Georgia assisted living community permit: the 25-bed, medication-aide tier

Personal care home or assisted living community: which permit you need

Georgia licenses residential care for adults through one program with two permit tiers. A personal care home is any dwelling that provides housing, food service and one or more personal services for two or more unrelated adults.⁠¹ An assisted living community is “a personal care home serving 25 residents or more that is licensed by the department to provide assisted living care.”⁠¹ Both sit in DCH’s Personal Care Home Program. That program’s 24 surveyors oversee 2,910 personal care homes, assisted living communities, community living arrangements and adult day centers.⁠³

What separates the two tiers is the care you plan to give. Rule 111-8-63 defines assisted living care as four things together: personal services, “the administration of medications by a certified medication aide,” assisted self-preservation, and limited nursing services.⁠¹ Ask these questions about your residents:

• Medications. Will staff only help capable residents take their own medications, or will staff actually administer them to residents who cannot? Administering them is an assisted living service.⁠¹
• Evacuation. Can every resident get out in an emergency without hands-on help? Assisted self-preservation means staff physically help residents reach a designated point of safety within a time set by the Safety Fire Commissioner.⁠¹
• Nursing. Will you need someone to assess residents and perform health maintenance activities or short nursing tasks? Limited nursing services cover assessment, health maintenance activities, and nursing care “that can be completed within seven days or intermittently.”⁠¹

If the answer to all three is no, you need a personal care home permit, whatever your bed count. A 25-bed or 120-bed home can stay a personal care home. The Georgia personal care home permit guide covers that route, including the extra rules that start at 25 beds. Choose the assisted living community permit if you want to admit or keep residents who need medication administration or hands-on evacuation help, and you will have at least 25 residents. Below 25 residents, Georgia has no assisted living permit at all.

The title is protected. Only a licensed assisted living community “may hold itself out as offering assisted living care.”⁠¹ Under a notice posted in April 2012, DCH refuses initial personal care home permits to homes that use the term “assisted living” in their name or marketing, “unless it is applying to become licensed as an ‘assisted living community’.”⁠¹¹⁠⁵ A licensed community, in turn, must state its classification as an assisted living community in its marketing materials.⁠¹

What the permit lets you do, and where it stops

The permit is still not a nursing license. Chapter 111-8-63 describes residents who need help with daily living “but who do not require continuous medical or nursing care.”⁠¹ At admission a resident must be at least 18. The resident must not have active tuberculosis or need continuous medical or nursing care, restraints or isolation, and must be able to take an active part in transferring from place to place.⁠¹ A physical exam on DCH’s form, dated within 30 days before admission, must confirm this.⁠¹

You must require a resident to move out if any one of these happens:⁠¹

• the resident needs continuous medical or nursing care;
• available staff cannot meet the resident’s needs, for example a resident who is not ambulatory and not capable of assisted self-preservation;
• the community cannot evacuate all current residents to a point of safety within fire safety standards.

The third trigger ties your census to your building and your staff. Each admission decision has to account for how much evacuation help current residents need, and for whether the building meets fire requirements for an existing health care occupancy.⁠¹

Apart from care plans, training, medication administration and skills checks, medical, nursing or health services a resident needs on a periodic basis or for a short-term illness may not be provided as services of the community. The resident buys them from licensed providers “managed independently and not owned or operated by the assisted living community.” The community may help arrange those services but may not provide them.⁠¹ That keeps a home health agency or hospice separate from your operation. See the Georgia home health agency license guide if you plan to own one too.

The certified medication aide system

Medication administration is the biggest operational change from a personal care home. A community that offers medication administration “must employ certified medication aides, at a minimum, to administer medications.”⁠¹ If the community employs proxy caregivers, it may not let them assist with or administer medications, and the proxy caregiver training rule repeats that only certified medication aides may administer medications on the community’s behalf.⁠¹

Rule 111-8-63-.20 places these duties on the community:⁠¹

• Registry check. Before an aide gives any medication, confirm the aide is listed in good standing on the Georgia Certified Medication Aide Registry and has no record of termination for cause tied to medication tasks.
• Skills checks at hire. For aides certified more than a year before you hire them, document current competency using a checklist that meets the state’s standardized clinical skills checklist.
• Quarterly observations. A registered nurse or pharmacist must make random medication pass observations every quarter.
• Quarterly drug regimen reviews. A licensed pharmacist must review each resident’s drug regimen every quarter, remove expired or discontinued drugs, set or review medication policies, and monitor storage and handling.
• Annual competency review. A Georgia-licensed RN, pharmacist or physician must complete a full skills competency review of each aide every year.
• Separations. If you fire an aide for cause related to medication tasks, the separation notice must explain the facts and warn the aide that the aide will lose registry good standing. You report it to the registry only once the termination is upheld by the Department of Labor or the appeal period has run out.

