Last updated 2026-07-24
TL;DR
Group home rules cover curfews, chores, visitors, medication schedules, house meetings, and behavior expectations, all set in a written resident agreement required by state licensing. Rules vary by state and population (IDD, mental health, recovery, senior), but every licensed home must post resident rights and follow its approved policy manual during inspections.
What is a group home, exactly?
A group home is a licensed residential setting where a small number of people, usually somewhere between 3 and 16 depending on the state and license type, live together and receive some level of support, supervision, or care. It is not a hospital and it is not usually a nursing home. Think of it as a house (often literally a single-family home converted for this use) where staff or a live-in provider help residents with daily living tasks, medication, behavior support, or recovery structure. The term covers a lot of ground. States use different names for different populations: adult foster care homes, residential care facilities for the elderly, IDD group homes, community residences for mental health, and sober living or recovery residences. Each has its own licensing category, and the specific rules a resident has to follow depend heavily on which category the home falls under and which state issued the license. What they have in common is a written resident agreement or admission contract, a set of house rules approved (or at least reviewed) by the state licensing agency, and staff who are trained to specific state standards. If you're researching this because you want to open one, the assisted living facility guide and assisted living facilities overview walk through how licensing categories differ by state.
What is assisted living?
Assisted living is a licensed residential care model for adults, usually seniors, who need help with activities of daily living (bathing, dressing, medication reminders, mobility) but do not need the 24-hour skilled nursing care a nursing home provides. Assisted living residents typically live in private or semi-private apartments and have access to shared dining, activities, and on-site staff. The federal government does not license or directly regulate assisted living. Licensing is a state function, and the Centers for Medicare & Medicaid Services (CMS) explicitly notes that assisted living facilities are "licensed and regulated by the state" rather than under a single federal standard [1]. That's why rules, staffing ratios, and even the name of the license (in some states it's "residential care facility for the elderly," in others "assisted living facility" or "personal care home") differ so much state to state. Because there's no federal licensing floor, a resident's day-to-day rules in Florida can look very different from a resident's rules in Oregon. Always confirm the specific requirements with your state licensing agency before assuming a rule is universal.
What is an assisted living facility (and what does it provide)?
An assisted living facility is the physical, licensed building or home where assisted living services happen. What it provides, at minimum in most state frameworks, includes three meals a day, help with activities of daily living, medication management or reminders, housekeeping, laundry, some social and recreational programming, and 24-hour staff availability for emergencies. What it does NOT typically provide is skilled nursing care, ventilator management, or complex wound care. If a resident's needs exceed what the assisted living license allows, the facility usually has to discharge them to a higher level of care. That's one of the most common, and hardest, conversations operators have with families. Most states set specific service minimums in their licensing regulations. For example, California's Residential Care Facilities for the Elderly regulations (Title 22, Division 6) require facilities to provide personal care services, safe and healthful accommodations, and planned activities [2]. Every state has its own version of this list, so check your state's specific regulation text rather than assuming a national standard applies.
What rules do residents actually have to follow in a group home?
Every licensed group home operates under a written resident agreement, and that document (not a verbal understanding) is what governs daily life. Typical rules fall into a handful of categories, though the exact content depends on population and state. Daily structure. Wake times, meal times, medication administration times, and curfews (especially common in recovery residences and some mental health group homes) are usually spelled out. Many IDD and mental health group homes also require participation in a certain number of structured activities or day programs per week, tied to the resident's individual service plan. House conduct. No violence, no weapons, no illegal drug or alcohol use (this one is universal, even in recovery homes, where sobriety itself is the rule), respectful behavior toward staff and housemates, and property care expectations (keeping your room reasonably clean, no smoking indoors in most states). Visitors and overnight guests. Most homes require visitors to sign in, restrict visiting hours, and require advance notice or approval for overnight guests. This is both a safety rule and, in HUD-funded or Medicaid-waiver homes, sometimes a condition of the funding source. Chores and self-care participation. Higher-functioning group homes (especially IDD homes working toward independence goals) often build in resident responsibilities like doing their own laundry, helping with light meal prep, or maintaining their own space, as part of the individual service plan rather than punishment. Money and personal property. Many states require homes to have a system for managing resident funds if the resident can't manage their own, with strict accounting and audit rules, because this is a common area of abuse if left unregulated. Grievance and rights protections. Every resident has to be told, usually in writing at admission, how to file a complaint, contact an ombudsman, or reach the state licensing agency directly, without retaliation. The federal Nursing Home Reform Act (part of OBRA '87) established resident rights standards that many state assisted living and group home regulations echo, even though it technically applies to Medicare/Medicaid-certified nursing facilities: rights to privacy, dignity, freedom from restraint, and participation in care planning [3]. States have adapted similar rights language into their own assisted living and group home codes.
