Residential assisted living national convention: what to know

Last updated 2026-07-25

What is the residential assisted living national convention

The residential assisted living national convention is a yearly trade show and training event built around the small-home (residential) model of assisted living, as opposed to big commercial facilities. It grew out of the Residential Assisted Living Association (RALNA), a private membership organization, not a government agency. People go to hear from existing operators, vendors, and consultants about running a home-based assisted living business: how to find a house, what staffing ratios look like in practice, how to market a small home, and how to think about the financial side of running one. It is worth being precise about what this event is and is not. It is not a state licensing board. It does not issue licenses, inspect homes, or set the rules you have to follow. Your state's health department, department of social services, or aging and disability agency does that, and those rules vary a lot by state. If you attend a convention like this, treat it as continuing education and networking, not as a substitute for reading your state's actual licensing statute and administrative code. Most attendees are either current small-facility owners looking to add a second or third home, or people early in the exploration phase trying to decide if this business is a fit for them at all. Sessions typically mix general business content (financing, staffing, marketing) with model-specific content about the residential (home-based) approach to senior care, sometimes contrasted with larger institutional facilities.

What is assisted living

Assisted living is a category of long-term care for people who need help with daily activities like bathing, dressing, medication reminders, and meals, but who do not need the round-the-clock skilled nursing care a nursing home provides. Medicaid.gov describes assisted living as a type of residential setting where states can help cover services, though not room and board, through home and community-based services programs ^[1]. There is no single federal assisted living law. Each state licenses and regulates assisted living under its own name and rules: some call it "assisted living facility," others use "residential care facility," "personal care home," "adult foster home," or "residential assisted living facility." That naming difference matters because it changes which statute and which agency you're dealing with. Before you do anything else, find your state's specific program page and read the actual rule text, not a summary. Our guides on assisted living and assisted living facility rules break down how states differ on staffing, admission criteria, and physical plant requirements. Because states set their own definitions, a home licensed for six residents in one state might need a completely different staffing plan than a 60-bed facility licensed in a neighboring state under a similar-sounding name.

What is a group home

A group home is a licensed residential setting where a small number of people, often somewhere between 2 and 10 depending on the state, live together and receive support services, supervision, or care. The term covers a lot of ground: group homes serve people with intellectual and developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, and seniors needing assisted living-level support. What separates a group home from just "a house with roommates" is licensing. States require anyone operating this kind of residential care setting to hold a license or certification, follow specific staffing ratios, pass life-safety and building inspections, and in many cases enroll as a Medicaid provider if residents' care is paid through Medicaid waiver programs. Medicaid.gov explains that home and community-based services (HCBS) waivers let states pay for services in settings like group homes as an alternative to institutional care ^[1]. The regulatory category you fall under (adult foster care, IDD group home, assisted living residence, residential care facility for the elderly) depends on who you plan to serve and which state program covers that population. This is the single most important decision you make before writing a business plan, because it determines your licensing agency, your staffing rules, and your funding sources.

What is an assisted living facility

An assisted living facility is a licensed residence, ranging from a converted single-family home with a handful of residents to a purpose-built building with over a hundred units, that provides housing plus help with daily living activities, medication management, meals, and often social and recreational programming. It sits between independent living (no hands-on care) and a nursing home (24-hour skilled nursing care). Assisted living facilities are licensed and regulated at the state level, and states set their own rules for services, staffing, and physical plant standards. There is meaningful variation in what counts as "assisted living" from state to state. Some states cap the level of care a facility can provide (for example, barring residents who need two-person transfers or ongoing IV therapy), while others allow a wider range through a tiered licensing system with different levels for different acuity. For the residential (small-home) model specifically, the facility is typically a house in a residential neighborhood, licensed to serve somewhere in the range of 4 to 20 residents depending on the state's definitions and your specific license type. That is the model most residential assisted living convention content focuses on, since it is the fastest-growing niche within the broader assisted living industry.

What is assisted living vs nursing home

Level of care	Help with daily activities, medication reminders	24-hour skilled nursing care
Regulation	State licensing only	State licensing plus federal Medicare/Medicaid certification (42 CFR Part 483)
Typical setting	Home-like, apartment or shared room	Clinical, hospital-adjacent design
Medicare coverage	Generally not covered [2]	Short-term skilled care may be covered after qualifying hospital stay [2]
Staffing	Direct care aides, medication aides, administrator	Registered nurses, LPNs, CNAs required around the clock	Someone whose needs increase past what an assisted living license allows (heavy nursing care, ventilator dependence, uncontrolled behavioral crises in some states) typically has to transition to a nursing home or a higher-acuity licensed setting.

