Last updated 2026-07-25
TL;DR
A residential assisted living facility is a licensed home, usually serving 6 to 20 residents, that provides housing, meals, supervision, and help with bathing, dressing, and medication. It's not a nursing home. Median cost is $5,900/month nationally (Genworth, 2021). Medicare does not pay for it; Medicaid may cover some services in certain states.
what is assisted living
Assisted living is a type of long-term care that combines housing with personal care support for people who need help with daily activities but don't need the round-the-clock medical care a nursing home provides. Residents typically get help with bathing, dressing, medication reminders, and meals, while keeping some independence: their own room or apartment, a say in their schedule, and often a lockable door. The federal government does not license or define assisted living directly. Each state writes its own rules, so "assisted living" can mean a 200-bed building with a dining hall and salon, or it can mean a converted single-family house with six bedrooms. States use different terms for the same basic concept: residential care facility, personal care home, adult foster care, board and care home, or assisted living residence. The Centers for Medicare & Medicaid Services (CMS) tracks assisted living as part of home and community-based services but leaves licensing entirely to the states [1]. What unifies the category is the service model, not the building size: help with activities of daily living (ADLs) delivered in a home-like, non-medical setting, paid for mostly out of pocket or through state Medicaid waivers rather than Medicare.
what is an assisted living facility (and what is a residential assisted living facility)
An assisted living facility is the licensed building and business entity that delivers assisted living services. A residential assisted living facility (sometimes called RAL) is the smaller, house-based version of that model: instead of a large institutional campus, the home looks like a regular residence in a regular neighborhood, usually holding somewhere between 6 and 20 residents depending on the state's licensing tier. The residential model has grown because it lets operators start with a single-family or converted home rather than building a large facility from scratch. Arizona, for example, licenses "assisted living homes" for up to 10 residents and "assisted living centers" for 11 or more, under rules set by the Arizona Department of Health Services [2]. Texas licenses assisted living facilities under Type A (residents who can evacuate without help) and Type B (residents who need evacuation assistance) through the Health and Human Services Commission [3]. California uses the term "Residential Care Facility for the Elderly" (RCFE), licensed by the Department of Social Services, Community Care Licensing Division [4]. Whatever the label, a residential assisted living facility still must meet a state's minimum staffing ratios, physical plant requirements (fire sprinklers, exits, bedroom square footage), medication management rules, and background check standards for staff. If you're comparing your state's specific category names and caps, check our guides on assisted living facility licensing categories and assisted living facilities by state.
what is a group home
A group home is a licensed residential setting where a small number of people, usually fewer than 10, live together and receive support with daily living, supervision, or behavioral health services. The term is broader than assisted living: group homes serve seniors, but also people with intellectual and developmental disabilities (IDD), mental illness, or substance use recovery needs. The key legal distinction is licensing category, not the word "group home" itself. A group home for adults with IDD is typically licensed under a state's developmental disabilities agency (often tied to a Medicaid Home and Community-Based Services waiver under Section 1915(c) of the Social Security Act [5]), while a senior-focused group home is licensed as assisted living or residential care under the state health or social services department. So a residential assisted living facility is one type of group home: specifically, one that serves older adults and is licensed under a state's assisted living or residential care statute rather than its IDD or behavioral health statute. If you're building a facility for a non-senior population, the population determines which state licensing track and which Medicaid authority applies, and the paperwork differs a lot even though the building might look identical.
