Alabama assisted living facility license: ADPH rules, fees and steps

Who needs an Alabama assisted living license

Alabama’s rule counts the people you serve, not the building. An assisted living facility is any individual, corporation, partnership, LLC or other entity that “provides, or offers to provide, any combination of residence, health supervision, and personal care to three or more individuals who are in need of assistance with activities of daily living.” The rule lists those activities as bathing, dressing, ambulation, feeding, toileting, grooming, medication assistance, diet and personal safety.⁠¹ Offering the service is enough to trigger the rule; you do not have to be caring for three people yet.

The rule has two exceptions:⁠¹

• Caring only for relatives. An individual who cares only for a spouse, parent, sibling, adult child, adult grandchild, grandparent, great-grandparent, adult niece or nephew, aunt, uncle or first cousin (or the same relation by marriage) is not an assisted living facility. The exception covers individuals only. It does not cover a corporation, partnership or LLC.
• Residents under another government agency. This applies where a government body both has a legal duty to oversee the residents and itself licenses or certifies the facility.

The facility application warns that “it is a violation of state law to provide assisted living facility services before you are issued a license.”⁠³ ADPH may also deny a license to anyone who “is operating, or has in the past operated, an unlicensed health care facility.” That makes an unlicensed start-up a lasting problem for any later application.⁠¹

There is no small-home license for new facilities

Many founders hope to start with two residents in a house. Alabama does not allow that for new facilities. The “family assisted living facility” category for two or three adults covers only facilities licensed before October 1, 2015. Those homes may renew each year, but if one closes “for any reason” it cannot be relicensed as a family facility. The rule is explicit: “No new license will be granted for assisted living facilities of fewer than three beds.”⁠¹ The smallest option open to you is a group facility.

Group, congregate or specialty care: pick the class first

The class you choose sets your building code, so decide it before you look at property.

Scroll the table sideways to see every column.

Sources: ⁠¹⁠⁶⁠⁷

A regular assisted living facility cannot serve people whose cognitive impairment would make them ineligible to live there. The SCALF license exists for those residents. ADPH defines a SCALF as a facility “specially licensed and staffed to permit it to care for residents with a degree of cognitive impairment that would ordinarily make them ineligible for admission or continued stay in an assisted living facility.”⁠¹⁠⁹ A regular facility also may not use names like “dementia care facility,” “impaired memory unit,” “Alzheimer’s care facility” or “specialty care facility.”⁠¹

If you plan one building with both a regular unit and a specialty care unit, the building is classified by the combined bed count for code purposes. The specialty care unit’s sleeping, bathing, dining and activity areas must be a distinct, separate unit, although administrative, kitchen and service areas may be shared.⁠¹ Specialty care has its own requirements, including a medical director who is a physician licensed in Alabama.⁠⁶

Certificate of need applies to specialty care beds

Alabama’s certificate-of-need definitions list hospitals, skilled nursing and intermediate care facilities, home health agencies, hospices and other providers. Assisted living facilities are not on the list.⁠⁸ The State Health Plan does treat SCALFs as intermediate care facilities and sets a county bed-need formula of six beds per 1,000 residents aged 65 and older. Under that plan, no SCALF beds are added in a county already above that ratio, except under narrow adjustments.⁠⁷ The sources checked do not say in so many words that a regular (non-specialty) facility is exempt from certificate of need. The definition of “health care facility” is written as an inclusive list that omits assisted living, and the State Health Plan sets a bed-need formula only for SCALFs.⁠⁷⁠⁸ Before you buy or build, ask the State Health Planning and Development Agency (SHPDA) to confirm in writing that your project needs no certificate of need.

Who you can admit and keep

The admission limits decide who your residents can be. An Alabama assisted living facility may not admit anyone who:⁠¹

• receives or requires skilled nursing care;
• has a wound that needs more than basic first aid;
• cannot make decisions about personal safety, or cannot direct their own care;
• has behaviors that may be dangerous to themselves or others;
• cannot safely manage medications, or self-administer them with assistance;
• is receiving or needs hospice services;
• can live there safely only if their exit from the building is restricted;
• has active tuberculosis, an acute infectious pulmonary disease such as influenza, or another disease spread through normal contact.

