Iowa elder group home certification: three to five elders, a 24-hour manager, and DIAL approval

What counts as an elder group home in Iowa

Iowa Code 231B.1 defines an elder group home as a single-family residence run by a person who provides room, board and personal care, and may provide health-related services, to three through five elders who are not related to that person within the third degree of consanguinity or affinity. The home must be staffed by an on-site manager 24 hours a day, seven days a week ⁠¹. An “elder” is anyone 60 or older ⁠¹.

Three parts of that definition do most of the work:

• Three through five tenants. One or two unrelated elders falls below the chapter; six or more is outside the model. DIAL’s own description is “three to five older adults who are not related to the person operating the residence” ⁠⁷.
• Personal care, with only part-time nursing. “Personal care” is help with activities such as transferring, bathing, hygiene, dressing, grooming and housekeeping. “Health-related care” means services by an RN, LPN or other licensed professional on a part-time or intermittent basis ⁠¹. A home whose tenants need more than that is not an EGH.
• A single-family residence. The statute requires the home to sit in a single- or multiple-family zone or an unincorporated area ⁠¹, which is why the physical rules below read like housing rules rather than facility rules.

Every elder group home operating in Iowa must be certified by DIAL, and no person or government unit may call a home an elder group home until it is certified ⁠¹. Iowa calls this certification, not licensure, but it is a condition of operating, not an optional quality mark.

Penalties for opening first

Iowa makes unlicensed operation a crime and pulls referral sources into enforcement:

• Establishing, managing or operating an elder group home without a certificate is a serious misdemeanor. After a conviction or a certified-mail notice from DIAL, each further day is a separate offense, and the state can seek an injunction ⁠¹.
• No one may place, refer or recommend placement of a person in an uncertified home, and anyone who knows a home is operating without certification must report its name and address to DIAL ⁠¹.
• No state agency or local government may pay public funds to an elder group home for a tenant unless the home holds a current certificate and meets all certification requirements ⁠¹.

Neighboring Iowa models to rule out

DIAL certifies three related programs under one shared rule chapter, 481 IAC 67, and you should pick the right one before you design the house ⁠³.

A hospital, a 135C health care facility, an assisted living program or an adult day services program may also run an elder group home, but the EGH still needs its own 231B certificate. Going the other way, a certified EGH does not need a second license unless it holds itself out as another type of facility ⁠¹.

Location and zoning

Iowa Code 231B.4 requires an elder group home to sit in an area zoned for single-family or multiple-family housing, or in an unincorporated area. It must be built to local housing codes and to DIAL’s rules for this classification. Where there is no local building code, the state plumbing code and state building code apply. The state rules on second-floor occupancy must take tenants’ mobility into account ⁠¹.

Iowa also limits how local zoning can treat these homes. A city council or city zoning commission must treat an elder group home as a family home for zoning purposes ⁠⁵. County boards of supervisors and county zoning commissions must do the same ⁠⁶. Both statutes let the local body limit how close one proposed elder group home may be to another ⁠⁵⁠⁶. Ask your city or county whether it has adopted a spacing rule before you buy or lease.

The house: space, bathrooms and bedrooms

481 IAC 68.25 sets the physical standards. Several figures depend on whether the home was built or remodeled after July 1, 2005, so pin that date down for any house you are considering ⁠².

“Household occupant” means every tenant and everyone else who lives in the home, including the manager and family ⁠². Bedroom floor space excludes any area where a sloped ceiling keeps a person from standing upright. “Usable floor space” means open floor not under fixtures or furniture that is available for walking or wheelchair use ⁠². Every floor where tenants live needs at least one toilet and one sink, and each toilet needs a sink near it ⁠².

Worked example: in a post-2005 home with five tenants and one live-in manager, there are six household occupants. That means at least three toilets, three sinks and two tubs or showers.

Other standards in the same rule ⁠²:

• Common space may not be in a basement or garage unless it was built for that purpose. DIAL may require more space if tenants use wheelchairs, walkers or other equipment.
• Each tenant bedroom must open directly to a hallway or common area, not through another bedroom or a shared bathroom. It holds one tenant unless the occupancy agreement says otherwise. It must be on the ground level for tenants with impaired mobility, and it must be close enough to the on-site manager to alert them at night, or have a call system.
• Owners, operators, managers, their families and personal care providers may not sleep in designated living areas or tenant bedrooms. Common space and bedrooms may not be used for storage.
• Grab bars at every toilet, tub and shower. Barrier-free, private access to bathrooms. Handrails on stairways. Covered light bulbs. Doorways wide enough for wheelchairs and walkers when mobility-impaired tenants live there. A telephone tenants can use privately.
• A qualified technician must inspect combustion appliances every year for carbon monoxide and other hazards. Extension cords may not replace permanent wiring.
• Use public water if it is available. A private well needs state laboratory documentation that the water is potable and tested as required. Septic systems must meet state and local wastewater rules.
• The home must be able to control maximum water temperature at tenant taps to prevent scalding ⁠².

Fire and building approval comes before certification

481 IAC 68.24 requires the home’s structure and procedures to meet the rules adopted for elder group homes by DIAL’s building code bureau and fire safety bureau. The rule states that approval from both bureaus “is necessary for certification” ⁠². DIAL’s initial certification rule repeats this: it decides on the application only after it receives fire safety bureau approval and structural and evacuation review approval ⁠².