The core difference is the level of medical care and who is legally allowed to provide it. Assisted living provides help with daily activities, in an environment closer to home, without continuous licensed nursing coverage. A nursing home (skilled nursing facility) provides 24-hour care from licensed nurses and is built for people with significant medical needs, post-hospital rehabilitation, or conditions requiring ongoing clinical monitoring. Medicare.gov's Care Compare tool describes nursing homes as facilities that provide skilled nursing and rehabilitation services, distinct from the personal-care focus of assisted living. Nursing homes are also subject to federal oversight tied to Medicare and Medicaid certification under 42 CFR Part 483, in addition to state licensing. Assisted living, by contrast, is regulated almost entirely at the state level with no equivalent federal certification requirement. | Feature | Assisted living | Nursing home |

What does assisted living provide

At minimum, assisted living provides housing, meals, help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication management or reminders, housekeeping, laundry, and some level of social or recreational activity. Beyond that baseline, what's actually offered depends heavily on the state's licensing tier and the individual facility's own program. Many states use a tiered licensing structure, where a basic license covers only custodial care and a higher-tier license (sometimes called "assisted living plus" or a special needs designation) allows things like hospice coordination, diabetic insulin administration, or care for residents with dementia who need secured units. If you're building a staffing plan or a policy manual, you need to check exactly which services your specific license tier permits, because offering a service outside your license scope is one of the more common findings in state inspections. Assisted living generally does not provide ongoing skilled nursing, intravenous therapy, ventilator care, or ongoing physician-level medical treatment. Those fall under skilled nursing or hospital-level care. If a resident's needs cross that line, the facility typically has to either get a waiver, transfer the resident, or bring in outside home health or hospice services depending on what the state allows.

Does Medicare cover assisted living facilities

No. Medicare does not cover the cost of room and board or personal care services in an assisted living facility. Medicare.gov states plainly that "Medicare doesn't cover... long-term care (also called custodial care)" and clarifies that Medicare pays for medically necessary skilled services, not the custodial help most assisted living residents need ^[2]. Medicare will pay for certain medical services delivered to someone living in assisted living, like doctor visits, physical therapy ordered by a doctor, or a short covered stay in a skilled nursing facility after a qualifying hospital stay, but it will not pay the facility's monthly rate for room, board, and personal care. Medicaid is a different story, and this is where the funding conversation actually happens for a lot of operators. Medicaid.gov explains that states can use HCBS waivers to help cover the cost of services (not typically room and board) in assisted living or residential settings for people who qualify financially and functionally ^[1]. Not every state extends its Medicaid waiver to assisted living, and the ones that do set their own payment rates, provider enrollment rules, and bed caps. If your business plan depends on Medicaid waiver residents, confirm with your state Medicaid agency exactly which waiver programs cover assisted living or residential care settings and what the current provider enrollment process looks like before you commit to a location or a lease.

How to start a group home

Starting a group home is a licensing project before it's a real estate project or a hiring project. Skipping ahead to buying a house or hiring staff before you understand your state's licensing category is the most common expensive mistake in this business. Here's the realistic sequence: 1. Pick your population and license category. Decide whether you're serving seniors needing assisted living-level care, adults with intellectual or developmental disabilities, people in mental health recovery, or people in substance use recovery. Each population usually has its own license type, its own agency, and its own rulebook. 2. Find your state's specific licensing agency and program. This is often the department of health, department of social services, or a specific division for aging and disability services, but the exact name changes state to state. Search your state's official.gov site for the specific program name (for example, "residential care facility for the elderly license" or "adult foster care license") rather than relying on a general web search. 3. Read the actual regulation text, not a summary. Look for staffing ratio requirements, physical plant standards (fire sprinklers, room sizes, bathroom counts), background check requirements for staff, and any caps on the number of residents. 4. Check zoning before you sign a lease or make an offer. Many states protect small group homes from discriminatory zoning under the Fair Housing Act, but occupancy limits, spacing requirements between homes, and permit processes still vary by county and city. Confirm with your local planning or zoning office before committing to a property. 5. Build your policy and procedure manual, staffing plan, and emergency/disaster plan. Most states require these as part of the application packet, and inspectors will ask for them again at your first survey. 6. Submit your license application with the required fee (fees vary widely by state and license type; confirm the current fee schedule with your state licensing agency). 7. Pass your pre-licensing inspection, covering life safety, physical plant, and staff files. 8. If you plan to accept Medicaid waiver residents, apply separately for Medicaid provider enrollment through your state Medicaid agency once your license is in hand. A lot of first-time operators underestimate step 3 and step 4. States genuinely differ on things like minimum square footage per resident, required staff-to-resident ratios during waking versus sleeping hours, and whether a house needs a residential sprinkler system retrofit. None of that is standard across states, so a manual written for one state's rules will not pass inspection in another.

