Last updated 2026-07-22
TL;DR
Assisted living facilities are state-licensed homes for older adults who need help with daily tasks but not full-time nursing care. To find one near you, use the Eldercare Locator (1-800-677-1116) or your state licensing agency's facility search tool. Medicare does not cover room and board; Medicaid sometimes does through state waiver programs.
What is assisted living?
Assisted living is housing for older adults who need help with everyday tasks, like bathing, dressing, taking medication on schedule, or getting to and from meals, but who don't need the round-the-clock medical care a nursing home provides. Residents usually live in a private or semi-private apartment or room and pay for some combination of rent, meals, and personal care services. It's not a hospital. It's not a nursing home either. Think of it as the middle rung on the ladder: more support than living alone, less clinical than skilled nursing. Every state licenses and regulates assisted living under its own rules, and often under its own name for the license. California calls it a Residential Care Facility for the Elderly (RCFE), Florida calls it an Assisted Living Facility (ALF), and plenty of other states use terms like "residential care home," "personal care home," or "adult foster care." There is no single federal assisted living license. Unlike nursing homes, assisted living communities "are licensed and regulated by individual states" rather than by the federal government, according to the National Center for Assisted Living [1]. That distinction matters whether you're searching for a place for a parent or thinking about opening one yourself. Services, staffing ratios, admission criteria, and even the legal size limits on a facility vary state to state, and sometimes county to county. What counts as "assisted living" in Texas can look pretty different from a similarly named facility in Ohio.
What is an assisted living facility, and what does it actually provide?
An assisted living facility is the physical building and licensed operation where assisted living services happen. It's usually a purpose-built residence, sometimes a converted large house, with private or shared rooms, common dining areas, and staff on site. What does assisted living provide day to day? At minimum, most licensed facilities offer meals, housekeeping, laundry, help with activities of daily living (bathing, dressing, toileting, mobility), medication reminders or administration depending on state rules, social and recreational activities, and some level of staff supervision around the clock. Many also coordinate transportation to medical appointments and monitor residents for changes in condition. What it generally does not provide is skilled nursing care. A resident who needs IV therapy or wound care beyond basic first aid, plus daily physician-level monitoring, usually needs a nursing home or a facility with a specialized health care license, not standard assisted living. The National Center for Assisted Living estimates the country has more than 28,900 licensed assisted living communities [1], ranging from small six- to ten-bed homes to large campuses with over a hundred units. If you're comparing options or building a license application, the assisted living facility guide breaks down how states define the term and what paperwork typically comes with it.
How do I find senior assisted living facilities near me?
Start with the Eldercare Locator, a free federal service run by the Administration for Community Living. Call 1-800-677-1116 or visit eldercare.acl.gov, and staff will connect you to your local Area Agency on Aging, which keeps updated lists of licensed facilities, waitlists, and payment help in your specific county [2]. Next, check your state licensing agency's facility search tool. Nearly every state posts a searchable database of licensed assisted living providers, including inspection history and any citations. The exact agency name varies (confirm with your state licensing agency), but it's usually housed inside the state health department or social services department. One thing to know: CMS's Care Compare tool is excellent for finding and comparing nursing homes, home health agencies, and hospice providers, because those are federally certified for Medicare and Medicaid [3]. It generally does not cover assisted living, since assisted living isn't federally certified or regulated. Don't expect to find assisted living ratings there. Finally, tour in person. Ask to see the most recent state inspection report, ask about current staff-to-resident ratios on day and night shifts, ask how the facility handles a resident whose care needs increase, and ask what a typical shift change actually looks like. A facility that hesitates to show you inspection history is a facility to be cautious about. If you're researching the category broadly before narrowing your search, the senior assisted living overview is a reasonable starting point.
