Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition Executive Summary


Paula Carder, PhD, Janet O'Keeffe, Dr.PH, RN, and Christine O'Keeffe, BA

RTI International

June 15, 2015

Residential care settings are an important option for older adults and people with disabilities who require long-term services and supports. They provide a community-based living alternative to individuals who might otherwise require nursing home care and those who do not need this level of care but are unable to continue living in their own or a relative's home.

Based on a 2012 study conducted by the National Center for Health Statistics, the United States has an estimated 22,200 residential care settings with 713,300 residents. Just over half of settings with 50 or more units had a dementia care program or unit and 52 percent were certified to receive Medicaid payments.

Residential care settings are licensed and regulated at the state level, and all states have at least one category of residential care. The purpose of this Compendium is to summarize and compare states' residential care setting regulations.

Although states generally have provisions covering the same areas--such as staff training--their requirements vary considerably. For example, 40 states require direct care worker training, but the number of required training hours ranges from 1 to 80. This Compendium notes similarities and differences among states and provides examples from state regulations.

In 2014, the Centers for Medicare and Medicaid Services established requirements for community-based service providers, including residential care settings that receive Medicaid payment for services provided to eligible residents. The requirements address characteristics and standards that must be present for a setting to be considered non-institutional. Some states may need to revise their residential care regulations to comply with the requirements regarding, for example, person-centered planning, privacy, choice of roommate, access to food, and other issues related to autonomy and choice. Thus, this Compendium may serve as a baseline of regulations before these requirements were established.

The Full Report is also available from the DALTCP page ( or directly at