There are also limits on keeping residents. You may not keep a resident whose medical or skilled nursing needs are expected to last more than 90 days. The exceptions are a resident who performs their own care, and a resident who cannot do some tasks physically but can direct staff to do them. A resident who develops a terminal illness other than dementia may receive hospice from a licensed hospice and stay beyond 90 days. Skilled services such as wound care or catheter insertion must come from licensed or certified outside agencies and “shall not be delegated to facility staff.”⁠¹ No part of the facility may be run in a way that prevents residents from leaving freely.⁠¹

Medication administration for a resident who cannot self-administer may be provided only by a physician, RN or LPN. Unlicensed staff may only assist with self-administration, within limits the rule spells out. For example, they may remind residents, open containers and bring medication to the resident. Crushing, splitting or mixing medication into food is allowed only with a physician’s order and other conditions.⁠¹ Admission agreements must state that the facility is not staffed or authorized to provide skilled nursing or care for severe cognitive impairment.⁠¹

Choosing a site and building

Location. A new facility must be at least 1,000 feet from railroads, freight yards and disposal plants. The distance drops to 500 feet with a board fence at least six feet high. The facility must also be on a publicly maintained street or road.⁠¹ It must meet local zoning, building and fire ordinances, and ADPH may require signed proof from local officials. If your site has no local zoning, building or fire review, get a letter saying so from the county commission (by official board action) or from the probate judge’s office.⁠¹ The application itself requires a copy of the local zoning approval.⁠³

No other businesses on site. No part of the facility may be rented or used for a commercial purpose that residents do not reasonably need, and ADPH approves all occupancy plans.⁠¹

Group facilities. A group facility licensed, built or renovated after December 25, 1991 must be a single-story building that meets the currently adopted building code and Life Safety Code. The rule also requires:⁠¹

• at least two exits remote from each other, with no dead-end corridor longer than 20 feet;
• no more than 100 feet of travel from any occupied room’s corridor door to an exit;
• a door from each bedroom or suite directly outside or to an exit corridor that leads outside;
• exit doors that swing outward, with panic hardware in facilities going through plan review;
• exit corridors at least 36 inches wide;
• in buildings over 3,000 square feet, smoke barriers that split the building roughly in half by beds.

Congregate facilities must meet the requirements for limited care facilities in the Life Safety Code’s “New Health Care Occupancies” chapter.⁠¹

Rooms and bathrooms. Bedrooms hold no more than two residents. Minimum sizes are 80 square feet for a private room and 130 for a double, or 160 and 200 square feet if the room has a sitting area.⁠¹ Where bedrooms lack their own bathrooms, you need at least one tub or shower per eight beds, one lavatory per six beds and one toilet per six beds.⁠¹ Each bedroom must be reachable from a main corridor, or through no more than one sitting room in the suite. No bedroom may be the route into another resident’s room.⁠¹

Fire alarm and sprinklers. If the fire alarm or sprinkler system is out for more than 4 hours, you must evacuate or post a continuous fire watch coordinated with ADPH and the local fire marshal. You must report the outage to ADPH within 12 hours or by the next duty day. Both systems need inspection by qualified personnel at least twice a year.⁠¹

The application, in the order ADPH needs it

1. Get an administrator licensed, or start the process

   The application asks for a copy of the administrator’s current license.⁠³ Licensing takes exams and a course (see below), so start this early.

2. File the Pre-License Filing

   ADPH requires a Pre-License Filing for every new facility that must submit building plans. It “must be submitted and approved before plans will be reviewed by Technical Services.”⁠⁴

3. Submit plans and specifications

   Plans for any building that will house an assisted living facility, whether new construction or an existing structure, go to ADPH for review under Ala. Admin. Code 420-5-22.⁠¹ Technical Services can be reached at (334) 206-5177.⁠³

4. Build or renovate and obtain the Certificate of Completion

   The application asks for a copy of the Certificate of Completion, because the site “must comply with certain requirements and be approved by this agency.”⁠³ ADPH may inspect construction at any time while work is under way.⁠¹

5. Form the entity and register it

   Attach your articles of incorporation or organization, operating or partnership agreement, or sole proprietorship statement. Also attach your Alabama Secretary of State Certificate of Existence, or a certificate of registration for an out-of-state entity.⁠³ The applicant must be the operator: the party that hires and fires the administrator and pays the bills. If you lease the building, the lessee is the applicant.⁠³

6. Write the required policies

   ADPH reviews the policies the rules require before it grants a license.⁠³ See the list below.