How do I start a group home if I've never worked in senior care or disability services before

You don't need a nursing license or a background in disability services to open a group home in most states, but you do usually need to show the state you have, or will hire, qualified staff and an administrator who meets specific training or certification requirements. States commonly require the administrator or a designated "qualified provider" to complete a set number of training hours, pass a background check, and sometimes hold a specific credential depending on the population served. What trips up people without direct-care experience is underestimating staffing complexity: 24-hour coverage, medication administration training requirements, mandatory reporting rules for abuse and neglect, and documentation standards for every shift. This is where a lot of first-time operators spend real money on consultants, or lean on a structured resource. A $299 one-time State Group Home Licensing Kit can shortcut a lot of the paperwork research (state-specific application checklists, policy manual templates, staffing plan templates), but it does not replace reading your state's actual regulations or waiting on your state's own review and inspection timeline. No kit, course, or convention can guarantee approval; that decision sits entirely with your state licensing agency. People coming from outside healthcare often do best by pairing a strong operations background (property management, hospitality, small business ownership) with a hired administrator or director of care who has the required clinical or program credential. Check your state's specific administrator qualification rule early, since some states require the administrator to be named on the application itself.

What happens at a residential assisted living convention, in practical terms

Expect a trade show floor with vendors (medication management systems, insurance brokers, staffing agencies, construction and renovation firms specializing in group home conversions) and a schedule of breakout sessions on topics like financing a home purchase, marketing to families and placement agencies, staffing and retention, and operations for a residential-model assisted living business. Speakers are typically current operators, consultants, and vendors, not state regulators. That matters because session content reflects business practice and operator experience, which is genuinely useful, but it is not a legal interpretation of your state's rules. If a speaker tells you "most states require X," verify that against your specific state's regulation text before you rely on it in an application or a policy manual. The practical value of attending is networking (talking to people who've been through licensing and inspection in your state or a similar one) and getting a realistic feel for the day-to-day workload of running a home, which is easy to underestimate from the outside. It is not a substitute for working directly with your state licensing agency, and it is not a licensing or accreditation body itself.

How does zoning affect where I can open a group home

Zoning determines whether a specific property, in a specific city or county, is legally allowed to operate as a licensed group home, separate from whether the state approves your operator license. This is one of the most common places projects stall, because a property can be perfectly fine for state licensing purposes and still be blocked or delayed by local zoning or permitting requirements. The federal Fair Housing Act, at 42 U.S.C. § 3604, prohibits some forms of zoning discrimination against group homes for people with disabilities. The statute makes it unlawful to discriminate in the sale or rental of a dwelling on the basis of disability, a protection courts have applied to zoning ordinances that single out group homes ^[3]. That said, general zoning tools like occupancy limits, parking requirements, and spacing rules between similar facilities still apply in many jurisdictions and vary block to block, city to city. Before signing a lease or closing on a property, confirm with your local zoning or planning department whether the address is zoned for the specific license category you're pursuing, and ask directly whether any conditional use permit, special exception, or public hearing process applies. Our guides on assisted living facilities and facility assisted living rules walk through how zoning and licensing interact in more detail.

What should I actually take away from a convention like this

Treat the residential assisted living national convention, or any similar industry event, as one input among several, not the source of truth for your licensing requirements. Use it for networking, vendor comparisons, and hearing how experienced operators actually run their homes day to day. For anything that touches your legal obligations, staffing ratios, physical plant standards, inspection checklists, Medicaid provider enrollment, go directly to your state licensing agency's published regulations and your state Medicaid agency's provider manual. Those are the documents an inspector will hold you to, not a slide deck from a conference session. If you're comparing markets or license types before you commit, it helps to look at real comparisons of what different senior living options actually offer versus what families are told they offer; our guide on senior assisted living facilities near me covers how to evaluate existing facilities from a consumer and competitor-research angle, and assisted living at home covers the in-home care alternative some families choose instead of a licensed facility.

Frequently asked questions

What is assisted living?

Assisted living is a licensed residential care option for people who need help with daily activities like bathing, dressing, and medication reminders, but not 24-hour skilled nursing care. States license and regulate it individually, and rules and terminology differ from state to state, with Medicaid.gov noting HCBS programs can help cover services in these settings ^[2].