What is the difference between assisted living and a nursing home?
| Regulation | State licensed, no single federal standard | Certified by CMS for Medicare/Medicaid, plus state licensing [3] | |
|---|---|---|---|
| Staffing | Caregivers, med aides, some states require an RN consultant | 24-hour licensed nursing staff required | |
| Medical care level | Help with ADLs, medication management | Skilled nursing, rehab, complex medical needs | |
| Typical setting | Apartment-style room, communal dining | Hospital-like room, often shared | |
| Medicare coverage | Generally not covered [1] | Short-term skilled care can be covered under specific conditions [4] | Nursing homes that accept Medicare or Medicaid must meet federal Conditions of Participation under 42 CFR Part 483, which includes detailed resident rights, care planning, and staffing requirements [5]. Assisted living facilities are not subject to that federal certification process at all, which is part of why quality and rules vary so much by state. |
The core difference is the level of medical care and the type of license. Assisted living is a residential model with supportive services. A nursing home (also called a skilled nursing facility) is a medical model with licensed nursing staff on-site around the clock. | Feature | Assisted Living | Nursing Home (Skilled Nursing) |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board in an assisted living facility. CMS states plainly that "Medicare doesn't cover room and board when you get hospice care in your home or in a nursing home" and separately does not list assisted living custodial care as a covered benefit at all [1] [4]. Medicare Part A can cover a short stay in a skilled nursing facility, but only after a qualifying hospital stay and only for skilled care needs, not for long-term custodial assisted living [4]. Medicare Part B may still cover doctor visits, physical therapy, or medical equipment for someone who happens to live in an assisted living facility, but it does not pay for the facility's housing or personal care costs. Medicaid is a different story: many states have Medicaid waiver programs (Home and Community-Based Services waivers under Section 1915(c) of the Social Security Act) that can help cover personal care and some services in assisted living or group home settings, though room and board is still usually the resident's responsibility [6]. This is a major area of confusion for families, and it's worth confirming the exact waiver rules with your state Medicaid agency rather than assuming coverage.
What is assisted living vs. a group home, in plain terms?
Assisted living is usually one specific license type, aimed mostly at seniors who need help with daily living but not medical care. "Group home" is a broader, less formal term that can describe an assisted living home, but it can also describe an IDD group home, a mental health residential program, a recovery residence, or an adult foster care home. Size is often a practical difference too. Assisted living facilities can range from a small 6-bed residential home to a large community with over 100 units. Group homes, especially IDD and mental health group homes, are more often small (3 to 8 residents is common under many state licensing categories) because smaller settings are tied to community integration goals under the Americans with Disabilities Act's integration mandate as interpreted in *Olmstead v. L.C.* (1999) [7]. If you're comparing options for a family member or comparing license types as an operator, the assisted living overview and senior assisted living facilities near me page break down how to evaluate specific homes by license type and population served.
Who decides what rules a specific group home has to follow?
Two forces set the rules: state licensing regulations (the floor everyone must meet) and the individual home's own policy and procedure manual (which has to meet or exceed that floor and gets approved or reviewed during licensing). State licensing agencies (the name varies: Department of Social Services, Department of Health, Department of Aging, Department of Human Services, depending on the state) publish the actual regulatory text, usually in an administrative code. That code sets minimums for staffing ratios, resident rights, physical plant requirements, medication administration rules, and grounds for involuntary discharge. On top of that floor, each home writes its own house rules and resident agreement, tailored to its population. A recovery residence will have strict sobriety and drug-testing rules that an assisted living home for seniors won't have. An IDD group home will have individualized service plan requirements tied to each resident's specific goals, reviewed at least annually in most states. During an inspection, licensing surveyors check that the home's actual practice matches both the state regulation and the home's own written policies. A mismatch (say, a policy manual that promises weekly outings but a log showing none happened in six months) is a common citation.
