: Medicare.gov states that Medicare does not cover long-term care (also called custodial care) if that's the only care a person needs [5]. Medicare Part A or Part B may still cover specific medical services a resident receives while living in an assisted living facility, such as doctor visits, physical therapy, or durable medical equipment, the same as it would if that person lived at home. But the facility's monthly charge itself is not a Medicare-covered expense. Medicaid is a different story, sort of. Some states, through Medicaid Home and Community-Based Services waivers, will pay for personal care services delivered in an assisted living setting, though typically not for room and board. New Hampshire operates HCBS waiver programs through its Medicaid program that can help cover services for eligible seniors and adults with disabilities in community settings, subject to financial and functional eligibility rules set by the state [6]. If you're helping a family evaluate whether a Derry facility is financially workable, get the facility's private-pay rate in writing and separately confirm, with the facility and with the state Medicaid office, exactly which services (if any) a waiver would cover versus what stays out-of-pocket.
How to start a group home (the licensing sequence)
Starting a licensed residential care home, whether it's an assisted living residence or a group home for another population, follows a similar sequence in most states, New Hampshire included. The order matters because skipping ahead (signing a lease before confirming zoning, for instance) is how projects lose money before they open. 1. Decide your population and license category. Seniors needing personal care point you toward an assisted living residence license under He-P 804. Adults with IDD or mental health needs point toward different DHHS program licenses. This decision drives everything downstream, so confirm the correct category with the New Hampshire Department of Health and Human Services before you do anything else [1]. 2. Check local zoning in Derry specifically. Residential care uses are often allowed in residential zones as a matter of state or federal fair housing law for smaller group homes, but larger assisted living residences may fall under a different zoning classification that requires a conditional use permit or site plan review from the town. Confirm with Derry's planning and zoning office directly; don't assume based on what another town allows. 3. Secure a property that can meet fire and life-safety code for the resident count and mobility level you plan to serve. This usually means a fire marshal inspection, sprinkler requirements above a certain occupancy, and accessible egress. Retrofit costs here are a common budget-buster, so get a fire marshal's opinion on a specific property before you buy or lease it. 4. Write your policy and procedure manual: admissions, resident rights, medication management, staffing plan, emergency and disaster procedures, grievance process, discharge policy. This is the document set the state licensing surveyor reviews, and it's also the operational backbone you'll use every day once residents move in. A lot of first-time operators underestimate how much of the licensing process is really about paperwork quality, more than the building. 5. Hire and train staff to the ratios and qualifications your license category requires, then submit your license application with all required attachments (floor plans, staffing plan, policy manual, background check documentation, fire inspection approval) to the state licensing agency. 6. Pass your pre-licensure inspection. The state agency will schedule an on-site survey before issuing the initial license, and (separately) periodic surveys after you're operating. Confirm current fee amounts, application forms, and survey scheduling directly with the New Hampshire Department of Health and Human Services licensing unit [1], since these details change and a stale number is worse than no number. If you want a structured starting point for the paperwork side of this (policy manual templates, staffing plan worksheets, application checklists organized by state), GroupHomePath's $299 one-time State Group Home Licensing Kit is built around exactly this sequence. It doesn't replace talking to your state agency, nothing does, but it saves you from building every document from a blank page.
How do I start a group home in New Hampshire specifically?
The mechanics are the same as above, but a few New Hampshire-specific touchpoints are worth naming. First, licensing authority for residential care and assisted living facilities sits with the New Hampshire Department of Health and Human Services, under the rules published as He-P 804 in the New Hampshire Administrative Code [1]. That's your primary regulator and the office to call with any question about category, forms, or fees. Second, if your home will serve adults with developmental disabilities rather than seniors, you're likely working with the Bureau of Developmental Services within DHHS instead, which has its own separate licensing and provider agreement process. These are not interchangeable tracks, and choosing wrong early costs real time. Third, Derry itself is in Rockingham County, and while the state license is what legally allows you to operate, the Town of Derry's planning department and fire department will have their own review steps tied to your specific address (zoning district, occupancy classification, local fire code enforcement). Call the town before you call anyone else about a specific property, because a property that fails local zoning kills the project regardless of what the state license would allow elsewhere.
