Illinois assisted living establishment license: IDPH rules, fees and steps

What Illinois counts as an assisted living establishment

Illinois licenses assisted living under the Assisted Living and Shared Housing Act (210 ILCS 9), and IDPH has done so since July 2002 through its Division of Assisted Living in Springfield.⁠³ Section 10 of the Act defines an assisted living establishment as any home, building or residence that provides sleeping accommodations “for at least 3 unrelated adults, at least 80% of whom are 55 years of age or older,” together with four things:⁠¹

• services based on a social model, in which the resident’s unit is treated as the resident’s own home;
• community-based residential care for people who need help with activities of daily living (eating, dressing, bathing, toileting, transferring, personal hygiene), with personal, supportive and intermittent health-related services available 24 hours a day;
• the mandatory services, provided directly or arranged by the establishment;
• a homelike physical environment with individual living units.

The mandatory services are spelled out: 3 meals a day, housekeeping of the resident’s unit, personal laundry and linen service, 24-hour security (locked entrances or security staff), a 24-hour emergency communication response system, and help with activities of daily living as each resident needs it.⁠¹ If you offer apartments to seniors but none of these services, the Act does not reach you. Once you add them for 3 or more unrelated adults in the 55-plus mix, it does.

Section 25 bars anyone from establishing, operating, maintaining or offering an establishment without a license. An unlicensed operator is subject to the provisions and penalties of the Nursing Home Care Act. The Act also protects the term itself: no entity may use “assisted living” in its name or advertising unless it is licensed under the Act (or is a shelter care facility under the Nursing Home Care Act that meets the definition). The one exception is a licensed shared housing establishment, which may advertise assisted living services.⁠¹ Public officials may not place anyone in an unlicensed establishment or list one on a program list.⁠²

The neighboring license types

Section 10 excludes several settings that a founder might mistake for assisted living:⁠¹

• Shared housing establishment. A free-standing residence for 16 or fewer people, at least 80% age 55 or older, unrelated to the owners and one manager. It is licensed under the same Act and rules but carries a lower fee and different building rules. If you are converting a house, read the Illinois shared housing establishment guide.
• Supportive living facility. Medicaid-funded assisted living under section 5-5.01a of the Illinois Public Aid Code, run by the Department of Healthcare and Family Services (HFS), not IDPH.⁠¹⁠⁶
• Nursing homes licensed under the Nursing Home Care Act, which may convert distinct parts to assisted living and keep the certificate of need for the converted beds.
• Community-integrated living arrangements as defined in the Community-Integrated Living Arrangements Licensure and Certification Act, supportive residences licensed under the Supportive Residences Licensing Act, free-standing licensed hospice facilities, and the parts of a life care community not licensed as assisted living.
• Facilities operated by the federal government or the State of Illinois.

Home care delivered in a resident’s private home is a separate license from IDPH. See the Illinois home services agency guide.

No certificate of need, but a hard admission line

Illinois does not require a certificate of need for assisted living. The Health Facilities Planning Act states that “health care facilities” do not include facilities licensed under the Assisted Living and Shared Housing Act.⁠⁵ You do not apply to the Health Facilities and Services Review Board.

The trade-off is that the Act sets firm limits on who you may admit and keep, and those limits shape your market and staffing model. Under Section 75, a person may not be accepted, and must have their residency terminated, if they:⁠¹

• pose a serious threat to themselves or others;
• cannot communicate their needs and have no resident representative living in the establishment with a prior relationship to them;
• need total assistance with 2 or more activities of daily living;
• need more than one paid caregiver at a time for an activity of daily living;
• need more than minimal help moving to a safe area in an emergency;
• have a severe mental illness as the section defines it (Alzheimer’s disease and other dementias are expressly not included);
• need intravenous therapy, gastrostomy feedings, catheter insertion, sterile irrigation and replacement (routine urinary catheter maintenance excepted), sterile wound care or routine insulin injections, unless self-administered or given by a licensed health care professional;
• need treatment of stage 3 or 4 decubitus ulcers or exfoliative dermatitis;
• need 5 or more skilled nursing visits a week for 3 consecutive weeks or more, unless a physician certifies the treatment as temporary and rehabilitative.