A certified medication aide may handle only unit- or multidose-packaged medications. Permitted tasks are oral, feeding-tube, eye, topical, ear, nasal, vaginal and rectal medications; insulin, epinephrine and B12 under physician direction and protocol; metered-dose inhalers; finger-stick glucose tests; commercially prepared disposable enemas; supervising self-administration; and liquid morphine for a hospice patient under a hospice physician’s written order.⁠¹ Aides who give liquid morphine need training from a licensed hospice before they start and every year after. The community may keep no more than 50 ml on hand per hospice patient with an order.⁠¹

You may also train your own aides. The community must use the state-approved training program taught by a Georgia-licensed RN, pharmacist or physician. It must verify the trainee is in good standing on the Georgia certified nurse aide registry, and it may not let the aide give medications alone until the aide appears in good standing on the medication aide registry.⁠¹ Staff who are not medication aides can still help capable residents take their own medications, after documented training on topics the rule lists and a skills check at hire and every year after.⁠¹ Every medication, including over-the-counter drugs, needs a physician’s order on file. If the community procures residents’ medications, it must obtain new prescriptions within 48 hours of notice.⁠¹

Health planning comes before HFRD: letter of determination and CON

The application checklist requires “A Letter of Determination approved by DCH Office of Health Planning (OHP)” for every initial assisted living community. An increase in bed capacity requires one too.⁠⁴ This step runs through a different DCH office on its own clock, so start it first.

• Fee and timing. A determination request costs $500. The fee rose from $250 on January 13, 2025.⁠⁸ If no one files an objection within 30 days, OHP has 60 days from receipt to issue the letter. It can extend that by 30 days, to 90.⁠⁷
• When a full certificate of need applies. DCH’s fact sheet lists “Personal care homes with 25 or more beds that are Medicaid certified” among the projects that need a CON.⁠⁶ The CON rules use the same definition: a residential facility certified as a Medicaid provider “having at least twenty-five (25) beds.”⁠⁷ A CON application must be preceded by a letter of intent.⁠⁶
• What a CON review tests. Rule 111-2-2-.31 projects bed need per planning area at 18 beds per 1,000 residents aged 65 to 74, 40 per 1,000 aged 75 to 84 and 60 per 1,000 aged 85 and older, minus existing and approved beds.⁠⁷ Applicants also commit to uncompensated care for indigent or charity residents of at least 1% of annual gross revenue after bad debt. They must show that no Georgia personal care home they or a related entity own has been sanctioned by HFRD in the past two years.⁠⁷

On the payment side, Georgia Medicaid’s CCSP and SOURCE waiver programs serve people who meet nursing facility level of care. Their services include “alternative living services.”⁠¹² If that revenue is part of your plan, budget time for the CON review as well as the determination letter.

The building: a health care occupancy, not a house

The fire code is where an assisted living community differs most from a personal care home. Georgia’s Safety Fire Commissioner defines an assisted living community as a facility of 25 or more residents that meets the requirements of “an existing health care occupancy found in Chapter 19 of the Life Safety Code or the requirements established in Chapter 34 or 35.”⁠⁹ Georgia wrote its own Chapter 34 (new assisted living community occupancies) and Chapter 35 (existing ones) into NFPA 101. It also classes these communities as Institutional Group I-2 under the International Fire Code, alongside nursing homes and hospitals.⁠⁹

For a new building, Chapter 34 requires:⁠⁹

• an approved, supervised automatic sprinkler system throughout, with quick-response or residential heads;
• at least two smoke compartments on every story, each no larger than 22,500 square feet;
• evacuation drills in which residents, as a group, reach an exit or cross a smoke barrier in under 13 minutes. A building that cannot do that must change its group evacuation capability classification and comply with section 35.1.8.