What is the difference between assisted living and nursing home, in day-to-day terms?
| Primary regulator | State licensing agency (in NH, DHHS under He-P 804) [1] | State agency + CMS certification for Medicare/Medicaid [2] | |
|---|---|---|---|
| Staffing requirement | Set by state rule, varies by resident acuity | Federal minimum of 3.48 nursing hours/resident/day, RN 24/7 (2024 CMS rule) [3] | |
| Medicare coverage of room/board | No [5] | Limited, only for skilled care after qualifying hospital stay, time-limited | |
| Median annual cost (2023, national) | $64,200 [4] | $104,025 (semi-private room) [4] | |
| Typical resident needs | Help with ADLs, medication reminders, supervision | 24-hour skilled nursing, rehab, complex medical needs | The line between the two isn't always crisp in practice. Some assisted living residences, especially ones licensed for higher acuity under a state's rules, look a lot like a light version of nursing home care. That's exactly why it matters to ask a specific facility which license category it holds, more than what the marketing brochure calls itself. |
Beyond the regulatory definitions, the practical difference shows up in daily life. In assisted living, residents generally have their own room or apartment, come and go with more independence, and staff support is scheduled around meals, medication times, and care needs rather than continuous bedside presence. In a nursing home, residents are more likely to need help with nearly everything, and licensed nurses are present around the clock as a federal requirement tied to Medicare and Medicaid certification [3]. Here's a side-by-side on the basics: | Feature | Assisted Living | Nursing Home |
What should families ask when touring a facility in Derry?
Ask to see the current license and confirm it's active and in good standing with the New Hampshire Department of Health and Human Services. Facilities are generally required to post or provide their license on request, and the state maintains licensing information you can also verify independently [1]. Ask what happens if a resident's needs increase past what the facility can provide. A good facility will have a clear, written policy on level-of-care reassessment and discharge planning, not a vague answer. Ask for the full fee schedule in writing, including base rate, levels-of-care add-ons, community fees, and what triggers a rate increase. Assisted living pricing structures are often tiered in ways that aren't obvious from a single quoted number, and the gap between the advertised rate and the actual monthly bill six months in can be substantial. Ask about staffing on nights and weekends specifically, more than during business hours when you're touring. Ratios published in a policy manual don't always reflect what's staffed at 2 a.m. on a Sunday.
Where do zoning and inspections fit into a licensed facility in Derry?
Zoning and state licensing are two separate approval tracks that both have to clear before a facility can legally operate. The state license under He-P 804 governs the program of care [1]. Local zoning in Derry governs whether that use is permitted on that specific parcel, and that's a town-level decision that can vary block by block depending on the zoning district. Inspections likewise come from more than one source. Expect a state licensing survey (initial and periodic, tied to your DHHS license), a local fire marshal inspection tied to life-safety code, and potentially a local health inspection depending on what services the facility provides (food service in particular often triggers a separate local health department review). None of these substitute for each other, and an operator who assumes passing one covers the others is setting up a bad surprise. If you're earlier in the process and still evaluating whether a property or business model works, it's worth reading through general licensing frameworks like assisted living and assisted living facilities to understand how other states structure similar rules, since New Hampshire's approach isn't wildly different from the national pattern even though the specific chapter numbers and fee amounts are its own.
Frequently asked questions
What is assisted living?
Assisted living is residential housing with support services for people who need help with daily activities like bathing, dressing, and medication, but don't need the round-the-clock skilled nursing care a nursing home provides. It combines a living space (private or shared room) with staff-provided personal care, meals, and supervision under a state license.
What is a group home?
A group home is a smaller residential setting, often a house, where a limited number of residents live together with support staff. Group homes serve varied populations, including adults with intellectual or developmental disabilities, people in mental health recovery, or seniors, and the specific license and rules depend on which population the home is licensed to serve.
What is an assisted living facility?