7. Sign the physician agreements

   The application asks for a Medical Director’s agreement and a copy of the physician’s license. It also asks for at least one physician who agrees to respond to emergencies when a resident’s own doctor cannot be reached, with a copy of that agreement.⁠³

8. Submit the application and fee

   Include a facility diagram showing licensed beds and room numbers. Disclose every board member and officer and anyone with a 5% or more ownership interest, plus any other facilities they run, past adverse actions and criminal history.⁠³ The rules separately require you to identify anyone holding 10% or more of the operator or of the real estate, and to report changes within 15 days.⁠¹

9. Answer deficiency notices quickly

   If ADPH finds the application incomplete, it keeps the fee and gives you 10 working days to send what is missing. If you miss that deadline, the application is denied.⁠¹

10. Pass the on-site survey

    A license may be granted “upon approval of the application, building approval from Technical Services, and a successful on-site survey.”⁠³

ADPH says that because of workload, “application review takes a minimum of thirty days.” The earliest a license can be issued is the day the complete application and all additional reviews are approved.⁠³ Licensing questions go to (334) 206-5175.⁠³ License certificates are printed online with a facility ID and PIN that ADPH issues.⁠³

Each facility needs its own license, even if one company owns several. A license is valid only at the licensed address and for the named licensee.⁠¹

Fees

Sources: ⁠¹⁠²⁠³

At those rates, a 16-bed group facility pays $240 + (16 × $18) = $528 a year. Fees are payable to the Alabama Department of Public Health by check or money order (the rule also allows cash) and are non-refundable. ADPH returns an application sent with no fee and holds an underpaid one until the difference arrives.⁠¹⁠³ The specialty care license uses the same fee schedule.⁠² The fee is set by Code of Ala. § 22-21-24.⁠¹

The administrator license

Every administrator, and any substitute who acts for them, must be at least 19 years old and of “reputable and responsible character.” The administrator must be properly licensed. A facility may never run more than 45 days without a licensed administrator.⁠¹ In group facilities the owner and the administrator may be the same person, which is how many small operators start.⁠¹

Licenses come from the Alabama Board of Examiners of Assisted Living Administrators. A Category I license covers regular assisted living facilities. A Category II license covers both regular and specialty care facilities.⁠⁵ For Category I, under board rules effective November 20, 2013, you need:⁠⁵

• age 19 or older, good moral character, and US citizenship or legal presence;
• a high school diploma or GED plus two years of full-time work in an administrative and resident-care position in an assisted living facility, nursing home, hospital or similar setting, within the two years before you apply, with an endorsement from that employer; or at least 60 semester hours (96 quarter hours) of college plus three months of that work or a 240-hour board-approved internship, either within the two years before you apply or within six months after you pass Section A;
• a passing score on Section A of the exam, which covers ADPH’s Chapter 420-5-4 rules;
• completion of the board’s 20-hour classroom course, then a passing score on Section B.

Category II follows the same path with Section A on the specialty care rules (420-5-20) and a 30-hour course. It also requires an 8-hour board-approved dementia education program before you sit for Section A.⁠⁵ Passing Section A earns a provisional license that lets you serve as administrator for up to nine months. You must pass Section B before it expires.⁠⁵

Staffing and training

Alabama sets no numerical staff-to-resident ratio for regular assisted living. The standard is about outcomes: enough staff on duty “to meet the care and safety needs of all residents 24 hours a day, 7 days a week.” That includes enough staff to evacuate every resident in a fire, and at least one person with current CPR certification on duty at all times.⁠¹ If staffing levels are adequate on paper but care is not being delivered, the administration requirement is still not met.⁠¹ Post a staff schedule and keep it for six months.⁠¹

Before a new employee has any contact with residents, the rules require:⁠¹

• a physical exam showing the employee is free of transmissible skin lesions and diseases;
• a tuberculosis evaluation within the 30 days before contact;
• a check that the person is not on ADPH’s Nurse Aide Abuse Registry;
• training in 12 subjects. These include state assisted living law and rules, facility policies, resident rights, reporting abuse, neglect and exploitation, basic first aid, advance directives, confidentiality, fire safety, special needs of elderly and mentally ill residents, nutrition, and recognizing signs of dementia.