what does assisted living provide
Assisted living provides a bundle of housing, meals, supervision, and help with activities of daily living, but it does not provide skilled nursing care as a baseline service. Most state rules require at minimum three meals a day, housekeeping, laundry, staff available 24 hours, medication assistance (not always administration, depending on state rules on delegated nursing tasks), and help with bathing, dressing, toileting, and mobility. Beyond that floor, service levels typically scale with acuity. Many states use a tiered licensing or assessment system: a resident who needs minimal help pays a base rate, while a resident with memory care needs, incontinence care, or two-person transfer assistance moves into a higher tier with a higher monthly rate. Florida's assisted living statute, for instance, distinguishes standard licenses from "limited nursing services" and "extended congregate care" licenses that allow a facility to keep residents who need more hands-on care [6]. What assisted living generally does NOT provide: ventilator care, IV therapy, wound care beyond a basic level, or the kind of 24/7 skilled nursing oversight a nursing home offers. If a resident's needs exceed what the state's assisted living license allows, the facility is usually required to help transition that resident to a nursing home or hospice care.
what is assisted living vs nursing home (and the actual differences)
| Care level | Non-medical personal care, ADL help | Skilled nursing, 24/7 medical care | |
|---|---|---|---|
| Staffing | Caregivers, med aides; RN/LPN oversight varies by state | Licensed nurses on-site around the clock | |
| Typical setting | Home-like, private/semi-private room or apartment | Clinical, hospital-like setting | |
| Medicare coverage | Not covered (custodial care excluded) [7] | Short-term skilled stays covered after qualifying hospital stay [8] | |
| Medicaid coverage | Sometimes, via HCBS waiver, for services not room/board | Yes, for eligible long-term residents | |
| Median monthly cost (2021) | $4,500 (Genworth) [9] | $7,908 semi-private (Genworth) [9] | The practical difference for a family: assisted living is chosen when someone needs supervision and help with daily tasks but is medically stable. A nursing home (skilled nursing facility) is chosen when someone needs ongoing medical treatment, has complex health conditions, or needs rehabilitation after a hospital stay. Medicare's own consumer guidance describes nursing home care as covering "skilled nursing or rehabilitation services" and explicitly states that Medicare does not pay for assisted living [7]. |
Assisted living and nursing homes both house people who need help, but they sit at different points on the care intensity spectrum, and they're licensed and paid for differently. | Feature | Assisted living | Nursing home |
does medicare cover assisted living facilities
No. Medicare does not cover the room, board, or personal care costs of assisted living. Medicare.gov states plainly that Medicare does not pay for "custodial care" if that's the only care needed, and assisted living is generally classified as custodial [7]. Medicare Part A will cover a short-term stay in a skilled nursing facility after a qualifying inpatient hospital stay of at least three days, but that's a different setting and a different purpose (rehab, not long-term residential living) [8]. 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 doesn't pay the facility itself for housing or personal care. Medicaid is the payer that sometimes helps. States can use HCBS waivers under Section 1915(c) of the Social Security Act to pay for services (not room and board) delivered in assisted living settings for people who qualify financially and functionally [5]. Coverage, waiting lists, and eligibility rules vary enormously by state, so any specific Medicaid assisted living benefit should be confirmed with your state Medicaid agency and state licensing agency directly.
how to start a group home
Starting a group home (including a residential assisted living facility) generally runs through the same core sequence, though exact steps, fees, and timelines vary by state and by population served, so always confirm specifics with your state licensing agency. 1. Pick your population and license category. Seniors go under assisted living/residential care statutes; IDD, mental health, or recovery populations go under different state licensing tracks entirely, often tied to Medicaid HCBS waivers. 2. Check zoning before you sign a lease or purchase. Many states and cities treat small group homes as a permitted residential use under fair housing law, but occupancy caps, spacing requirements between homes, and fire code triggers vary by jurisdiction. This is the step most first-time operators underestimate; a house that looks perfect can fail zoning or fire marshal review before you ever file a licensing application. 3. Write your policy and procedure manual. States typically require written policies on medication management, emergency preparedness, resident rights, admission/discharge criteria, staffing plans, and abuse reporting before they'll approve a license application. 4. Build your staffing plan. Most states set minimum staff-to-resident ratios and require background checks (often through a state or FBI fingerprint system) plus training hours for direct care staff before they can work unsupervised. 5. Submit the license application, pay the fee, and schedule the pre-licensing inspection. Fees, forms, and inspection checklists differ by state; expect a physical plant inspection covering fire safety, exits, bedroom square footage per resident, and kitchen sanitation. 6. Pass the licensing survey and get your certificate. After that, expect periodic renewal inspections, usually annually or every two years depending on the state. Building all six pieces (entity formation, zoning research, policy manual, staffing plan, application forms, and inspection prep) from scratch usually takes new operators several months and a lot of trial and error, mostly because state requirements are scattered across different agency pages rather than existing in one document.