What is the difference between assisted living and a nursing home?
| Level of care | Help with daily activities, medication reminders | 24/7 skilled nursing, rehab therapy, medical monitoring | |
|---|---|---|---|
| Who licenses it | State licensing agency (name varies by state) | State agency, plus federal Medicare/Medicaid certification | |
| Typical staffing | Caregivers, often with an RN or LPN on call, not always on site | RNs and LPNs on staff around the clock | |
| Median monthly cost (2021) | $4,500 [4] | $7,908 semi-private / $9,034 private [4] | |
| Medicare coverage | Not covered; considered custodial care [5] | Up to 100 days per benefit period after a qualifying hospital stay [5] | |
| Medicaid coverage | Sometimes, through a state HCBS waiver, but not room and board [6] | Yes, for eligible long-term residents | The cost and coverage gap is the part most families get wrong. Assisted living generally costs less per month than nursing home care, but it's also less likely to be covered by any government program. Nursing home care is more expensive but has a real, if limited, Medicare pathway for short-term rehab stays. |
The short version: assisted living is for people who need help with daily tasks but are medically stable, while a nursing home (also called a skilled nursing facility) is for people who need ongoing medical or rehabilitative care, often around the clock. | Feature | Assisted living | Nursing home (skilled nursing facility) |
What is a group home, and how is it different from assisted living?
A group home is a small residential setting, usually a single house or converted duplex, where a handful of residents who need support live together with paid staff. Group homes exist for a lot of different populations: seniors, adults with intellectual or developmental disabilities (IDD), people in mental health recovery, and people in substance use recovery. A lot of "senior assisted living" that people search for near them is actually a small group home licensed as a residential care home, adult foster care home, or board and care home, rather than a large assisted living campus. States often set different rules by bed count. A six-bed home might fall under a lighter-touch residential license, while a 50-unit assisted living community faces a fuller set of staffing, dietary, and life safety requirements. The practical difference for a family searching nearby: a group home tends to feel more like a house, with a smaller staff-to-resident ratio and a more personal routine, while a larger assisted living community offers more amenities, more social programming, and more built-in redundancy if a caregiver calls in sick. Neither is automatically better. It depends on the resident's needs and personality. If you're comparing small-home models to larger licensed communities, the facility assisted living and assisted living at home guides walk through how the license categories and physical setups differ.
Does Medicare cover assisted living facilities?
No, not the room and board part. Medicare treats assisted living as custodial care, and Medicare doesn't pay for custodial care by itself. Medicare's own guidance states plainly that the program "doesn't cover long-term care (also called custodial care) if that's the only care you need" [7]. Medicare Part A can cover up to 100 days of care in a skilled nursing facility per benefit period, but only after a qualifying inpatient hospital stay, and only for skilled rehabilitation or medical care, not for ongoing personal care in an assisted living setting [5]. That coverage also isn't automatic for the full 100 days; it depends on continued medical necessity and comes with daily coinsurance after the first 20 days. Some Medicare Advantage plans now offer limited supplemental benefits, like a small allowance for personal care aides or home modifications, but that's not the same as covering assisted living rent, and benefits vary a lot by plan and year. Medicaid is a different story, and a messier one. Many states use Home and Community-Based Services (HCBS) waivers, sometimes called 1915(c) waivers, to pay for personal care and some support services delivered inside an assisted living setting [6][8]. Medicaid.gov describes HCBS as a way to let people "receive services in their own home or community rather than institutions." What Medicaid still generally won't pay for is the room and board charge itself, and waiver availability, waitlists, and income limits vary sharply by state. Confirm current waiver rules with your state Medicaid agency before assuming coverage.
What does assisted living cost, and who ends up paying?
According to the Genworth Cost of Care Survey (2021), the national median cost of assisted living was $4,500 per month [4]. That's meaningfully less than nursing home care, but still adds up to $54,000 a year, and most of that comes out of pocket. For comparison, that same survey put in-home health aide care at a median of $5,148 a month, a semi-private nursing home room at $7,908 a month, and a private nursing home room at $9,034 a month [4]. These are 2021 national medians; costs have almost certainly risen since with general inflation in wages and health care, so treat them as a floor for planning purposes, not a current quote. Who pays? Mostly families, out of pocket, at least at first. Long-term care insurance can help if the resident bought a policy years earlier. Veterans and surviving spouses may qualify for the VA Aid and Attendance benefit, which can offset assisted living costs for eligible veterans. Medicaid HCBS waivers help in some states, for some residents, once other assets are largely spent down and eligibility is confirmed. There is no single "assisted living insurance" that most people carry, which is exactly why cost is the first question families ask when comparing facilities near them.
How do you start a group home or assisted living business?