Two exceptions matter in practice. Terminally ill residents who receive or qualify for hospice care may stay if all parties agree. People with quadriplegia, paraplegia or neuromuscular diseases may be exempt from the total-assistance, two-caregiver, emergency-movement and catheter limits if they can communicate their needs, do not need help with complex medical problems, and the establishment can accommodate them.⁠¹

One rule catches operators who plan to bring nursing in-house. For IV therapy, gastrostomy feedings, catheter care and sterile wound care, the licensed health care professional may not be employed by the owner or operator, its parent, or any affiliate with common ownership. Those services must come from an outside provider such as a licensed home health agency. Life care communities that have both assisted living and a skilled nursing facility are exempt for residents under life care contracts, but the licensed professional must then be employed by an entity licensed under the Nursing Home Care Act or the Home Health, Home Services, and Home Nursing Agency Licensing Act.⁠¹

The building: units, Life Safety Code and local codes

Plan the building around the unit standard in Section 10 and Subpart I of the rules. Each unit must accommodate small kitchen appliances and have either private bathing, washing and toilet facilities, or private washing and toilet facilities with a common bathing room readily accessible to each resident. Units are single occupancy unless 2 residents choose to share.⁠¹

The table summarizes the rules.⁠² A unit may not be used as the path to a common room, common bathroom or another unit. Shared bathing rooms must lock from the inside, and showers and tubs need slip-resistant, nonporous surfaces.⁠²

For fire safety, the establishment must meet the residential board and care occupancies chapter of NFPA 101, the Life Safety Code: Chapter 32 for new establishments and Chapter 33 for existing ones. It must also meet local and State building codes for the building type, local ordinances, fire codes and zoning, and ADA accessibility standards.⁠² Where a local requirement conflicts with Part 295, the stricter one applies. You may petition IDPH to decide which applies, and it must respond within 30 days.⁠² IDPH may waive some physical plant standards but will not waive Life Safety Code compliance, though it recognizes equivalencies.⁠² A building housing 10 or more residents must meet NFPA 96 for commercial cooking.⁠²

If you license only some units in a larger senior building, the entire building that has any licensed units must meet the physical plant requirements.⁠²

Plan review before you build

Section 21 of the Act adds a step before construction. Before starting a new establishment, or alterations or additions that count as major construction “as defined by rule,” you submit architectural drawings and specifications to IDPH for review and approval.⁠¹ IDPH tells you within 10 working days whether the submission is complete, and approves or disapproves a complete submission within 45 calendar days.⁠¹ Part 295 as published on 2026-10-12 has no section defining major construction, so ask the Division which of your projects it covers.⁠²

Review fees apply to reviews after the January 1, 2025 amendment: none if the estimated project value is under $100,000, the greater of $2,400 or 1.2% for projects from $100,000 to under $500,000, and the greater of $11,000 or 0.11% (capped at $30,000) for projects of $5,000,000 or more, with intermediate tiers in between.⁠¹ IDPH does not begin review until the fee is paid. After you report the project complete, IDPH must inspect within 30 working days and issue written approval for occupancy within 10 working days of the final inspection. New major construction may not be occupied until that approval is issued, unless IDPH misses those deadlines.⁠¹

The pre-licensure Life Safety Code survey

IDPH’s Design and Construction Section performs the Life Safety Code and physical plant survey before licensure.⁠³ You request it on IDPH’s “Request for Life Safety Code/Physical Environment Inspection” form, which also covers additions of units and memory care units. IDPH schedules the survey only after it has received:⁠⁴

• current Code Certification of Compliance forms for the area to be inspected;
• building floor plans on sheets at least 11 x 17 inches;
• the NFPA 72 fire alarm system record of completion;
• for a new fully sprinklered area, the sprinkler contractor’s material and test certificates (the form references NFPA 13/13R, 1999 edition);
• a narrative and floor plan for any special locking devices, such as magnetic or delayed-egress locks;
• hood fire-extinguishing documentation under NFPA 96 if you cook for 10 or more residents.

All life safety systems must be working at the survey and will be tested, and someone must be on hand to reset them. The packet goes to the Division of Assisted Living, Illinois Department of Public Health, 525 W. Jefferson St., 5th Floor, Springfield, IL 62761.⁠⁴

Plumbing is the item most likely to hold up the license. Any plumbing work on the project must be approved by IDPH’s Plumbing and Water Quality Program, and life safety approval “will not be issued” until IDPH has a copy of the final approved plumbing inspection report. The report must show the inspector’s name, signature and Illinois license number and the inspections completed (underground, rough-in, final).⁠⁴

The full-time director

Section 35 requires a full-time director who is at least 21 and has a high school diploma or equivalent plus one of the following:⁠¹

1. Care experience

   2 years of management experience, or 2 years in positions of progressive responsibility, in health care, housing with services, adult day care or similar services to older adults.

2. Hospitality experience

   2 years of management or progressive responsibility in hospitality, plus training in health care and housing with services management as defined by rule.

3. Education

   A college degree in health administration, or completion of an approved program within 6 months after hiring.

