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. Operators need a facility license, background-checked staff, a written policy manual, fire safety approval, and a passed pre-licensure inspection before admitting a single resident.
What is assisted living?
Assisted living is a licensed residential setting where older adults or adults with disabilities get help with daily tasks like bathing, dressing, medication reminders, and meals, while keeping as much independence as possible. It sits between fully independent senior housing and a nursing home. Residents usually live in private or semi-private apartments or rooms and pay for a bundle of housing plus personal care services. In Illinois, the legal term is "assisted living establishment," defined and regulated under the Assisted Living and Shared Housing Act, 210 ILCS 9 [1]. The Illinois Department of Public Health (IDPH) is the licensing authority, and it also licenses a related but distinct category called "shared housing establishments," which are smaller, more home-like settings [1]. The federal government does not license assisted living. There is no national assisted living license or federal inspection program. Every state writes its own rules, which is why a facility that's fine in Missouri might be out of compliance the day it opens in Illinois. If you're comparing structures across states, our assisted living overview walks through how licensing categories differ state to state.
What is a group home?
A group home is a residential setting, usually a house in a regular neighborhood, where a small number of unrelated people with a shared support need (intellectual/developmental disability, mental illness, substance use recovery, or aging) live together with staff support. The term is used loosely across the country and covers a lot of different license types. In Illinois specifically, "group home" most often refers to Community Integrated Living Arrangements (CILAs) for adults with intellectual or developmental disabilities, licensed through the Illinois Department of Human Services (IDHS) Division of Developmental Disabilities [2]. Group homes for people with mental illness may fall under a different IDHS or IDPH category, and youth group homes are licensed separately by the Illinois Department of Children and Family Services (DCFS) under the Child Care Act, 225 ILCS 10 [3]. None of these are the same license as an assisted living establishment, so confirm which population you intend to serve before you pick a license type; that choice drives your building code, staffing ratio, and application packet.
What is an assisted living facility (and what does the paperwork call it in Illinois)?
An assisted living facility is the common, everyday name for what Illinois law calls an "assisted living establishment." The statute defines it as a facility that provides, at minimum, housing, meals, and personal care to at least three unrelated adults, along with 24-hour staff availability to respond to needs [1]. Illinois separates this from a "shared housing establishment," which is smaller (generally fewer beds, more home-like, with a service package that can be lighter) [1]. Both license types fall under 210 ILCS 9 and both are administered by IDPH, but the physical plant requirements, staffing math, and application fees differ. When you fill out your license application, IDPH will ask you to specify which establishment type you're applying as, so get that decision locked in early with your architect and your IDPH regional office. For a broader look at what these facilities cover nationally, see assisted living facility and assisted living facilities.
What does assisted living provide?
At minimum, Illinois-licensed assisted living establishments provide housing, three meals a day, housekeeping, laundry, social and recreational programming, and personal care assistance (bathing, dressing, grooming, mobility help) [1]. Medication management or reminders are typically included, though the exact scope depends on whether the resident's assessed needs call for it and whether the facility staffs a licensed nurse. Staff must be available 24 hours a day to respond to residents' scheduled and unscheduled needs, per the Act [1]. What assisted living is explicitly not required to provide is skilled nursing care, ventilator support, or continuous medical monitoring; residents who need that level of care typically transition to a nursing facility. Every resident admitted must have a written service plan, developed after an assessment, that documents which of these services they actually need and how often. IDPH surveyors check this file during inspections, so a service plan that doesn't match what staff are actually doing on the floor is one of the more common citations operators get.