how do i start a group home in my state specifically
Because every state licenses group homes and residential assisted living facilities under its own statute and its own agency, the honest first move is identifying which specific agency governs your population and your state, and pulling their current application packet directly. There is no single national application. Start by searching "[your state] assisted living license application" or "[your state] residential care home license" on your state government's own website, not a third-party aggregator, since fee schedules and forms change. Cross-check zoning with your county or city planning department separately from the state health agency; these are usually two different processes running on two different timelines. If you want a structured way to organize the paperwork instead of hunting across a dozen agency PDFs, GroupHomePath's $299 State Group Home Licensing Kit compiles the application checklist, policy manual template, and staffing plan template for a given state into one package, which can save time compared to assembling everything from scratch. It doesn't replace your state's own application or guarantee approval; every application is still reviewed and approved solely by your state licensing agency on its own timeline.
what is the difference between assisted living and independent living or memory care
Independent living is housing with amenities (meals, activities, transportation) but no licensed personal care; residents are largely self-sufficient. Assisted living adds licensed help with ADLs on top of housing. Memory care is a specialized, usually secured unit within or alongside assisted living, licensed with additional staffing and training requirements for residents with Alzheimer's disease or other dementias. Many residential assisted living facilities operate on a continuum: a resident might move in needing minimal help, add services over time, and eventually transition to a memory care wing or unit within the same building if their state's license permits it. Others operate as freestanding memory care homes only. State rules on required additional staffing ratios, locked-door protocols, and specialized training hours for memory care vary; some states require a distinct license endorsement for memory care beyond the base assisted living license. The practical takeaway for someone comparing options: ask directly which license category a specific building holds and what that category legally allows the facility to do, rather than relying on marketing language like "senior living community," which isn't a licensing term in any state.
how much does assisted living cost and who pays
The national median cost of assisted living was $4,500 per month in 2021, according to Genworth's Cost of Care Survey, with wide state-by-state variation driven by labor costs, real estate, and regulation [9]. Rural states tend to run lower; states with high labor costs and dense regulation (much of the Northeast and West Coast) run well above the median. Most residents pay privately, at least initially, drawing down savings, home sale proceeds, or long-term care insurance. Medicaid HCBS waivers can help cover the services portion of the cost (not room and board) for financially and functionally eligible residents in states that include assisted living settings in their waiver, but availability and waiting lists vary by state [5]. Veterans may also access the VA's Aid and Attendance benefit to help offset costs, which is a separate program from Medicare or Medicaid. For operators, understanding the payer mix in your state matters before you finalize a business plan: a state with a strong assisted living HCBS waiver program may support a different resident population and rate structure than a state where nearly all residents pay privately.
Frequently asked questions
what is assisted living in simple terms
Assisted living is licensed housing for people, usually seniors, who need help with daily tasks like bathing, dressing, or medication but don't need full-time medical nursing care. It combines a private or semi-private living space with staff support, meals, and supervision, and is regulated at the state level rather than by the federal government.
what is a group home vs an assisted living facility
A group home is the broader category: any small licensed residential setting providing support and supervision, serving seniors, people with IDD, mental illness, or recovery needs. An assisted living facility is a group home specifically licensed under a state's senior/elder care statute, focused on ADL support for older adults.
what is assisted living facility care actually like day to day
Day to day, residents get help getting up, dressed, and to meals; medication reminders or assistance at scheduled times; housekeeping and laundry; and access to staff around the clock. Many facilities offer group activities, transportation to appointments, and a call system in each room, but daily structure and staffing levels vary by facility and state licensing tier.
