Georgia adult day center license: social vs medical model, the 1:8 ratio and GAHLES filing

Who Georgia requires to be licensed

Georgia’s rule defines an adult day center as a facility serving aging adults that provides adult day care or adult day health services for compensation to three or more persons ⁠¹. “Aging adults” means people 60 or older, or younger adults whose needs are substantially similar because physical or mental limitations restrict their daily activities and independent living ⁠¹. The rules come from the Adult Day Center for Aging Adults Licensure Act, O.C.G.A. § 49-6-80 et seq., and have been in force since January 7, 2015 ⁠¹⁠².

Rule 111-8-1-.03 carves out four groups that do not need the license ⁠¹:

• Programs that receive no compensation as a condition of a participant’s attendance.
• Providers paid to serve only one or two participants.
• Day habilitation and treatment programs serving only people with developmental disabilities.
• Respite care services programs that meet every part of the definition: run by a nonprofit, open no more than 25 hours a week, managed by a director who has completed a Department-approved adult day training and orientation program, staffed primarily by volunteers, and existing only to give primary caregivers of aging adults relief.

The respite exemption is narrow. A church or nonprofit caregiver-relief program that opens 30 hours a week, or that relies mainly on paid staff, falls outside it. Georgia also restricts the name: no one may use terms in a business name or marketing that imply an adult day center unless they hold a license ⁠¹.

The licensing agency is the Department of Community Health’s Healthcare Facility Regulation Division (HFRD). Adult day centers sit inside HFRD’s Personal Care Home Program, which also oversees personal care homes, assisted living communities and community living arrangements; the program’s team line is (404) 657-5700 ⁠⁵. If you plan to house participants overnight, you are looking at a personal care home permit or an assisted living community permit instead. Care delivered in clients’ homes falls under the private home care provider license. Adult day rules in other states are compared on the adult day license page.

Social model or medical model

Georgia issues one license type but classifies each center by the program it runs, and that classification drives the fee, the staffing and the floor plan ⁠¹⁠⁴:

• Adult day care (ADC), the social model, primarily offers social and recreational activities, with limited personal care help, supervision or help with daily living activities as required ⁠¹.
• Adult day health services (ADHS), the medical model, provides social, rehabilitative, health and personal care services to sustain daily living and restore or maintain self-care, based on individual plans of care ⁠¹.

Switching later is possible, but it is a filing: HFRD’s packet treats “Change of Service Level from Adult Day Center to Adult Day Health Service” as its own application, needing an RN license copy and photos of an accessible bathroom and shower ⁠⁷, and the fee schedule charges $300 for a change in service level that requires an on-site visit ⁠⁴. DCH’s CCSP overview describes the Medicaid waiver service as adult day health at an adult day health center, so weigh the medical model early if you expect waiver participants (see the payment section below) ⁠⁹.

Mobile adult day centers

Georgia also licenses a traveling program. A mobile adult day center uses a designated staff that travels from one central location to off-site locations, bringing staff, records, supplies and program materials, and offers services four days a week or less at any one location ⁠¹. One mobile license covers no more than five off-site locations, every one of which must be listed on the application, and each off-site space must meet the physical plant and fire safety rules ⁠¹. If you run a regular center and a mobile one, each carries its own license fee ⁠¹. HFRD’s packet has separate checklists for a mobile center attached to an existing freestanding center (which must hold a current permit) and for a mobile center without one; the second needs the full ownership, affidavit and background check documents ⁠⁷.

The rule also lets a center operate in donated space: written permission from the property owner authorizing the center to operate exclusively within a designated space substitutes for a deed or lease ⁠¹.

Space and building standards

Your licensed capacity is set by two numbers: the floor space available for participant activity and the occupancy load set by the local fire authority or the State Fire Marshal. The license states the maximum participants per day, and you may not schedule above it ⁠¹.