Every administrator and staff member needs three hours of initial fire safety training, from an instructor registered with the Safety Fire Commissioner, within 90 days. A two-hour refresher is due every three years.⁠⁹

DCH’s own rule adds the physical plant details:⁠¹

• Bedrooms. At least 80 square feet of usable floor space per resident, under a ceiling at least 7 feet high, with no more than two residents per room. A personal care home approved on or before February 6, 1981 at 70 square feet and operating continuously since may keep that standard. It loses it on revocation, a change of ownership, a move, extensive renovation or any other surrender of the permit. Each room needs an exterior window and a secondary exit.
• Bathrooms. One toilet and lavatory per four residents and one bath or shower per eight, counted against licensed capacity. You also need a toilet on each bedroom floor and a separate staff toilet that does not count toward those ratios.
• Access. Handrails, doorways and corridors must fit walkers and wheelchairs. If you serve wheelchair users, you need two remote, wheelchair-accessible exits.
• Systems. Hardwired smoke detectors with battery backup; 5 lb ABC extinguishers tagged every year; hot water no hotter than 120°F; no space heaters except in an emergency with written approval from the fire authority.
• Food. A Department of Public Health food service permit, or a copy of your caterer’s. Three meals a day with no more than 14 hours between the evening meal and breakfast, plus a 3-day emergency food and water supply.

New construction and major renovation must meet state and local building and fire codes. Zoning and other local requirements are yours to settle with local officials, and DCH’s checklist asks for the city or county zoning approval with the application.⁠¹⁠⁴

The administrator and leadership

Each community must have a full-time administrator who is at least 21. The administrator must hold a license from the State Board of Long-Term Care Facility Administrators, effective no more than 60 days from the date of hire (or by July 1, 2021, whichever is later).⁠¹ The community also needs a separate administrator or on-site manager working under the administrator.⁠¹ The on-site manager and the responsible staff who stand in during absences must be at least 21.⁠¹

Under Board rule 393-3-.04, a candidate for an Assisted Living Community Administrator license must be 21, of reputable character, and a U.S. citizen or lawfully present and authorized to work. The candidate must also meet one of these routes:⁠¹⁰

1. Experience plus a course

   One year of full-time healthcare facility experience, or managerial or supervisory experience outside healthcare, plus certification from a nationally recognized program, a NAB-accredited program or another Board-approved program of at least 14 hours that ends in a written exam.

2. HSE

   The Health Services Executive qualification from the National Association of Long Term Care Administrator Boards (NAB).

3. Master’s degree plus RCAL

   A health-related master’s degree with at least 21 semester hours in health care administration, plus a passing score on NAB’s Resident Care/Assisted Living exam.

4. Nursing home license

   An active, unencumbered Georgia nursing home administrator license.

The administrator runs a quality assurance program. It investigates injuries and deaths, monitors staff performance, and collects resident and family feedback at least once a year.⁠¹

Applying through GAHLES

Applications go through DCH’s GAHLES portal. DCH asks you not to submit until every document is ready, and it treats a failure to upload requested documents as grounds for denial.⁠⁴ The packet DCH marked “Updated 07/13/26” asks for these items with an initial application:⁠⁴⁠⁵

1. Secretary of State evidence that your corporation or LLC is registered.
2. City or county zoning approval.
3. A notarized affidavit of personal identification under O.C.G.A. § 50-36-1, with a copy of the photo ID shown to the notary.
4. Proof of ownership or legal control of the property (deed, lease, bill of sale or property record).
5. A Georgia State Fire Marshal’s Office inspection report with no violations, showing capacity load, dated within 12 months.
6. DCH’s electrical inspection form, signed by a Georgia-licensed electrician, dated within 6 months. If you already hold a personal care home permit at the site, the rule waives a new electrical inspection unless renovation or repair work has been done.⁠¹
7. A floor sketch with room measurements, doors, windows and bed placement, plus one photo each of the exterior, a common area and a typical resident room.
8. The electronic owner form in GAHLES.
9. A satisfactory GCHEXS fingerprint determination letter, dated within 12 months, for each administrator and each individual owning 10% or more. If no one owns 10%, a signed letter on company letterhead saying so.
10. Water and sewer approval: a water bill, or the county environmentalist’s septic form, plus a water test dated within 6 months if you are on a private source.
11. The OHP letter of determination.
12. The notarized affidavit of financial stability.
13. The licensure fee.