what is the difference between assisted living and nursing home care
Assisted living provides non-medical help with daily activities in a home-like setting; nursing homes provide 24/7 skilled nursing and medical care, often after a hospital stay. Medicare can cover short skilled nursing home stays under specific conditions but never covers assisted living, according to Medicare's official coverage guidance.
does medicare cover assisted living facilities at all
No. Medicare.gov states that Medicare does not pay for custodial care, which is how assisted living is classified. Medicare may still cover separate medical services (doctor visits, therapy) for someone living in assisted living, but it never pays the facility for room, board, or personal care.
does medicaid pay for assisted living
Sometimes, through state HCBS waivers authorized under Section 1915(c) of the Social Security Act, which can cover the service portion of assisted living (not room and board) for residents who meet financial and functional eligibility. Availability, waiting lists, and covered services differ by state, so confirm with your state Medicaid agency.
how do i start a group home from scratch
Identify your population and correct state license category, check zoning before committing to a property, write required policies (medication management, emergencies, resident rights), build a compliant staffing plan with background checks, then submit your license application and pass a pre-licensing inspection. Steps and fees vary by state; confirm specifics with your state licensing agency.
how much does it cost to start a residential assisted living facility
Startup costs vary enormously by state and property type. There is no single reliable national figure, since costs depend on whether you're buying, leasing, or retrofitting a home, plus state-specific licensing fees, required renovations for fire code and ADA-type access, and staffing costs before opening. Get a state-specific fee schedule from your licensing agency.
what is the difference between assisted living and memory care
Memory care is a specialized, often secured level of care within or alongside assisted living, designed for residents with dementia, with higher staffing ratios and additional training requirements in most states. Assisted living is the broader base license; memory care usually requires an additional endorsement or separate license depending on the state.
what size is a typical residential assisted living facility
Residential assisted living facilities are typically licensed for somewhere between 6 and 20 residents, depending on the state's licensing tier, compared to institutional assisted living communities that can house over 100 residents. The exact resident cap and the license category name both vary by state.
can i convert my house into a group home
Often yes, but zoning, fire code, and licensing requirements must all be satisfied first, and requirements vary significantly by city and county. Check local zoning for group home use before signing a lease or purchase agreement, and separately confirm state licensing physical plant requirements (exits, bedroom square footage, sprinklers) with your state licensing agency.
what's the difference between assisted living and independent living
Independent living offers housing and amenities for self-sufficient residents with no licensed personal care included. Assisted living adds licensed help with daily activities like bathing, dressing, and medication on top of housing, and is regulated as a care setting rather than just a housing arrangement.
Sources
- Medicaid.gov, Home & Community-Based Services: CMS tracks assisted living within home and community-based services but leaves licensing to states
- Arizona Department of Health Services, Assisted Living Licensing: Arizona licenses assisted living homes up to 10 residents and centers for 11 or more
- Texas Health and Human Services, Assisted Living Facilities: Texas licenses Type A and Type B assisted living facilities based on evacuation capability
- California Department of Social Services, Community Care Licensing: California licenses Residential Care Facilities for the Elderly (RCFE) through Community Care Licensing
- Social Security Administration, Section 1915(c) of the Social Security Act: States use 1915(c) HCBS waivers to fund services in assisted living settings
- Florida Statutes, Chapter 429, Assisted Living Facilities: Florida distinguishes standard licenses from limited nursing services and extended congregate care licenses
- Medicare.gov, Long-Term Care Coverage: Medicare does not pay for custodial care, which includes assisted living
- Medicare.gov, Skilled Nursing Facility Care Coverage: Medicare Part A covers skilled nursing facility stays after a qualifying inpatient hospital stay
- Genworth, Cost of Care Survey 2021: National median monthly cost figures for assisted living and nursing home care in 2021