How to start a group home or assisted living establishment in Illinois
Starting in Illinois takes roughly seven concrete steps, and skipping any of them tends to cost you months later. 1. Pick your population and license type. Seniors and adults needing personal care but not skilled nursing generally point you to an assisted living or shared housing establishment license under IDPH (210 ILCS 9) [1]. Adults with intellectual or developmental disabilities point you toward a CILA license through IDHS [2]. These are different agencies with different applications; don't mix them up. 2. Confirm zoning and building code fit before you sign a lease. Group and assisted living homes often need a specific occupancy classification under local building and fire code, and some municipalities require a special use permit or conditional use approval even in residential zones. This step alone can take 60 to 120 days in some jurisdictions, so start it in parallel with everything else. Related reading: zoning and property considerations apply on top of, not instead of, state licensing. 3. Write your policy and procedure manual. IDPH expects written policies covering admission and discharge criteria, medication handling, emergency and disaster planning, staff training, resident rights, and abuse/neglect reporting, generally before it will schedule your pre-licensure inspection. 4. Hire and background-check staff. Illinois requires criminal background checks for employees of licensed establishments, run through the Illinois State Police and, depending on population served, the DHS/DCFS background check systems. 5. Get your fire safety and life safety inspection. The State Fire Marshal or local fire authority, coordinating with IDPH, has to sign off on your building before a license issues. 6. Submit your license application and fee to IDPH, including your floor plan, staffing plan, policy manual, and proof of financial capacity to operate. 7. Pass the pre-licensure survey. An IDPH surveyor visits and checks the physical plant, records, and staff qualifications against the Act and its administrative rules before issuing your initial license. Exact fee amounts, minimum square footage per resident, and staffing ratios are set in IDPH's administrative rules and are updated periodically, so confirm current figures directly with your IDPH regional office rather than relying on any number you find secondhand.
What is the difference between assisted living and a nursing home?
| Illinois statute | 210 ILCS 9 [1] | 210 ILCS 45 [4] | |
|---|---|---|---|
| Licensing agency | IDPH | IDPH | |
| Staffing | 24-hr staff availability, personal care aides | 24-hr licensed nursing staff | |
| Medical care level | Non-skilled personal care | Skilled nursing, rehab, medical oversight | |
| Typical setting | Apartment-style or shared housing | Hospital-like rooms, nursing stations | |
| Medicare coverage | Not covered as a residence | Covers short-term skilled stays only | Some residents move from assisted living to a nursing home when their care needs exceed what personal care staff can safely provide; Illinois's assisted living rules include specific criteria for when a facility must initiate a transfer or discharge for that reason [1]. |
Assisted living and nursing homes differ mainly in the level of medical care provided and the license/regulatory framework each falls under. Nursing homes (called "skilled nursing facilities" or "long-term care facilities") provide 24-hour skilled nursing care, are usually staffed with licensed nurses around the clock, and are licensed in Illinois under the Nursing Home Care Act, 210 ILCS 45 [4], a completely different statute from the Assisted Living and Shared Housing Act. Assisted living is built for people who need help with daily activities but not ongoing medical or skilled nursing care. Nursing homes serve people with more significant medical needs, including post-surgical recovery, complex wound care, or conditions requiring a physician's ongoing order. | Feature | Assisted living establishment | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for assisted living room and board or personal care services. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need" [5], and assisted living is generally categorized as custodial, not medical, care. Medicare Part A and Part B may still cover specific medical services a resident receives while living in assisted living, things like doctor visits, physical therapy, or a short skilled nursing stay after a qualifying hospitalization, but Medicare does not pay the facility's monthly rent or personal care fee. Medicaid is a different story. Illinois offers Medicaid Home and Community-Based Services (HCBS) waivers that can help cover certain services for eligible low-income seniors and people with disabilities in supportive living or assisted-living-type settings, administered through the Illinois Department of Healthcare and Family Services in coordination with IDPH and IDHS [6]. Illinois's Supportive Living Program specifically is a Medicaid-funded assisted-living alternative for eligible low-income seniors and people with physical disabilities, authorized under the Illinois Public Aid Code and 89 Ill. Admin. Code Part 146 . Coverage rules, income limits, and available slots change, so confirm current eligibility and waiver capacity directly with Illinois Healthcare and Family Services before you count on Medicaid revenue in your business plan.
Which Illinois agency actually licenses your facility, and where do you start?
For assisted living and shared housing establishments, the licensing agency is the Illinois Department of Public Health, Division of Health Care Facilities and Programs [1]. For CILAs serving adults with intellectual or developmental disabilities, it's the Illinois Department of Human Services, Division of Developmental Disabilities [2]. For youth group homes and childcare institutions, it's the Illinois Department of Children and Family Services, under its Child Care Act licensing authority [3]. Call the correct agency before you draft any policy manual or sign a lease. Each agency has its own application forms, its own inspection checklist, and its own timeline, and describing your project to the wrong office wastes weeks. If you're unsure which category fits, ask directly: "which license type covers adults who need help with daily living but not skilled nursing care," and let the agency point you to the right statute.