Rule 111-8-1-.10 sets the space standard at 35 square feet of usable floor space per participant, excluding passageways, bathrooms, lockers, storage rooms, staff rooms and anything else not used for participant activities ⁠¹. Measure your activity rooms only. Other physical requirements ⁠¹:

• A standard landline-type telephone on the premises during open hours; a cell phone or pay phone does not satisfy the rule. Emergency numbers are posted at each phone.
• Accessibility for people with physical disabilities and compliance with building codes.
• One toilet per 12 participants or fraction of 12, with individual stalls where a room has several, and bathroom doors that staff can open from outside.
• Rest areas furnished with a bed, recliner, sofa or chair with back and arm support, and a private area for first aid, ADL help and counseling.
• Table space to seat every participant for dining at once, arranged for wheelchairs.
• Room temperatures kept between 70 and 85 degrees Fahrenheit.
• A shaded, secure outdoor area directly connected to the center if you offer outdoor activities.
• Quarterly fire drills with participants, annual fire extinguisher inspections, smoke detectors on house current, and no space heaters or open-flame heaters.

A center may share a building with a licensed nursing home, personal care home or assisted living community, but it may not use residents’ rooms or furnishings, and both programs must keep their own staffing ratios ⁠¹.

Local approvals to collect first

Georgia leaves zoning entirely to local government: the applicant must address location requirements with local officials ⁠¹. HFRD’s initial checklist then asks for documents that only third parties can produce ⁠⁷:

1. Zoning

   City or county zoning approval or the equivalent document.

2. Fire safety

   A fire safety inspection report with no violations or hazards, from the appropriate fire authority, showing the capacity load and dated within six months of submission.

3. Water and sewer

   A water bill showing sewer charges if you are on public utilities. On a septic system, the county environmentalist completes HFRD’s Water and Septic Tank Report Form; on private water, attach a water test dated within six months.

4. Food service permit

   , only if you will be licensed for 24 or more participants. Below 24, no permit is required, but the rule still sets kitchen standards, including refrigerators at or below 41°F and freezers at 0°F ⁠¹⁠⁷.

5. Vehicles

   If you transport participants, proof of property damage, uninsured motorist and bodily injury coverage plus vehicle registration ⁠¹⁠⁷.

Because the fire report and any private-water test go stale after six months and the GCHEXS letter after 12, time those three so they are all current on the day you submit ⁠⁷.

Staffing, the director and training

Rule 111-8-1-.13 sets the floor for every center ⁠¹:

• A Director responsible for daily operations, with a designated stand-in when the Director is absent. Each center run by the same governing body needs its own Director available on site during operating hours ⁠¹.
• At least one staff member with current first aid and CPR certification in the center at all times.
• A named staff person who directs activities.
• A ratio of no less than one staff member or volunteer to eight participants among people providing direct services. Clerical, office, maintenance and food service workers do not count.
• A monthly work schedule plus a record of actual coverage by date, name and hours.
• Enough staff to evacuate everyone promptly, increased as the number of non-ambulatory participants rises.

Volunteers count toward the 1:8 ratio, but they need screening and training on abuse, neglect and exploitation reporting ⁠¹.

Within the first 90 days of employment, each employee or contractor needs Department-acceptable training covering the adult day rules and your policies, CPR with return demonstration, standard precautions and infection control, recognizing elder abuse and self-neglect, participant rights, confidentiality, influenza and vaccination, diversity, and Alzheimer’s disease and other dementias ⁠¹. Unlicensed staff who help participants self-administer medication need a medication curriculum covering label reading, the “rights” of medication assistance, side effects and documentation on the Medication Assistance Record ⁠¹. Medical-model centers add training on the laws governing medication administration ⁠¹. Before starting work, every employee must be screened for tuberculosis following CDC guidance for health care personnel ⁠¹.

Medication limits shape hiring. Without an RN, LPN or proxy caregiver on staff, staff may only remind participants, check the dose against the label and help open containers; injections such as insulin need a nurse or proxy caregiver if the participant cannot self-inject ⁠¹.

Background checks through GCHEXS

Before a new license is issued, the owner must comply with Georgia’s criminal background check rules, chapter 111-8-12. The Director and every direct access employee need a satisfactory fingerprint records check determination before starting work ⁠¹. In practice HFRD’s checklist asks for a satisfactory determination letter from the DCH Georgia Criminal History Check System (GCHEXS), dated within 12 months of submission, covering all administrators and every individual who owns 10 percent or more ⁠⁷. If no individual owns 10 percent, you submit a signed letter on company letterhead saying so. The owner requests GCHEXS access online; DCH’s Office of Inspector General answers questions at 404-463-7154 or [email protected] ⁠⁷.