Starting a group home or assisted living facility is a licensing project first and a real estate project second. Skip either one and the state will not approve you, no matter how good your care plan is. The rough sequence looks like this. First, pick the population you intend to serve (seniors, IDD, mental health, recovery) and find the exact license category your state uses for it, since that determines everything downstream. Second, write your policies and procedures manual: admission criteria, medication management, emergency procedures, staff training, grievance process. Third, confirm the property's zoning allows a group care use, and start any conditional use permit process early, since this step often takes longer than the license application itself. Fourth, hire toward your state's required staffing ratios and background check rules. Fifth, schedule and pass fire marshal and health department inspections before your license can be issued. Sixth, submit the license application itself, along with whatever fee your state charges (confirm the current fee with your state licensing agency, since these amounts change and vary widely). A lot of first-time operators underestimate how much of this is paperwork, not construction. A well-organized policy manual, staffing plan, and application packet built around your specific state's checklist saves real time compared to assembling everything from scratch. That's the gap the $299 State Group Home Licensing Kit is built to close: state-specific checklists, policy templates, staffing plan templates, and application guidance in one place, rather than piecing it together from a dozen agency PDFs. You can start building your state packet at /licensing-kit-builder. For more on how the license categories and facility types compare before you commit to one, see assisted living facilities.
What licenses, staffing, and inspections should a new operator expect?
Expect several layers, not one single approval. A typical path includes a state application (with a fee that varies by state, so confirm with your state licensing agency), criminal background checks for owners and staff, an administrator training or certification requirement in many states, and mandatory staff training in first aid and CPR, plus medication assistance training depending on the license level. Inspections come from more than one agency. The state licensing agency inspects for compliance with care and staffing rules. The local fire marshal inspects egress routes and fire suppression equipment, including sprinklers and alarm systems. The health department may inspect kitchen and food handling if you serve meals. Nursing homes go through an additional layer: they're surveyed for Medicare and Medicaid certification under CMS rules, since federal payment is on the line [3]. Assisted living and group homes usually don't carry that federal certification, but they still face regular, sometimes unannounced, state inspections after opening. The U.S. Small Business Administration's general guidance on business licenses and permits is a useful baseline reminder that most care businesses need a stack of approvals working together, more than a single state license, before residents can move in . Budget real time for this. Rushing the inspection stage is one of the more common ways new operators lose months waiting for a re-inspection.
What zoning and property issues come up when opening a facility?
Most small group homes and assisted living facilities need to operate in a residential zone, and that's usually fine for homes under a certain bed count. Problems tend to show up as the resident count climbs, or when a facility looks and functions more like a commercial operation than a single-family home. Cities and counties can require a conditional use permit or extra parking once you cross certain thresholds, and sometimes specific fire code upgrades too, like sprinklers or a second exit. These thresholds differ by jurisdiction, so a six-bed home might sail through zoning review while a ten-bed home next door triggers a public hearing. There's an important legal limit on how far local zoning can go. The Fair Housing Act, as amended in 1988, protects people with disabilities, including many seniors and group home residents, from housing discrimination, and HUD guidance notes this includes certain zoning and land use restrictions aimed at group homes for people with disabilities . That doesn't mean zoning boards can't ask questions, but it does mean an outright ban on group homes in residential zones is legally shaky in a lot of cases. Before signing a lease or buying property, get the zoning determination in writing from the local planning department, more than a verbal "should be fine." This single step prevents more license delays than almost anything else in the process. If you want a structured way to track zoning, staffing, and inspection requirements side by side for your specific state, that's exactly what the State Group Home Licensing Kit at /licensing-kit-builder is built to organize.
Frequently asked questions
What is assisted living?
Assisted living is housing for older adults who need help with daily tasks such as bathing, dressing, medication reminders, or getting to meals, but who don't need full-time nursing care. Residents live in private or semi-private units and pay for a mix of rent, meals, and personal care services. It's licensed and regulated at the state level, with no single federal definition or license.
What is a group home?
A group home is a small residential setting, often a single house, where a limited number of residents needing support live together with paid staff. Group homes serve many populations, including seniors, adults with intellectual or developmental disabilities, and people in mental health or substance use recovery. Rules and bed limits vary widely by state license category.
