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What Are the State Requirements for Assisted Living Communities? An Overview

15 minute readLast updated January 8, 2024
fact checkedon January 8, 2024
Written by Rebecca Schier-Akamelu, assisted living writer
Reviewed by Saul Chapnick, MSWAssisted living executive Saul Chapnick has extensive experience revitalizing distressed facilities and ensuring new ones start strong.
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When considering assisted living communities for your loved one, you’ll likely have questions around licensing and regulations. Each state has its own guidelines and licensing requirements for assisted living communities, which means there are subtle differences in what assisted living communities provide in each state. States also must keep records of inspections, reports, and violations. Take a look at some common questions about assisted living regulations, including how to check licenses and inspection reports of senior living facilities in your state.

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Key Takeaways

  1. The federal government doesn’t regulate assisted living communities. State governments are in charge of licensing and regulated assisted living facilities.
  2. Some assisted living communities provide memory care. States typically have more specific regulations for communities offering specialized services for residents with dementia.
  3. Communities need regular inspections to maintain their license. Each state has different guidelines for how often these inspections should occur.
  4. Communities with violations may have inspections more often. States can fine communities or may even revoke their license.

Which agency regulates assisted living facilities?

Individual state agencies — not the federal government — regulate assisted living facilities. In most cases, it’s up to the state health or social services department to regulate assisted living communities, sometimes referred to as “residential care settings” or “residential assisted living facilities.”

Assisted living communities and residential care settings provide the following:

  • Housing and meals
  • Supportive services
  • Personalized assistance with activities of daily living (ADLs)
  • Medication management
  • Minor health care, generally excluding hospital-level care

In your senior living search, you may come across residential care homes, sometimes called “personal care homes” or “board and care homes.” These homes are similar to larger assisted living facilities, although they have a more homelike environment with fewer residents. Typically, the same state agency is also in charge of regulating these care homes, as they’re a form of assisted living.

In some states, residential care homes may be licensed as an assisted living facility. In other states, there may be more of a distinction between assisted living and residential care homes, usually centering on the number of residents.

Are assisted living facilities and nursing homes regulated the same way?

Nursing homes and assisted living communities are different, both in the level of care they offer and in the way they are regulated. Nursing homes are regulated at the federal level. The Centers for Medicare and Medicaid Services (CMS) regulates and provides ratings for nursing homes and skilled nursing facilities. If you’re searching for a nursing home, you can view the audit and licensing history of Medicare-approved nursing homes on the Medicare website.

Nursing homes offer 24/7 care for seniors who need a high-level of medical oversight due to a serious or chronic health condition. Unlike assisted living, nursing home care is based on a medical model. Typically, a doctor needs to prescribe a nursing-home level of care before a senior is admitted as a full-time resident. A senior who doesn’t quite need this level of care may be better suited for assisted living.

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Who regulates memory care facilities?

The same state department that regulates assisted living communities typically licenses memory care communities. Most of the time, memory care is licensed as a specialized form of assisted living. If your loved one is experiencing memory loss, you may find communities that offer both assisted living and memory care on the same campus.

In this multi-care setting, the memory care area of a community will typically have additional security features for residents. Many states also have additional training requirements for caregivers working with people who have Alzheimer’s or another form of dementia. Again, these regulations and training requirements will vary depending on the state you live in.

Typically, requirements for assisted living communities offering memory care focus on:

  • Features of a memory care unit or apartment
  • Staff-to-resident ratios
  • Staff training
  • Behavior management methods

When applying for licensure, memory care communities often must provide a disclosure form describing how they meet these requirements.[01]

Do assisted living communities need a license?

Yes — before opening, assisted living communities must have a license from the proper state agency. The agency then proceeds to inspect or survey each community on a routine basis to maintain its license. Inspections usually occur both annually and when someone files a complaint.

To obtain a license, an assisted living community has to show that they meet the rules and regulations established on the state, local, and municipal level. This could include rules set by any of the following agencies:[01]

  • The office of sanitation
  • The office of public health
  • The office of the state fire marshal
  • The city fire department
  • The local zoning or permit office

Once a community is licensed, it’ll receive regular inspections. Many states conduct these annually, and in many cases inspections are unscheduled. If a community has a reported violation, they’ll receive more frequent inspections, and the state can impose a penalty or even revoke a facility’s license if they fail to make corrections.[01]

Regulations vary from state to state. Some common state regulations include:

  • The type of training staff is required to receive
  • What must be covered in the initial service agreement
  • Which staff members can provide medical services
  • When an initial care assessment should take place
  • How often care plans are reassessed
  • Caregiver-to-resident ratios or caregiver hours in relation to facility size
  • Standards for community cleanliness
  • Updated medical records

It’s important to note that although state-specific regulations may overlap with broader assisted living regulations, the specifics of the requirements can vary considerably. Researching the regulations specific to your state can help you to better understand what’s required of a prospective community and how to identify potential red flags during a tour.

How do I report a violation of assisted living regulations?

If you suspect that a community isn’t complying with state guidelines for cleanliness or care, or even neglect or elder abuse, contact the state’s Adult Protective Services (APS) agency. This listing of APS agencies by state provides contact information. You can also contact the licensing organization in your state, which you can find listed on a community’s license. Many assisted living facilities are required to post these licenses in a public area according to state regulations.

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A state-by-state guide to assisted living regulations

Our state-by-state guide to assisted living provides an overview of what you can expect from assisted living communities in each state. We provide information on top-rated communities, cost information, state regulation details, reviews from families, and more. Each state page also includes a summary of how to obtain licensing records on your local assisted living communities.

In many states, you can find a community’s license and inspection reports online. However, in other states, you may need to request this information from a state agency. You can also request the latest survey or inspection report directly from individual assisted living communities.

We’ve rated each state’s regulation system based on the following:

  • The amount of information available to the public
  • The ease of access to the information
  • The frequency of state inspections

When in doubt, you can connect with one of A Place for Mom’s Senior Living Advisors. These dedicated local experts can help you better understand the many regulations for assisted living in your state, as well as other features you can expect from your individual market. They’ll work with your family to help you find a community that meets your care needs and budget, all at no cost to your family.

State assisted living guides:


  1. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Compendium of residential care and assisted living regulations and policy: 2015 edition.

Meet the Author
Rebecca Schier-Akamelu, assisted living writer

Rebecca Schier-Akamelu is a senior copywriter at A Place for Mom, specializing in topics such as assisted living and payment options. With more than a decade of experience as a content creator, Rebecca brings a person-centered approach to her work and holds a certificate in digital media and marketing from Duke University.

Edited by

Marlena Gates

Reviewed by

Saul Chapnick, MSW

The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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