What does the Illinois inspection and survey process actually check?
IDPH surveyors conducting a pre-licensure or renewal inspection generally check three broad areas: the physical plant (fire safety, resident room size and privacy, common areas, kitchen and food storage sanitation), the resident records (assessments, service plans, medication administration records, incident reports), and staff files (background checks, training documentation, required certifications). Expect the surveyor to interview a sample of residents and staff, walk every resident-accessible area of the building, and review your emergency preparedness and evacuation plan. Facilities found out of compliance receive a statement of deficiencies and a required plan of correction with a deadline; repeated or serious deficiencies can lead to conditional licensure, fines, or license revocation depending on severity. Our inspections hub covers how to prepare for these visits across states, including what surveyors flag most often and how to build a mock-inspection routine into your monthly operations.
How much staffing does Illinois require, and who can work there?
Illinois's Assisted Living and Shared Housing Act requires staff availability 24 hours a day to respond to residents' scheduled and unscheduled needs [1], but the exact staff-to-resident ratio and minimum training hours are set out in IDPH's administrative rules (77 Ill. Admin. Code Part 295), which are updated periodically. Don't build your staffing budget off a number you saw on a forum; pull the current rule text or call IDPH directly. All direct care staff generally need a criminal background check cleared through the Illinois State Police before starting work, and additional checks (such as the Health Care Worker Registry or DCFS Child Abuse and Neglect Tracking System, depending on population) may apply depending on the resident population you serve. Most operators budget for ongoing training beyond the initial hire: dementia care training, medication administration certification if your facility handles medication passes, and annual fire/life-safety drills. Build this into your first-year operating budget, not as an afterthought once you're already licensed.
What should your written policy manual actually cover?
IDPH expects a written policy and procedure manual before it will schedule your pre-licensure survey, and a thin manual is one of the most common reasons an inspection gets delayed. At minimum, plan on dedicated sections for: admission and discharge criteria (including transfer criteria to a higher level of care), resident rights and grievance procedures, medication management, emergency and disaster preparedness, infection control, staff training and supervision, abuse/neglect reporting, and incident/accident reporting. This is also where a purpose-built template saves real time. Building every policy from scratch, cross-referenced against 210 ILCS 9 and the corresponding administrative rules, easily takes 40 to 80 hours for a first-time operator working alone. GroupHomePath's $299 State Group Home Licensing Kit gives you an Illinois-specific starting framework, so you're editing an existing manual against your building and staffing plan instead of drafting one from a blank page. You can start building yours at /licensing-kit-builder.
What does it cost, and how long does licensing take, roughly?
Illinois doesn't publish a single flat licensing fee that applies to every applicant; the fee depends on your establishment type and bed count, and it's set in IDPH's administrative rules, which change periodically. Confirm the current fee schedule directly with IDPH before you budget. Timeline-wise, expect the overall path from lease signing to open doors to run somewhere in the range of 6 to 12 months for a first-time operator, driven mostly by zoning/building code approval, fire marshal sign-off, and construction or renovation timelines, not by IDPH's paperwork review alone. Operators who've already run a licensed facility in another state, or who are opening a second Illinois location, generally move faster because the policy manual and staffing plan don't need to be built from zero. Budget separately for build-out or renovation costs (sprinkler systems, accessible bathrooms, egress requirements), which typically dwarf the license application fee itself for any facility not already built to code.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential setting that combines housing, meals, and personal care help (bathing, dressing, medication reminders) for adults who need daily support but not skilled nursing care. In Illinois, it's legally called an "assisted living establishment" and is licensed under 210 ILCS 9 by the Illinois Department of Public Health.
What is a group home?
A group home is a residential setting where a small number of unrelated people with a shared support need live together with staff help. In Illinois, group homes for adults with intellectual or developmental disabilities are usually licensed as Community Integrated Living Arrangements (CILAs) through the Illinois Department of Human Services, not IDPH.
What is an assisted living facility?
An assisted living facility is the common name for what Illinois law calls an assisted living establishment, defined under 210 ILCS 9 as a facility providing housing, meals, and personal care to at least three unrelated adults with 24-hour staff availability. It's licensed and inspected by the Illinois Department of Public Health.