Policies HFRD expects before it licenses you

Rule 111-8-1-.08 requires written policies before a license is granted ⁠¹. They must cover:

• The services offered, whether ADC, ADHS or both, the participants you expect to serve, and an Alzheimer’s Disclosure Form where O.C.G.A. § 31-8-182 applies.
• Number and qualifications of staff and volunteers, and whether any services are contracted.
• Days and hours, and core hours of operation.
• Fees, including the daily charge and every extra charge (transportation, bathing, hygiene products), how fee changes are announced, refunds and voluntary contributions.
• Incident documentation, emergency medical situations, standard precautions, keeping sick staff and visitors off the premises, medication storage, smoking and discharge criteria.
• Complaints, resolved within seven business days, with referral information for outside agencies.

Participants get 30 days’ written notice before any substantive change in fees or the participant agreement ⁠¹. The agreement must state fees, attendance days and hours (no more than 14 hours in 24), the refund policy, holiday closures and how you announce weather closings ⁠¹.

You also need a disaster preparedness plan in the format DCH provides, submitted for approval, with a copy to the local emergency management agency and every part rehearsed each year. Emergency procedures must include a plan to call local law enforcement once a participant has been missing more than 30 minutes ⁠¹. Policies are not on HFRD’s upload checklist, but the packet says they must be established and readily available on request ⁠⁷.

Filing the application in GAHLES

HFRD takes applications online through its GAHLES portal (gahles.dch.georgia.gov). HFRD last updated the Adult Day Center Application Packet on July 13, 2026 ⁠⁶⁠⁷. The order that works:

1. Register the entity

   Upload evidence from the Georgia Secretary of State that your corporation or LLC is registered, or other proof of legal authority ⁠⁷.

2. Secure the space

   Deed, lease, bill of sale or property record in the governing body’s name, or the owner’s written permission for donated space ⁠¹⁠⁷.

3. Collect local approvals

   Zoning, fire inspection, water and sewer, and a food permit if licensed for 24 or more ⁠⁷.

4. Run GCHEXS checks

   for administrators and 10 percent owners ⁠⁷.

5. Prepare the identity affidavit

   A notarized affidavit of personal identification under O.C.G.A. § 50-36-1, declaring citizenship or lawful status, plus a copy of the photo ID shown to the notary ⁠⁷.

6. Draw the floor sketch

   with every room, door and window labeled and measurements for common areas, and take photos of the accessible bathroom and shower ⁠⁷.

7. Submit in GAHLES and pay

   Complete the electronic Owner Form, list any other adult day centers and mobile sites you operate, add the RN license if you chose the medical model, and pay the fees ⁠⁷.

8. Respond to HFRD

   Applications are reviewed in the order received, and the initial review takes 30 business days from submission. Requests for more documents arrive from [email protected] with an invitation code; failing to upload what is requested results in denial ⁠⁷.

9. Pass the licensure inspection

   HFRD inspects each center before licensure, and a license issues only after substantial compliance ⁠¹.

HFRD warns not to submit until every document is ready, since an incomplete filing can be rejected and the application fee forfeited ⁠⁷. General application questions go to [email protected] and payment problems to [email protected] ⁠⁷.

Fees as published

The Board of Community Health sets fees in rule 111-8-25-.03 ⁠¹⁠⁴. As published on October 12, 2026:

A new social-model center therefore pays $550 at filing and a medical-model center $650. A mobile center operated alongside a regular center pays a separate license fee ⁠¹. The schedule marks adult day centers as eligible for a 25 percent discount if accredited by a nationally recognized organization DCH approves, with the accreditation decision on file at renewal ⁠⁴. Fees are not refundable except in extraordinary circumstances, and DCH accepts no cash ⁠⁴.

Inspections, annual fees and enforcement

Renewal in Georgia is an annual fee rather than a new application: the center pays it due on the anniversary of the previous year’s license, within 30 days of DCH’s invoice ⁠¹⁠⁴. DCH may revoke a license if that fee goes unpaid 60 days after the invoice ⁠⁴. Ownership changes, moves, added locations, name changes, capacity changes and changes in scope of services each require a new application, and the license is returned when it stops being valid ⁠¹.

DCH inspects before licensure and periodically after that, and may enter during any operating hours ⁠¹. A center accredited by an entity DCH recognizes may ask to be exempted from periodic inspections by submitting its latest accreditation report ⁠¹. Waivers and variances of specific rules can be requested on DCH forms, and any that are granted are time-limited and posted on the state’s rules waiver register ⁠¹.

