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Who Regulates Assisted Living Communities in the U.S.?

Who Regulates Assisted Living Communities in the U. S

Key Summary

Assisted Living Communities must have a license to open and maintain certain standards. Learn who regulates senior communities and what regulators look for.

If you or a loved one are thinking about moving to an Assisted Living Community, you’re about to make one of the most important decisions of your life. You want to ensure the Assisted Living Communities you’re checking out are up to scratch in terms of the upkeep of the community, staff qualifications, safety and security, ability to help with medication management, and many other factors.  

Before opening, Assisted Living Communities must have a license from the proper agency—and they must maintain certain standards from that point forward. 

Who regulates Assisted Living Communities in the U.S.? What factors are taken into consideration by the regulators? Are some types of senior communities regulated by state agencies, while others fall under the purview of federal regulators? Let’s take a look at the key factors you need to know regarding the regulation of Assisted Living Communities in the U.S. 

Federal vs. State Regulations 

The federal government regulates Memory Care Communities, Long-Term Care (LTC) centers, residential care centers, and Skilled Nursing Facilities (SNFs) that accept funding such as Medicaid and Medicare. Agencies such as the Centers for Medicare and Medicaid Services (CMS) regulate communities such as Skilled Nursing Facilities. 

CDC Guidelines for Assisted Living Communities 

The Centers for Disease Control and Prevention (CDC) provides extensive guidance for LTC centers, including Assisted Living Communities. This includes guidance for staff, safety precautions for residents, infection prevention, and numerous other resources. 

State Regulations for Assisted Living Communities 

Individual states regulate Assisted Living and Memory Care Communities, which provide senior housing, support services, personalized assistance with activities of daily living (ADLs), companionship with other residents and staffers, and many other benefits. You can learn more in our article, “What Services and Activities Do Assisted Living Communities Provide?” 

As mentioned, regardless of the state in which you live, an Assisted Living Community must acquire a license from the proper state agency. This agency will then inspect the community on a regular basis. Agencies will also sometimes conduct inspections if a complaint is filed. States can revoke or suspend a license if an Assisted Living Community fails to comply with state requirements. 

Each state’s department of public health regulates Assisted Living Communities through an established set of rules. Some qualifications will vary from state to state. According to the Illinois General Assembly, for example, an Assisted Living Community is defined as an establishment that provides “community-based residential care for at least three unrelated adults…who need assistance with Activities of Daily Living (ADLs) including personal, supportive, and intermittent health-related services available 24 hours per day, if needed, to meet the scheduled and unscheduled needs of a resident.”  

While the list can vary depending on the state and regulations, Assisted Living Communities must demonstrate that they provide certain services, as defined under the following categories.   

Disclosure Items 

The Assisted Living Community shall provide residents with a copy of current resident policies: whether each unit has individual heating and air conditioning controls, the facility’s policies concerning response to medical emergencies, and whether the facility provides therapeutic diets. 

Scope of Care 

Assisted Living Communities must provide services such as three meals per day, laundry and housekeeping, security measures and an emergency response system, and assistance with ADLs. 

Resident Assessment 

A physician’s assessment must be completed within a designated period of time prior to a resident moving. Re-evaluations must be completed annually. Establishments can develop their own methods of evaluating residents. 

COVID-19 has played a major role in regard to current additions to assessment protocols. You can learn more in our article, “Which COVID Vaccine is Best for Seniors Citizens?”  

Residents Allowed Per Room 

Assisted Living Community units are individual units, unless residents choose to share a unit. The maximum per unit is usually two residents. 


Assisted Living Communities must comply with National Fire Protection Association Life Safety Codes

Staffing Requirements 

Each community must have a full-time manager. The staff should include an adequate number of individuals with the education, qualifications, skills, and experience to meet the needs of residents. At least one staff member must be on duty and on-site, 24 hours a day. 

Other Established Regulations 

States regulate Assisted Living Communities in a number of ways and make sure they are adhering to an established set of rules, protocols, and procedures. They might do this by: 

  • Completing scheduled surveys 
  • Completing unannounced visits 

Every community has an ombudsman, so if you’re not sure where to go with your concerns, you can contact the ombudsman. 

If any Assisted Living Community does not comply with said rules and regulations, violations can result in fines and other severe penalties. 

Find Senior Living Near You 

Selecting an Assisted Living Community that follows the rules can bring you peace of mind that you or your loved one is in a safe location. Referah Family Connection Agents have resources to connect you with communities that meet these standards, so you can inform your search with quality communities that care. Talk with us today about your senior living needs. From Assisted Living to Independent Living and Memory Care, we have professional care and support available across the US. Find your community today! 

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