The facility must immunize employees in line with CDC recommendations, and the State Health Officer may waive or delay a vaccine during a shortage.⁠¹ Every staff member with resident contact must hold American Heart Association or American Red Cross CPR certification within 90 days of hire. If you keep an AED, someone certified to use it must be on duty at all times.⁠¹ Residents with diabetes, hospice care or oxygen require matching staff training. All staff need annual continuing education.⁠¹

Policies ADPH reviews before licensing

The governing authority must adopt written policies covering:⁠¹

• protecting residents from abuse, neglect and exploitation, and handling allegations;
• confidentiality;
• admission, continued-stay and discharge criteria, and notice procedures;
• lost belongings;
• the services you can and cannot provide;
• medication management;
• infection control;
• meals and food handling;
• fire safety, drills, alarm, sprinkler and extinguisher checks, and disaster preparedness;
• staffing and staff conduct;
• oxygen use and storage, if any.

Dietary policies are developed by a dietitian and approved by the administrator, following the FDA Food Code. They must include disaster menus and a plan for keeping food safe without electricity.⁠¹ Residents must get a copy of any new or changed policy at least 30 days before it takes effect.⁠¹

Fire drills are monthly, at varying times. Group and congregate facilities must also drill quarterly on each shift. Every drill must be set off by the fire alarm system and must involve actually moving residents out of the area.⁠¹

After you open: renewal, inspections and changes

• Renewal. Every license expires at midnight on December 31. If you renew after the last business day of December, you owe a late fee equal to the license fee. A license not renewed by the end of January is void.⁠¹
• Inspections. ADPH may inspect “at such intervals as the Board may direct.”⁠¹ A facility with serious, chronic or uncorrected deficiencies can be placed on a probational license for up to one year and may not add beds while on probation.⁠¹
• Staying open. If the facility is not open and staffed for 30 days, the license becomes void unless you told ADPH that services were suspended for remodeling.⁠¹
• Notices. Tell ADPH at least 30 days before a voluntary closure. Report a new administrator or management company within 15 days.⁠¹
• Selling. A license cannot be transferred. The buyer must file a change-of-ownership application, with the full fee, at least 30 days before the transfer. Without approval, the license becomes void and continued operation is unlawful.⁠¹

How residents pay

The Alabama State Health Plan states that “assisted living is available in Alabama on a private-pay basis only.” In practice, plan your revenue on residents’ own funds, not on a Medicaid assisted living rate.⁠⁷ The same plan counted 194 licensed facilities with 7,253 beds as of September 2019. At that time 19 of the state’s 67 counties had no assisted living facility.⁠⁷

Recent and pending changes

Chapter 420-5-4 was rewritten effective April 7, 2019 and last amended effective May 15, 2022.⁠¹ The application form in use was revised in December 2019, and the fee table has been in effect since July 30, 2016.⁠²⁠³ The State Health Plan’s long-term care chapter, which holds the specialty care bed-need formula, was readopted effective June 14, 2024.⁠⁷ No pending amendment to the assisted living rules was found on the sources checked on 2026-10-12.

If you are looking at child care instead, see the Alabama family day care home guide and the Alabama day care center guide.

Sources

1. 1
   Alabama Legislative Services Agency, Alabama Administrative Code, Ala. Admin. Code Chapter 420-5-4, Assisted Living Facilities (revised May 15, 2022) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Alabama Department of Public Health, Bureau of Health Provider Standards, Licensure Application (applications and Health Care Facilities License Fees) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Alabama Department of Public Health, Initial License Application to Operate an Assisted Living Facility (revised December 2019) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Alabama Department of Public Health, Bureau of Health Provider Standards, Pre-License Filing Checked 12 Oct 2026 · Back to text ↑
5. 5
   Alabama Board of Examiners of Assisted Living Administrators, Qualifications for Licensure as an Assisted Living Administrator Checked 12 Oct 2026 · Back to text ↑
6. 6
   Alabama Legislative Services Agency, Alabama Administrative Code, Ala. Admin. Code Chapter 420-5-20, Specialty Care Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
7. 7
   Alabama Legislative Services Agency, Alabama Administrative Code, Ala. Admin. Code Chapter 410-2-4, Alabama State Health Plan: Long-term care (effective June 14, 2024) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Alabama Legislative Services Agency, Alabama Administrative Code, Ala. Admin. Code Chapter 410-1-2, State Health Planning and Development Agency: Definitions Checked 12 Oct 2026 · Back to text ↑
9. 9
   Alabama Department of Public Health, Bureau of Health Provider Standards, Facilities Descriptions Checked 12 Oct 2026 · Back to text ↑

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