The financial stability affidavit must come from a certified public accountant “affirming the applicant’s ability to operate as a going concern for the next two years.”⁠¹ On DCH’s form, the CPA swears to having reviewed the prior fiscal year’s financial documents. A new applicant with no history can instead use other sufficient documents, which “may include forward-looking documents” such as a pro forma statement.⁠⁴ A CPA licensed outside Georgia may sign if the CPA’s firm is licensed with the Georgia State Board of Accountancy. The same affidavit is required again on a change of ownership.⁠⁴

The packet also contains DCH’s affidavit of compliance, and its cover page reminds applicants that all required policies and procedures must already be established and available on request. In the affidavit, the applicant attests that it has written the policies the rules require and will put them into effect immediately if licensed.⁠⁴ The rule lists 16 policy areas. Two are specific to this tier: a staffing plan under which staffing rises “proportionally as the number of residents who require assisted self-preservation increases,” and policies on the use and professional oversight of certified medication aides.⁠¹

If you name the administrator later, DCH must have the name before it issues the permit.⁠¹ DCH says applications are reviewed in the order received, with an initial review time of 30 business days from submission.⁠⁴ Questions go to the Applications and Waivers Team at [email protected]. The Personal Care Home team handles surveys and permits at [email protected] or 404-657-5700.⁠³⁠⁴

Fees as published

Rule 111-8-25 lists assisted living communities as “(see Personal Care Homes)”, so the personal care home bed scale applies.⁠²

Source: ⁠²

So a 40-bed community pays HFRD $1,050 in application and initial license fees, and a 60-bed community pays $1,800. Rule 111-8-25 says the initial license fee is submitted with the application fee; DCH’s fee schedule posted November 5, 2024 says it is submitted before the license issues.⁠²⁠¹³ The $500 OHP determination fee is separate.⁠⁸ Fees are not refundable and DCH accepts no cash.⁠² All fees must be paid before a permit issues.⁠⁴ Rule 111-8-25 marks the assisted living, personal care home and memory care certificate fees as eligible for a 25% discount if the community is accredited by an organization DCH approves and a copy of the decision is on file at renewal.⁠² DCH’s November 2024 fee schedule does not mark those three fees as discount-eligible, and its list of approved accreditors names none for assisted living, so confirm with the HFRD Finance Team ([email protected]) before you count on it.⁠¹³⁠⁴ DCH may revoke a license if the annual fee is unpaid 60 days after the invoice.⁠²

Staffing floors and nurse hours

Assisted living communities follow their own staffing rule, which is stricter than the personal care home rule mainly on nursing:⁠¹

• Ratios. A monthly average of at least one awake direct care staff person per 15 residents during waking hours and one per 20 during non-waking hours, “where the residents have minimal care needs.” You must staff above that when residents need more. Cooks, maintenance staff, hospice or home care agency staff and private sitters do not count.
• Floor coverage. At least two direct care staff on site 24 hours a day, with one on each occupied floor. The floor post may move around the building only if you run a medical alert system that meets the rule’s requirements (wearable sensor, immediate staff alert, written testing and outage procedures) and have offered every resident a wearable device.
• Nurse time. An RN or LPN must be on site for a minimum number of hours each week, by census.

Source: ⁠¹

All staff must receive initial training within their first 60 days of employment. Hands-on staff need first aid and CPR with a return demonstration, plus training on residents with dementia. Hands-on staff, including the administrator, need 24 hours of continuing education in the first year and 16 hours a year after that.⁠¹ Before working, the owner, administrator, on-site manager and every direct access employee need a satisfactory fingerprint check under chapter 111-8-12. Each employee also needs a TB screening and physical within the prior 12 months.⁠¹ Personnel files stay on site for three years after an employee leaves, and staff schedules for one year.⁠¹

Adding a memory care center

A community that markets specialized care for residents with Alzheimer’s disease or other dementia, or charges them more, is running a memory care center. It needs a certificate.⁠¹ DCH accepts the certificate application only from a community that already holds a current assisted living community permit. The application is the identity affidavit, a photo ID and a notarized affidavit of compliance.⁠⁴ The fire rules treat memory care units under the same Chapters 34 and 35.⁠⁹

Rule 111-8-63-.19 adds these requirements:⁠¹

• Direct care staffing. One dementia-trained direct care staff person per 12 residents while awake and per 15 overnight (monthly average), with at least two direct care staff in the center at all times.
• Licensed or certified staff. An RN, LPN or certified medication aide on site or in the building at all times.
• Nurse hours. 8, 16, 24 or 40 nurse hours a week for centers of 1 to 12, 13 to 30, 31 to 40 and more than 40 residents.
• Training. Four hours of dementia orientation for every staff member within 30 days and 16 hours of competency-based training for direct care staff. Staff who pass DCH’s memory care specialist exam can complete a 4-hour version instead. After that, 8 hours of dementia training a year.
• Building. Secured outdoor space, bedrooms for no more than two, an automated alert on unattended exits, and code compliance for any center built or majorly renovated after December 9, 2009.
• Paperwork. A written description of the center, covering staffing patterns and fees, in your licensed residential care profile, and care plans reviewed at least every quarter.