Ongoing reporting ⁠¹:

• Death, rape, serious injury needing medical attention, suspected abuse, neglect or exploitation, or a participant missing more than 30 minutes: report to DCH by the next business day, then finish an internal investigation report within five business days.
• A participant’s death at the center: call local law enforcement immediately and notify DCH within 24 hours.
• Using the disaster plan: notify DCH within one business day, in writing within three.
• Discharges other than emergencies need 14 days’ written notice.
• Records are kept at least three years.

Penalties follow the general enforcement rule. DCH may impose a public reprimand, suspension, revocation or civil fines up to $2,000 per day per violation, capped at $40,000 for violations found in one inspection ⁠⁴. Chapter 111-8-25 counts adult day centers as long-term care facilities, so a violation that causes a participant’s death or serious physical harm carries a mandatory fine of at least $5,000 that cannot be reduced for financial hardship ⁠⁴.

How Georgia centers get paid

Medicaid pays for adult day services through the Elderly and Disabled Waiver Program, specifically its Community Care Services Program (CCSP) and SOURCE, which serve frail older and disabled Georgians who meet nursing facility level of care and include adult day care among their services ⁠⁸. DCH’s CCSP overview describes the waiver service as Adult Day Health, a “medically supervised group day program at an adult day health center” that can include physical, occupational or speech therapy, and lists out-of-home respite that can be delivered in an adult day health center ⁠⁹. DCH contracts with Georgia’s 12 Area Agencies on Aging to run CCSP. Admission depends on funding set by the legislature, and applicants wait on a list ranked by a Determination of Need score ⁠⁹. People apply through the Aging and Disability Resource Connection or by calling 866-55-AGING ⁠⁸⁠⁹.

Non-Medicaid public funding runs through the Department of Human Services, Division of Aging Services. Its HCBS manual section 302, effective October 1, 2025, governs Area Agencies on Aging that provide or contract for adult day and adult day health services with Division of Aging Services funds, including Older Americans Act and state funds. It requires those services to comply with the adult day center rules and targets people 60 or older, with an exception allowing state or local funds to serve adults of any age with Alzheimer’s disease or related disorders ⁠¹⁰. These funds reach centers through Area Agency on Aging contracts, and the AAA monitors contracted providers at least annually ⁠¹⁰.

What changed recently

• January 7, 2015: chapter 111-8-1 took effect; centers already operating had 90 days to apply ⁠¹⁠².
• July 29, 2026: an amendment to rule 111-8-1-.14 (Personnel), covering background checks, training, staff records and employee health screening, took effect ⁠³. The current text requires TB screening following CDC guidance for health care personnel ⁠¹.
• July 13, 2026: HFRD updated the Adult Day Center Application Packet ⁠⁶.

Rule 111-8-1-.05 (application) still carries only its original December 2014 filing and January 7, 2015 effective date ⁠².

Sources

1. 1
   Georgia Secretary of State, Ga. Comp. R. & Regs. Subject 111-8-1: Rules and Regulations for Adult Day Centers Checked 12 Oct 2026 · Back to text ↑
2. 2
   Georgia Secretary of State, Rule 111-8-1-.05: Application for a License Checked 12 Oct 2026 · Back to text ↑
3. 3
   Georgia Secretary of State, Rule 111-8-1-.14: Personnel Checked 12 Oct 2026 · Back to text ↑
4. 4
   Georgia Secretary of State, Ga. Comp. R. & Regs. Subject 111-8-25: General Licensing and Enforcement Requirements Checked 12 Oct 2026 · Back to text ↑
5. 5
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Personal Care Homes (Personal Care Home Program) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Licensure Forms & Information Packets Checked 12 Oct 2026 · Back to text ↑
7. 7
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Adult Day Center Application Packet (updated July 13, 2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Georgia Medicaid, Department of Community Health, Waiver Programs Checked 12 Oct 2026 · Back to text ↑
9. 9
   Georgia Department of Community Health, Community Care Services Program overview (August 2019) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Georgia Department of Human Services, Division of Aging Services, HCBS Manual 5300, Section 302: Adult Day Care / Day Health Services Checked 12 Oct 2026 · Back to text ↑

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