What is a group home?

A group home is a licensed residential setting where a small number of people live together and receive supervision or care, covering populations like IDD, mental health recovery, substance use recovery, and seniors needing assisted living support. It requires state licensing, background-checked staff, and often Medicaid provider enrollment if funded through an HCBS waiver ^[2].

What is an assisted living facility?

An assisted living facility is a licensed residence, from a converted house to a large building, that provides housing plus help with daily living, medication management, and meals. States set their own licensing rules and physical plant standards, so a facility's exact scope of services depends on its state's license tier.

What is assisted living vs nursing home?

Assisted living provides help with daily activities in a home-like setting without continuous nursing coverage. A nursing home provides 24-hour skilled nursing care and is federally certified under Medicare and Medicaid rules (42 CFR Part 483) in addition to state licensing. Nursing homes serve higher-acuity medical and rehabilitation needs than assisted living does ^[3].

What does assisted living provide?

At minimum: housing, meals, help with bathing, dressing, toileting, and eating, medication management or reminders, housekeeping, and some social activities. Exact services depend on the state's license tier; higher tiers may allow dementia care or hospice coordination, while a basic license may only cover custodial support.

Does Medicare cover assisted living facilities?

No. Medicare does not cover room, board, or custodial personal care in assisted living. Medicare.gov states Medicare doesn't cover long-term custodial care ^[4]. Medicare can cover separate medical services (doctor visits, ordered therapy) for someone living in assisted living, and Medicaid waivers, not Medicare, sometimes help cover service costs in these settings.

How do I start a group home?

Pick your population and matching license category, find your state's specific licensing agency, read the actual regulation text on staffing and physical plant, confirm zoning with your local planning office, build a policy and staffing manual, submit your application with the required fee, and pass your pre-licensing inspection. Medicaid provider enrollment, if applicable, comes after licensing.

What is the residential assisted living national convention?

It is an industry trade show and training event for people who own or want to open small, home-based assisted living businesses, run by a private industry association, not a government body. It covers startup logistics, staffing, marketing, and operations, but it does not issue licenses or set regulations; your state licensing agency does that.

Is a residential assisted living home the same as a nursing home?

No. A residential assisted living home is a small, house-based version of assisted living, providing personal care and supervision without 24-hour skilled nursing. A nursing home provides continuous nursing care under federal certification rules in addition to state licensing, and typically serves people with higher medical acuity.

Do I need a nursing background to open a group home?

Not usually, but most states require an administrator or designated qualified provider to complete specific training hours, pass a background check, and sometimes hold a defined credential depending on the population served. People without direct-care experience often pair strong operations skills with a hired administrator who meets the state's clinical or program requirement.

How much does it cost to start a group home?

Costs vary enormously by state, license type, and whether you lease, buy, or renovate a property, including licensing fees, background checks, staff training, and physical plant upgrades like sprinklers. There is no single national figure; confirm current fee schedules with your specific state licensing agency before budgeting.

Does Medicaid pay for assisted living or group home care?

In many states, yes, through Home and Community-Based Services (HCBS) waivers, which Medicaid.gov describes as a way to cover services in community settings as an alternative to institutional care ^[2]. Coverage typically applies to services, not room and board, and not every state extends its waiver to assisted living; confirm with your state Medicaid agency.

Can zoning stop me from opening a group home even if I have a state license?

Yes. State licensing and local zoning are separate processes. The Fair Housing Act restricts some discriminatory zoning against group homes for people with disabilities, but general rules like occupancy limits and spacing requirements still apply in many areas ^[5]. Confirm zoning compatibility with your local planning department before signing a lease or purchase agreement.

Sources

1. Medicaid.gov, Home & Community-Based Services: States regulate assisted living individually and can use HCBS programs to help cover services in these settings
2. Medicare.gov, Long-Term Care: Medicare does not cover long-term custodial care, including assisted living room, board, and personal care
3. Fair Housing Act, 42 U.S.C. § 3604: The Fair Housing Act restricts certain zoning practices that discriminate against group homes for people with disabilities
4. 42 CFR Part 483: Nursing homes are subject to federal Medicare and Medicaid certification requirements in addition to state licensing
5. Medicare.gov: Medicare Part A covers limited short-term skilled nursing facility care but does not cover long-term custodial care such as assisted living
6. Cornell Law School Legal Information Institute: Federal fair housing exemptions and provisions relevant to housing for older persons and group living arrangements
7. Medicaid.gov: Medicaid Home and Community-Based Services waivers can help cover costs of care in residential settings like group homes