Public Act 104-589 added the third path effective July 24, 2026.⁠⁷ Rule 295.3010 had not caught up when checked on 2026-10-12 and still lists only the two experience paths.⁠² The director must complete at least 20 hours of training every 2 years as a condition of licensure.⁠¹ The manager must name someone able to act in an emergency during absences, and a change of manager must be reported to IDPH within 10 working days.⁠²

If you plan a memory care program, the rules set a higher bar for its manager or supervisor. That person must be 21 and have either a college degree with documented dementia coursework plus one year working with people with dementia, or at least two years of management experience with people with dementia, and must complete six hours of dementia continuing education a year.⁠²

Staffing and training rules

Illinois sets no fixed staff-to-resident ratio for general assisted living. Staffing must be sufficient to meet residents’ 24-hour scheduled and unscheduled needs, the service plans, food and environmental services, and emergency evacuation.⁠² The rules then add specific minimums:⁠²

• At least one staff member awake, on duty and on site 24 hours a day.
• At least one direct care staff member on duty at all times with current adult CPR certification that included a skills demonstration.
• Enough awake staff 24 hours a day to move residents who cannot reach safety on their own.
• Direct care staff at least 16 years old on their first day.
• A Nurse Aide Registry check before hiring. You may not hire anyone with a registry finding of abuse, neglect or misappropriation.
• Health Care Worker Background Check Act compliance, an initial health evaluation, and a documented Nurse Aide Registry check in each direct care file; every employee file also needs documented freedom from tuberculosis, orientation and ongoing training.
• Personnel schedules that show actual hours, kept for at least 12 months.

Training runs in three layers. New employees complete one orientation within 10 days (philosophy, resident rights, confidentiality, infection control, abuse reporting, disaster procedures). They complete a second within 30 days (resident needs, service plans, policies, job limits, CPR and emergency procedures if applicable, ADL assistance). Every manager and direct care staff member then completes at least 8 hours of ongoing training every 12 months.⁠²

Dementia programs carry their own staffing floor of at least 1.4 hours of services per resident per day. All staff need 4 hours of dementia-specific orientation, direct care staff need 16 hours of supervised on-the-job training, and direct care staff need 12 hours of annual dementia in-service.⁠²

Medications, nurses and certified medication aides

Medication help is optional, and the Act defines three levels. Medication reminders and supervision of self-administered medication may be done by unlicensed staff under the direction of a licensed health care professional. Medication administration is reserved to a licensed health care professional employed by the establishment: an RN, APRN, physician assistant or LPN. It covers insulin and vitamin B12 injections, oral medications, topical treatments, eye and ear drops, nitroglycerin patches and, since Public Act 104-589 took effect on July 24, 2026, intramuscular injections.⁠¹⁠⁷

If you store or supervise medications, a physician, pharmacist or RN must approve your medication policies. Stored medication must be locked away from residents and never kept in a bathroom or laundry room.⁠² An establishment that offers medication administration must administer or arrange an influenza vaccination for each resident every year unless it is contraindicated or refused; one that does not must advise each prospective resident before admission to ask a physician about pneumococcal and influenza vaccination. Establishments that provide catheter care must designate an Infection Prevention and Control Professional.⁠¹

Section 79 creates a Certified Medication Aide Program. A licensed establishment in good standing can qualify to use certified medication aides if a registered nurse is on duty and present at all times to delegate and supervise, and the aides do not replace nurses. The aides may not give Schedule II controlled substances or any injected medication.⁠¹ An aide must be a certified nursing assistant with 2,000 hours of practice in the previous 3 years and must complete at least 60 classroom hours, 10 simulation hours and 30 hours of supervised clinical practicum, then pass the certification exam.⁠¹ Aides may not give any subcutaneous, intramuscular, intradermal or intravenous medication, and may not give medication until a physician has done an initial assessment of the resident.⁠¹ Part 295 has no certified medication aide section. Rule 295.5000(d) still states that non-licensed staff may not administer any medication, and the Part’s last amendment is effective July 29, 2024.⁠² The Act told IDPH to propose rules within 180 days of August 9, 2024, but none appear in Part 295 as of 2026-10-12.⁠¹⁠² Ask the Division of Assisted Living whether the program is open for establishment approval before you build a staffing plan around aides.