An assisted living facility is the licensed building and care program together: a property that meets fire and life-safety codes for this use, operating under state rules that require written service plans, staffing, and medication management policies. In New Hampshire, this falls under He-P 804 of the state administrative code.
What is assisted living vs nursing home?
Assisted living serves people who need help with daily tasks but not continuous medical care; nursing homes serve people who need 24-hour skilled nursing, often required to have a registered nurse on site around the clock under a 2024 CMS federal staffing rule. Nursing homes are also Medicare/Medicaid-certified facilities; most assisted living residences are not.
What does assisted living provide?
At minimum: a room, meals, housekeeping, help with bathing/dressing/mobility, medication management or reminders, and 24-hour staff availability for emergencies. Beyond that baseline, services vary widely by facility and license category, and higher levels of medical or memory care often cost extra beyond the base rate.
What is the difference between assisted living and nursing home costs?
Nationally, the median annual cost of assisted living was $64,200 in 2023, compared to $104,025 for a semi-private nursing home room, according to Genworth's Cost of Care Survey. Actual costs in Derry, NH will vary from these national medians, so get a current local quote rather than relying on national averages.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room-and-board or custodial care costs of assisted living. It may cover specific medical services (doctor visits, therapy, equipment) a resident receives while living there, the same as it would at home, but the facility's monthly charge itself is not a Medicare-covered expense.
Does Medicaid cover assisted living in New Hampshire?
Medicaid generally does not cover room and board in assisted living, but New Hampshire's Medicaid Home and Community-Based Services waiver programs can help cover personal care services for eligible individuals in community settings. Eligibility depends on financial and functional criteria set by the state; confirm current details with New Hampshire's Medicaid office directly.
How to start a group home?
Decide which population and license category applies, confirm local zoning for the specific property, secure a building that meets fire and life-safety code, write your policy and staffing manuals, hire and train staff, then submit your license application to the state agency and pass the pre-licensure inspection before opening.
How do I start a group home in New Hampshire?
Contact the New Hampshire Department of Health and Human Services to confirm which license category fits your planned population (seniors needing personal care versus adults with developmental disabilities use different tracks), then work through zoning with the local town, property fire-code compliance, staffing, and the state application and inspection process.
Is a licensed assisted living facility in Derry, NH regulated the same as facilities elsewhere in the state?
Yes, the state license (He-P 804) applies uniformly statewide. What varies locally in Derry is zoning approval and local fire and health inspections layered on top of the state license, not a different set of state licensing rules.
What is the difference between an assisted living residence and a residential care facility in New Hampshire?
New Hampshire's He-P 804 rules include multiple sub-categories, including Residential Care Facilities and Supported Residential Health Care Facilities, each tied to different resident acuity levels and staffing expectations. The exact category a facility holds determines what level of care it can legally provide; confirm the specific category with DHHS.
Can a licensed assisted living facility discharge a resident whose care needs increase?
Yes, generally. Facilities are typically required to have a written discharge or transfer policy for when a resident's needs exceed what the facility's license and staffing allow, often triggering a transition to a higher level of care like a nursing home. Ask any facility for this policy in writing before admission.
Sources
- New Hampshire Department of Health and Human Services, He-P 804 Residential Care and Health Facility Licensing rules: Definition and licensing framework for assisted living residences and related residential care categories in New Hampshire
- Code of Federal Regulations, 42 CFR Part 483 (Requirements for States and Long Term Care Facilities): Federal certification requirements for nursing homes tied to Medicare and Medicaid
- Federal Register, Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting, 89 FR 40876 (May 10, 2024): Federal minimum of 3.48 nursing hours per resident per day and 24/7 RN requirement for nursing homes
- Genworth, Cost of Care Survey 2023: Median annual cost of assisted living ($64,200) and semi-private nursing home room ($104,025) in 2023
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care such as assisted living room and board
- New Hampshire Department of Health and Human Services, Medicaid Home and Community-Based Care programs: New Hampshire Medicaid HCBS waiver programs may cover personal care services in community settings for eligible individuals