What is an assisted living facility?
An assisted living facility is the licensed building and operation where assisted living services take place: meals, housekeeping, help with daily activities, medication support, and staff supervision. It ranges from small six- to ten-bed homes to larger campuses with over a hundred units. States use different license names for this, like RCFE in California or ALF in Florida.
What's the difference between assisted living and a nursing home?
Assisted living helps residents who are medically stable but need support with daily tasks. Nursing homes (skilled nursing facilities) provide 24/7 medical care, rehabilitation, and nursing staff for residents with more complex health needs. Nursing homes are federally certified for Medicare and Medicaid; assisted living is licensed only at the state level and generally costs less per month.
Does Medicare cover assisted living facilities?
No. Medicare doesn't cover assisted living room and board, which it classifies as custodial care. Medicare Part A can cover up to 100 days in a skilled nursing facility after a qualifying hospital stay, but that's rehabilitation and medical care, not ongoing assisted living support. Some Medicare Advantage plans offer limited supplemental personal care benefits, but coverage varies by plan.
Does Medicaid cover assisted living?
Sometimes, through state Home and Community-Based Services (HCBS) waivers, which can pay for personal care services delivered inside an assisted living setting. Medicaid generally still won't cover the room and board charge itself. Waiver availability, waitlists, and income limits differ by state, so confirm current rules with your state Medicaid agency.
How do I start a group home?
Pick the population you'll serve and identify your state's exact license category, write a policies and procedures manual, confirm zoning allows the use, staff to your state's required ratios with background-checked employees, pass fire and health inspections, then submit your license application with the required fee. Expect this to take months, not weeks, in most states.
How much does it cost to open a group home or assisted living facility?
Costs vary enormously based on whether you're buying or leasing property, the state's application and licensing fees, required renovations for fire and life safety codes, and staffing needs before your first resident moves in. There's no single national figure; confirm specific fee schedules and renovation requirements with your state licensing agency and local building department.
What's the difference between assisted living and independent living?
Independent living is for seniors who don't need daily personal care help; it offers housing and meals in an age-restricted community, along with social activities, but no hands-on caregiving. Assisted living adds staff support for bathing, dressing, medication management, and mobility. Someone might move from independent living to assisted living as their care needs increase.
Is a background check required to work in assisted living?
Yes, in nearly every state. Most state licensing agencies require criminal background checks, and often fingerprinting, for owners, administrators, and direct care staff before hire or before a facility license is approved. Exact requirements, lookback periods, and disqualifying offenses vary by state, so confirm the specific list with your state licensing agency.
How many beds can a group home have?
Bed limits depend entirely on the state license category. Small residential care homes often cap out around 6 to 10 beds under a lighter regulatory tier, while larger assisted living communities can license 50, 100, or more units under a fuller set of staffing and life safety rules. Confirm your state's specific bed thresholds before choosing a property.
What's the difference between assisted living and memory care?
Memory care is a specialized level of assisted living designed for residents with Alzheimer's disease or other dementias. It usually features secured entries and higher staff-to-resident ratios, with staff trained specifically in dementia care. Many assisted living communities have a memory care wing or unit; some standalone facilities only offer memory care.
Sources
- Medicare.gov, Skilled Nursing Facility (SNF) Care coverage page: Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period after a qualifying hospital stay, but not custodial assisted living care
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS programs can pay for services in community settings, not room and board
- Genworth, Cost of Care Survey 2021: National median monthly costs for assisted living, in-home care, and nursing home care
- California Department of Social Services, Community Care Licensing Division: California licenses assisted living communities as Residential Care Facilities for the Elderly (RCFE)
- U.S. Small Business Administration, Licenses and Permits: New care businesses typically need multiple state and local licenses and permits before operating
- Medicaid.gov, Home & Community-Based Services 1915(c) waivers: States use 1915(c) HCBS waivers to fund services in community and residential settings instead of institutions
- Medicare.gov, What Medicare doesn't cover: Medicare does not cover long-term custodial care if that is the only care needed
- U.S. Department of Housing and Urban Development, Fair Housing Act overview: The Fair Housing Act, as amended in 1988, limits zoning discrimination against housing for people with disabilities, including many group homes