How to start a group home
Starting a group home means working through state licensing requirements, zoning approval, staffing plans, and a physical site that meets code, roughly in that order. There's no single national process because licensing is state-by-state, but the core steps repeat almost everywhere. 1. Pick your population and license type. IDD, mental health, adult foster care, or senior residential care each has a different license, different staffing ratios, and often a different state agency handling it. 2. Confirm zoning first. Many single-family zoning codes allow small group homes as a matter of right under state and federal fair housing protections, but larger homes or specific setback/parking rules can still apply. Confirm with your local planning or zoning office before signing a lease or purchase agreement. 3. Write your policy and procedure manual. This covers admission and discharge criteria, medication management, staffing plans, emergency procedures, resident rights, grievance processes, and behavior support plans. Licensing agencies typically require this manual as part of the application packet. 4. Meet physical plant requirements. Fire marshal approval, ADA accessibility where required, minimum square footage per resident, and specific safety features (grab bars, smoke detectors, sprinkler systems in some states) are standard checkpoints. 5. Hire and train staff to state standard. This includes background checks (most states require fingerprint-based criminal history checks and checks against abuse/neglect registries), CPR/first aid, and population-specific training hours. 6. Submit the license application and pay fees. Fees, timelines, and required attachments vary significantly by state; confirm current fee schedules and processing times directly with your state licensing agency's published fee page. 7. Pass the pre-licensing inspection. A surveyor visits the physical site and reviews your policy manual before the initial license is issued. The paperwork burden is the part most first-time operators underestimate. Building the resident agreement, staffing plan, medication policy, and emergency procedures from scratch, in the exact format your state expects, can take weeks of unpaid research time. This is the gap the $299 State Group Home Licensing Kit is built for: state-specific templates for the policy manual, staffing plan, and resident agreement pieces that licensing reviewers actually check line by line, so you're not starting from a blank page.
How do I start a group home if I've never done this before?
If you're brand new to this, the honest first move is not buying property or signing a lease. It's calling your state licensing agency and asking for the specific regulation citation and application packet for the population you want to serve. Every state publishes this, usually as a PDF or an online portal, and reading it before you spend money will save you from the single most common first-timer mistake: falling in love with a house that can't pass fire code or zoning for the license type you want. After that, talk to your local zoning or planning department separately from the state licensing agency. These are two different reviews and one does not clear the other. A property can be zoned fine and still fail the state's physical plant checklist, or vice versa. Budget realistically for the parts nobody advertises: fire suppression upgrades, staff training hours before you can bill or admit residents, and the weeks (sometimes months) of back-and-forth corrections on your policy manual before a surveyor signs off. States differ enormously on timeline; some initial license reviews take 30 to 60 days after a complete application, others take considerably longer if the application needs revisions. Confirm current timelines with your state licensing agency rather than assuming a number from another state applies to you.
What happens if a resident breaks the rules?
Consequences depend on the rule and the state, but licensed homes cannot evict someone on the spot in most cases. States generally require a formal involuntary discharge process, including written notice (often 30 days, though some emergency safety situations allow faster action), a stated reason tied to specific regulatory grounds, and information on how to appeal. Common grounds for involuntary discharge across many state regulations include danger to self or others, needs that exceed the facility's license level, non-payment, or repeated serious rule violations after documented attempts at correction. What states generally do NOT allow is discharge for retaliatory reasons, such as a resident filing a complaint with the ombudsman or licensing agency. For lower-level rule violations (missing curfew once, an untidy room), most homes use a graduated response: verbal reminder, written warning, then a care plan or behavior plan review, rather than jumping straight to discharge. This is part of what inspectors check: whether the home's discharge and behavior management practices actually match its written policy, and whether residents were given the rights notices and appeal information the state requires.
What rights does a group home resident have no matter what state they're in?
While the specific regulatory language differs by state, a few resident protections show up almost everywhere because they trace back to federal civil rights and disability law rather than state licensing rules alone. The right to be free from abuse, neglect, and unreasonable restraint is close to universal in state group home and assisted living codes. The right to privacy in communications and personal affairs, the right to manage your own money unless a court has appointed a guardian or conservator, and the right to participate in your own care or service plan are also standard. Under the Fair Housing Act, group homes for people with disabilities are generally protected from discriminatory zoning restrictions that single them out (this is why many single-family zones must allow small group homes as a matter of right) . And under the ADA's integration mandate, as the Supreme Court held in *Olmstead v. L.C.*, states must generally provide services in the most integrated setting appropriate, which is part of why the trend over the last two decades has moved toward smaller, more home-like group settings rather than large institutional facilities [7]. Residents also generally have the right to see and get a copy of their own service plan, to voice grievances without retaliation, and to be told in plain language, at admission, what the house rules actually are.
Frequently asked questions
What is assisted living?
Assisted living is a state-licensed residential care option for adults, usually seniors, who need help with daily activities like bathing, dressing, and medication but don't need 24-hour skilled nursing care. Residents typically live in private or semi-private rooms with shared dining and activities, and staff are on-site around the clock, though not necessarily licensed nurses.
What is a group home?
A group home is a licensed residential setting where a small number of people live together and receive support, supervision, or care matched to their needs, whether that's IDD services, mental health support, recovery housing, or senior care. It's a broad category; the exact license type and rules depend on the population served and the state.