What is the difference between assisted living and a nursing home?
Assisted living provides housing and personal care help for people who don't need ongoing medical care; nursing homes provide 24-hour skilled nursing under the Nursing Home Care Act (210 ILCS 45). Illinois licenses both through IDPH but under separate statutes with different staffing, medical oversight, and physical plant requirements.
What does assisted living provide?
At minimum, Illinois-licensed assisted living establishments provide housing, three daily meals, housekeeping, laundry, social programming, and personal care assistance, with staff available 24 hours a day, per 210 ILCS 9. Skilled nursing and continuous medical monitoring are not required and typically call for a nursing home instead.
Does Medicare cover assisted living facilities?
No. Medicare does not cover assisted living room, board, or personal care costs because it's considered custodial care, not medical care. Medicare may still cover specific medical services (doctor visits, therapy, a qualifying short-term skilled nursing stay) received while a person lives in assisted living, per Medicare.gov.
How do I start a group home in Illinois?
Pick your population and correct license type (IDPH for assisted living/shared housing, IDHS for CILAs, DCFS for youth), confirm zoning and building code fit, write your policy manual, background-check staff, pass fire safety inspection, submit your license application, then pass IDPH's pre-licensure survey before admitting residents.
Does Illinois Medicaid pay for assisted living?
Traditional Medicaid doesn't pay assisted living room and board directly, but Illinois's Supportive Living Program is a Medicaid-funded assisted-living alternative for eligible low-income seniors and adults with physical disabilities, administered by the Department of Healthcare and Family Services. Eligibility and available slots vary, so confirm current details with HFS.
How long does it take to get an assisted living license in Illinois?
Realistically 6 to 12 months from lease signing to opening for a first-time operator, mostly driven by zoning approval, fire marshal sign-off, and construction timelines rather than IDPH's paperwork review itself. Operators with an existing licensed facility or team generally move faster since their policy manual and staffing plan are already built.
What agency licenses assisted living in Illinois?
The Illinois Department of Public Health (IDPH), Division of Health Care Facilities and Programs, licenses assisted living and shared housing establishments under the Assisted Living and Shared Housing Act (210 ILCS 9). Group homes for adults with developmental disabilities go through a different agency, the Illinois Department of Human Services.
What's the difference between an assisted living establishment and a shared housing establishment in Illinois?
Both are licensed under 210 ILCS 9 by IDPH, but shared housing establishments are generally smaller and more home-like with a lighter service package, while assisted living establishments serve at least three unrelated adults with a fuller bundle of housing, meals, and personal care. Physical plant and staffing requirements differ between the two.
Can a nursing home resident move to assisted living, or vice versa?
Yes, in both directions. Residents whose care needs exceed what assisted living staff can safely provide typically transfer to a nursing home under criteria specified in Illinois's assisted living regulations, and residents recovering enough independence can sometimes move from a nursing home back into assisted living.
What background checks does Illinois require for group home or assisted living staff?
Direct care staff generally need a criminal background check cleared through the Illinois State Police before starting work. Depending on the population served, additional checks through the Health Care Worker Registry or the DCFS Child Abuse and Neglect Tracking System may also be required.
Sources
- Illinois Compiled Statutes, Assisted Living and Shared Housing Act, 210 ILCS 9: Definition, licensing framework, and service requirements for assisted living and shared housing establishments in Illinois
- Illinois Department of Human Services, Division of Developmental Disabilities: CILA group homes for adults with intellectual/developmental disabilities are licensed through IDHS Division of Developmental Disabilities
- Illinois Compiled Statutes, Child Care Act of 1969, 225 ILCS 10: Youth group homes and childcare institutions are licensed by DCFS under the Child Care Act, separate from IDPH assisted living licensure
- Illinois Compiled Statutes, Nursing Home Care Act, 210 ILCS 45: Nursing homes in Illinois are licensed under a separate statute, 210 ILCS 45, distinct from the Assisted Living and Shared Housing Act
- Medicare.gov, Nursing Home Care coverage: Medicare doesn't cover long-term custodial care if that's the only care needed, which includes typical assisted living services
- Illinois Department of Healthcare and Family Services, Home and Community Based Services: Illinois Medicaid HCBS waivers can help cover certain community-based services for eligible seniors and people with disabilities