A separate rule, 111-8-63-.18, covers any community serving residents at risk of elopement: magnetic locks on exit doors need fire marshal approval and must release on fire alarm or sprinkler activation, power failure, or continuous pressure for 30 seconds or less.⁠¹

After you open: inspections, reports and changes

HFRD makes unannounced compliance inspections “approximately every 11 to 15 months or as needed.”⁠³ After a cited inspection you have 10 days to submit a plan of correction. If your community has a website, its main page must link to all inspection reports and plans of correction from the last 18 months.⁠¹ The fines in rule 111-8-25 run up to $2,000 per day per violation, capped at $40,000 per inspection. The minimum is $5,000 when a violation causes a resident’s death or serious physical harm.⁠² DCH may accept accreditation from an approved body as deemed status, but it can still inspect.⁠¹

Ongoing reporting duties:⁠¹

• Missing residents. Call local police within 30 minutes of learning a resident is missing (Mattie’s Call), and tell DCH within 30 minutes of that contact.
• Serious incidents. Report to DCH within 24 hours, including unexpected deaths, injuries needing medical attention, and abuse.
• Bankruptcy or eviction. Give DCH and all residents 60 days’ written notice if bankruptcy or eviction could force residents to move.
• Change of ownership. Give 30 days’ notice, filed as an application. The permit does not transfer, and the new owner needs its own CPA affidavit.⁠⁴

Staff of the community may not act as a resident’s legal surrogate. If anyone connected to the community serves as a resident’s representative payee, a surety bond must cover them.⁠¹ For a later change in size, DCH’s packet has separate tracks for increasing capacity, which needs a new fire report, floor sketch and OHP letter, and for converting back to a personal care home.⁠⁴

For the rest of the state’s care licenses, see the Georgia overview and the assisted living license comparison.

Sources

1. 1
   Georgia Secretary of State, Ga. Comp. R. & Regs. ch. 111-8-63, Rules and Regulations for Assisted Living Communities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Georgia Secretary of State, Ga. Comp. R. & Regs. ch. 111-8-25, General Licensing and Enforcement Requirements Checked 12 Oct 2026 · Back to text ↑
3. 3
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Personal Care Homes Checked 12 Oct 2026 · Back to text ↑
4. 4
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Assisted Living Community Application Packet (updated 07/13/26) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Licensure Forms & Applications Checked 12 Oct 2026 · Back to text ↑
6. 6
   Georgia Department of Community Health, Office of Health Planning, Certificate of Need fact sheet (updated 2025) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Georgia Secretary of State, Ga. Comp. R. & Regs. ch. 111-2-2, Certificate of Need Checked 12 Oct 2026 · Back to text ↑
8. 8
   Georgia Department of Community Health, Office of Health Planning, CON Applications and Forms Checked 12 Oct 2026 · Back to text ↑
9. 9
   Georgia Office of Commissioner of Insurance and Safety Fire, Rules of the Safety Fire Commissioner, ch. 120-3-3, State Minimum Fire Safety Standards Checked 12 Oct 2026 · Back to text ↑
10. 10
    Georgia Secretary of State, Ga. Comp. R. & Regs. ch. 393-3, Licensure by Examination (State Board of Long-Term Care Facility Administrators) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Georgia Department of Community Health, Healthcare Facility Regulation Division, Notice: Use of the Term "Assisted Living" by Personal Care Homes Checked 12 Oct 2026 · Back to text ↑
12. 12
    Georgia Medicaid, Long-Term Services and Supports Checked 12 Oct 2026 · Back to text ↑
13. 13
    Georgia Department of Community Health, Healthcare Facility Regulation Division, Schedule of Licensure Activity Fees (posted 11/05/24) Checked 12 Oct 2026 · Back to text ↑

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