What goes into the application

Section 30 of the Act and rule 295.500 list the application contents.⁠¹⁠² The rule says applicants provide the information “on forms provided by the Department,” and names the Department’s Code Certification of Compliance form.⁠² IDPH’s assisted living page links forms for complaints, terminations and the Life Safety Code inspection, but no initial license application, Code Certification of Compliance form or online filing portal.⁠³ Ask the Division of Assisted Living, 525 W. Jefferson St., 5th Floor, Springfield (the address on the inspection request form), for the current application packet and certification form before you file.⁠⁴

The application must include:⁠²

• business name, addresses and phone; owners, and for entities, their officers and governing body members;
• the managing agent if different from the owner, and the name of the full-time director;
• one natural person authorized to accept service of notices for the owners and managing agent;
• the number and types of units and the maximum census, and the mandatory and optional services you will provide;
• the Code Certification of Compliance form, as proof of compliance with State and local residential standards;
• a copy of your standard resident contract, and verification that you will sign a service delivery contract with each resident;
• proof of an ongoing quality improvement program;
• documentation of adequate liability insurance;
• the Alzheimer’s Disease and Related Dementias Special Care Disclosure form;
• a schematic drawing of the establishment;
• a request for standard or floating licensure.

Financial feasibility must be shown in one of six ways: a surety bond equal to at least three months of operating expenses; an independent CPA’s report on the establishment’s financial status; an audited financial report; an “A” or better bond rating less than two years old from Fitch, Moody’s or Standard and Poor’s; evidence of at least two years operating a facility licensed under the Nursing Home Care Act, the ID/DD or MC/DD Acts, or this Act; or other information IDPH accepts.⁠² If you charge entrance or application fees above three months of a resident’s minimum fees and do not hold a Life Care Facilities Act permit, you must keep a bond or restricted account that guarantees refunds if you close.⁠²

The resident contract has statutory content. It must be titled “assisted living establishment contract,” printed in at least 12-point type, and state the base rate and the services it covers, fees for extra services, admission and termination criteria, the complaint process and the Department on Aging’s Senior Helpline, and whether you charge a community fee and on what terms it is refundable. It must also include a statement that Medicaid under Article V or VI of the Public Aid Code is not available to pay for services in the establishment, except for residents of establishments in the Department on Aging’s Comprehensive Care in Residential Settings Demonstration Project.⁠¹ Your quality improvement program must benchmark performance and be data driven, and it must include a documented process for detecting and resolving problems.⁠²

IDPH must deny an application if the applicant has not supplied all required information, or is not actively pursuing it, 6 months after the initial submission.⁠¹ Other grounds for denial include a felony, or 2 or more misdemeanors involving moral turpitude, in the previous 5 years by the applicant, its officers or stockholders, or the manager. A license revocation in the previous 5 years is also a ground.⁠¹ You have 10 days after a denial notice to request a hearing.⁠¹

Fees as published

The renewal application carries the same fee prescribed in section 295.500.⁠² IDPH notes that every establishment files an annual renewal application with the applicable fee.⁠³ Section 295.500 was last amended effective August 30, 2023.⁠²

From filing to a regular license

1. Confirm the model fits

   Check your residents against the 3-person and 80%-age-55 tests and the Section 75 exclusions, and decide between a standard license and a floating license.⁠¹

2. Get plans approved, then build or convert to code

   Submit drawings for Section 21 plan review if the work is major construction, and meet NFPA 101 Chapter 32 or 33, local building and zoning codes, ADA, and the unit standards. Get plumbing work approved by IDPH’s Plumbing and Water Quality Program.⁠¹⁠²⁠⁴

3. File the application and fee

   with the Division of Assisted Living, including the financial feasibility evidence, contract, insurance and disclosure form.⁠²

4. Request the Life Safety Code survey

   with the full inspection packet once construction is complete. Design and Construction surveys before licensure.⁠³⁠⁴

5. Receive the probationary license

   For an applicant not previously licensed, or an establishment not yet operating, the Act requires a probationary license once IDPH finds the licensure requirements met.⁠¹ The rules say IDPH may issue it within 90 days after a completed application, and that it will issue a regular license within 120 days after an application that meets requirements.⁠²

6. Pass the full review

   The probationary license lasts 120 days. Within the last 30 days, IDPH fully reviews the establishment and issues a regular license if it complies. If it has made substantial progress but does not yet comply, the probationary license can be renewed once for up to 120 days.⁠¹

The regular license states the address, issue and expiration dates and number of units, must be posted in public view, and covers only the premises and persons named. It cannot be transferred.⁠¹⁠² Changes in ownership details, units or services must be reported within 30 days.⁠²

Nursing homes converting beds to assisted living, and buyers of an existing establishment, also start on a probationary license.⁠²