What is an assisted living facility?
An assisted living facility is the licensed building or home where assisted living services are delivered. It provides help with daily living tasks, meals, medication management, housekeeping, and 24-hour staff availability, but it is regulated entirely at the state level since there's no single federal assisted living license or standard.
What is the difference between assisted living and a nursing home?
Assisted living is a residential model with supportive services and no federal certification requirement. A nursing home is a medical model with 24-hour licensed nursing staff, certified by CMS under federal Conditions of Participation (42 CFR Part 483) if it accepts Medicare or Medicaid. Nursing homes serve people with heavier medical or rehabilitation needs.
Does Medicare cover assisted living facilities?
No. Medicare does not cover room and board or custodial care in assisted living. Medicare Part A can cover a short, medically qualifying stay in a skilled nursing facility after a hospital stay, and Part B can cover doctor visits or therapy for someone living in assisted living, but the facility's housing and care costs are not a Medicare benefit.
What does assisted living provide day to day?
At minimum, most state-licensed assisted living facilities provide three meals a day, help with bathing and dressing, medication reminders or administration, housekeeping and laundry, some organized activities, and 24-hour staff availability for emergencies. Exact required services are set in each state's specific residential care regulations.
How do I start a group home?
Pick your population and license type, confirm zoning with your local planning office, write a policy and procedure manual covering admissions, staffing, and emergencies, meet your state's physical plant and fire safety requirements, hire staff who pass background checks, and submit your license application with the required fees to your state licensing agency.
Can a group home kick out a resident for breaking house rules?
Usually not immediately. Most states require a formal involuntary discharge process with written notice (commonly around 30 days, shorter for emergencies), a documented reason tied to specific regulatory grounds, and information on how to appeal. Retaliatory discharge, such as for filing a complaint, is generally prohibited.
What rules do IDD group homes have that other group homes don't?
IDD group homes typically build rules directly into each resident's individual service plan, including participation in day programs, skill-building chores, and behavior support strategies. These plans are reviewed at least annually in most states and are more individualized than the blanket house rules common in senior assisted living.
Do group home residents have visitor restrictions?
Most licensed group homes set visiting hours and require visitors to sign in for safety and supervision reasons, and many require advance notice for overnight guests. The specifics vary by state regulation and by the home's own written policy, so ask to see the visitor policy section of the resident agreement directly.
Are group home rules the same in every state?
No. Licensing, staffing ratios, resident rights language, and discharge procedures are all set at the state level, and there is no single federal assisted living or group home standard. Always confirm specifics, including fee amounts and processing timelines, directly with your state's licensing agency rather than assuming another state's rules apply.
What is the difference between a group home and assisted living for seniors specifically?
For seniors, assisted living is usually the specific license type used, focused on ADL support without heavy medical care. "Group home" is the broader umbrella term that also covers IDD, mental health, and recovery housing. A senior group home and a licensed assisted living facility are often the same thing, just described with different terminology.
Who enforces group home rules and checks compliance?
The state licensing agency (names vary: Department of Social Services, Department of Health, or similar) enforces the rules through periodic inspections, complaint investigations, and license renewal reviews. Inspectors check that the home's actual daily practice matches both state regulation minimums and the home's own approved policy manual.
Sources
- Medicare.gov, Hospice Care coverage page: Medicare doesn't cover room and board in assisted living or nursing home settings under hospice, illustrating Medicare's limited coverage of residential care costs
- California Department of Social Services, Title 22 Division 6 RCFE regulations: California RCFE regulations require personal care services, safe accommodations, and planned activities
- CMS, Nursing Home Reform provisions under OBRA 1987 / 42 CFR 483: Federal nursing home resident rights standards including dignity, privacy, and freedom from restraint originate from OBRA 1987
- Medicare.gov, Skilled Nursing Facility Care coverage page: Medicare Part A covers skilled nursing facility care only after a qualifying hospital stay and only for skilled care needs, not long-term custodial care
- eCFR, 42 CFR Part 483 Requirements for States and Long Term Care Facilities: Federal Conditions of Participation for Medicare/Medicaid certified nursing facilities are codified at 42 CFR Part 483
- Medicaid.gov, Home & Community-Based Services 1915(c) waivers: States use Section 1915(c) HCBS waivers to help cover personal care and services in community and group residential settings
- U.S. Department of Justice, Olmstead v. L.C. enforcement summary: Olmstead v. L.C. (1999) established the ADA integration mandate requiring services in the most integrated setting appropriate, shaping the shift toward smaller group homes