Floating licenses for mixed senior buildings

Illinois lets a senior housing building license some of its units and move the license between them. A floating license covers any number of units “up to, but not including, total capacity.” The location must keep 80% of residents at age 55 or older and be operated as housing for the elderly, must meet the Section 20 construction standards and Subpart I, and must staff the licensed units adequately.⁠² You may provide assisted living services only in designated units and must keep a current list of them. A unit can be designated temporarily so a resident whose needs change does not have to move.⁠²

Memory care disclosure

Any establishment that offers, advertises or markets an Alzheimer’s special care program must file an accurate disclosure under the Alzheimer’s Disease and Related Dementias Special Care Disclosure Act before licensure and at each renewal.⁠¹⁠² Section 150 also requires a designated resident representative for each resident in the program, policies for residents who may wander or need help evacuating, cognitive stimulation and activities, and dementia training.⁠¹ Residents must be assessed before admission using validated, expert-approved tools. The text of Section 150 amended by Public Act 104-295 (effective January 1, 2026) contains that requirement.⁠¹⁠⁸ The dementia assessment may now be approved by a physician, or by a physician assistant or APRN with geriatric dementia experience. Annual and change-of-condition assessments must be signed by a physician.⁠⁷ Adding a memory care unit later requires a new Life Safety Code survey request.⁠⁴

Inspections, renewal and ownership changes

IDPH makes an annual unannounced on-site visit to every establishment and may make more without notice. The visit focuses on resident issues and your quality improvement process.⁠¹⁠² IDPH sends written findings within 10 business days of leaving. You then have 15 days to file a statement of correction or a statement of dispute.⁠² Section 135(d) of the Act, which Public Act 104-589 amended, provides that repeated technical infractions within a calendar year may result in a Type 3 violation.⁠¹⁠⁷

File your renewal application 120 to 150 days before the license expires. IDPH issues a 2-year license if, in the preceding 24 months, you had no Type 1 or Type 2 violation, no inspection with 10 or more Type 3 violations, and no admission or retention that broke Section 75. If you later fall short, the 2-year license is replaced with a one-year license.⁠¹

A new owner must obtain its own probationary license. The buyer must apply, and both buyer and seller must notify IDPH, at least 30 days before the final transfer. The seller remains responsible for the establishment until the buyer’s license is issued.⁠¹

How residents pay: private pay versus Supportive Living

Licensed assisted living in Illinois is paid privately. The Act requires every resident contract to state that Medicaid under the Public Aid Code is not available for services in the establishment.⁠¹ The Medicaid route is HFS’s Supportive Living Program, which Illinois built as an alternative to nursing home care for low-income older adults and people with physical disabilities. Under a waiver it pays for personal care, homemaking, laundry, medication assistance, activities and 24-hour staff, while the resident pays room and board.⁠⁶ Supportive living facilities are a separate program and are excluded from the assisted living license.⁠¹ Plan for one or the other from the start.

Changes in 2026

• Public Act 104-295, effective January 1, 2026, amended Section 150 on Alzheimer and dementia programs; the amended text includes the requirement to assess residents with validated tools before admission.⁠⁸
• Public Act 104-589, effective July 24, 2026, added physician assistants and APRNs as approvers of dementia assessments and as completers of the Section 15 comprehensive assessments, created the degree path for directors, added intramuscular injections to medication administration by licensed professionals, and amended Section 135, which provides that repeated technical infractions may become a Type 3 violation.⁠¹⁠⁷
• The Part 295 rules have not yet been amended to match these changes, as of 2026-10-12. Rules 295.3010 and 295.5000 still reflect the earlier statute.⁠²

For the other care licenses in this state, see the Illinois state page.

Sources

1. 1
   Illinois General Assembly, Assisted Living and Shared Housing Act (210 ILCS 9) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Illinois General Assembly, Joint Committee on Administrative Rules, 77 Ill. Adm. Code 295, Assisted Living and Shared Housing Establishment Code Checked 12 Oct 2026 · Back to text ↑
3. 3
   Illinois Department of Public Health, Assisted Living Checked 12 Oct 2026 · Back to text ↑
4. 4
   Illinois Department of Public Health, Assisted Living and Shared Housing Facilities: Request for Life Safety Code/Physical Environment Inspection Checked 12 Oct 2026 · Back to text ↑
5. 5
   Illinois General Assembly, Health Facilities Planning Act, 20 ILCS 3960/3 (Definitions) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Illinois Department of Healthcare and Family Services, Illinois Supportive Living Program Checked 12 Oct 2026 · Back to text ↑
7. 7
   Illinois General Assembly, Public Act 104-0589 Checked 12 Oct 2026 · Back to text ↑
8. 8
   Illinois General Assembly, Public Act 104-0295 Checked 12 Oct 2026 · Back to text ↑

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