The fire rules moved in 2025. The former Department of Public Safety fire chapters were rescinded effective September 10, 2025, and fire control administration is now in 481 IAC 280. That chapter adopts the 2024 International Fire Code with Iowa amendments ⁠⁴. Its inspection fee schedule charges elder group homes $10 per bed. After one free reinspection, each further reinspection costs $125 until the original deficiencies are corrected. No certificate of occupancy issues until the inspection fee is paid ⁠⁴. Plan-review fees for construction projects are separate and go to the building code bureau ⁠⁴.

481 IAC 280 names elder group homes only in its fee rule, so it does not say which occupancy classification, smoke-alarm, sprinkler or evacuation provisions the fire safety bureau applies to them. Before you buy or remodel a house, ask the fire safety bureau ([email protected]) in writing which provisions of the 2024 International Fire Code it will apply to your house, and get that answer before you commit to plans ⁠⁴.

You must also submit written emergency policies to DIAL and follow them. They must cover a natural-disaster plan kept for easy reference, fire safety, fire drills, smoking, monitoring and testing smoke-control systems, tenant evacuation, head-injury and other emergency protocols, CPR and other lifesaving measures, periodic employee training, reporting, and how the plan is revised ⁠².

Staffing: the 24-hour manager, aides and a program nurse

• On-site manager, 24/7. The on-site manager is the person on duty who directly supervises or provides tenant care. It can be any household occupant over 18 who is qualified for the duties, but not a tenant ⁠². You must notify DIAL in writing within 10 business days whenever the manager changes ⁠².
• Personal care providers. Paid aides must have completed a home care aide training program that meets 441—Chapter 81. They and any nurses may be your employees or come through a contract with a home health agency or another provider, but the same requirements apply either way ⁠².
• Enough trained staff at all times to meet tenants’ identified needs, and every staff member able to carry out the accident, fire and emergency procedures ⁠³.
• Nurse delegation. Within 30 days of starting, all staff receive training from the program’s nurse. A newly hired program RN must document a competency review of delegated tasks within 60 days ⁠³.
• Nurse review. For tenants receiving personal or health-related care, an RN, or an LPN by nurse delegation, must review medications given by the program and assess each tenant’s health at least every 90 days and after significant changes ⁠².
• Dependent adult abuse training as required by Iowa Code 235B.16 ⁠³.
• Limits on staff roles. A staff member may not be a tenant’s attorney-in-fact, guardian, conservator or representative payee unless related by blood, marriage or adoption ⁠³.

Medication rules come from the statute. Medication setup (prompting, opening containers, filling reminder boxes) is allowed at the tenant’s request. If the tenant delegates administration to the home, an RN, LPN, Iowa-licensed ARNP, or a person they properly delegate to must give the medications. Medications the home stores go in locked storage, in their original containers ⁠¹.

Background checks before hire

Elder group homes must comply with Iowa Code 135C.33 ⁠¹. Under 481 IAC 67.18, before you employ anyone, you must ask the screening question about founded abuse and criminal convictions and get a signed acknowledgment. You then run criminal history and child and dependent adult abuse checks, either through the Department of Public Safety and HHS or through the single contact repository (SING). If a record turns up, HHS evaluates whether it bars employment ⁠³. Provisional employment is allowed only under the rule’s conditions, including a comprehensive preliminary check from an approved third-party vendor. Results are valid for 30 calendar days from receipt ⁠³.

Who you can admit and keep

481 IAC 68.14 lists tenants an elder group home may not knowingly admit or retain ⁠². A tenant who:

• is bed-bound, or needs routine one-person help with standing, transfer or evacuation;
• cannot, physically or mentally, travel a normal path to safety right away and without help, including stairs from their bedroom or bathroom;
• needs more than part-time or intermittent health-related care, is medically unstable, or needs maximal help with daily activities (total dependence for at least four activities for more than 21 days);
• has unmanageable incontinence on a routine basis despite an individualized toileting program;
• is dangerous to themselves or others, or is in an acute stage of alcoholism, drug addiction or uncontrolled mental illness;
• is under 18.

You may add your own admission or transfer criteria if you disclose them in the occupancy agreement before move-in ⁠². If DIAL finds a tenant exceeds the criteria, you have 10 working days from the report to ask for a retention waiver under 481 IAC 67.7 ⁠².

Before a tenant signs, someone must evaluate the prospective tenant’s functional, cognitive and health status, using a scored, objective cognitive tool. If the score shows moderate decline, the Global Deterioration Scale must be used at later evaluations. The evaluator must be a health care professional, a human service professional, or an LPN by nurse delegation ⁠². Repeat the evaluation within 30 days of move-in, after significant changes and at least once a year ⁠². A health care or human service professional must also prepare a preliminary service plan before move-in, signed by everyone who developed it and by the tenant ⁠².

Paperwork DIAL reviews: the occupancy agreement and policies

The occupancy agreement is part of your application ⁠², and Iowa regulates it closely.

• No elder group home may operate unless each tenant signs a written occupancy agreement before moving in. Changes need 30 days’ written notice, with narrow exceptions for safety threats and emergencies ⁠¹.
• Iowa Code 231B.5 lists required contents. These include all fees and optional service charges, the effect of the fees on third-party payment, the nonpayment procedure, the term, transfer criteria, the internal appeal process, grievances, the anti-retaliation statement, the emergency response policy, a staffing policy saying whether nurse delegation is used, the refund policy, and billing procedures ⁠¹.
• 481 IAC 68.12 adds: 12-point type or larger, plain language, phone numbers for DIAL complaints, the tenant advocate (the long-term care ombudsman) and dependent adult abuse reporting, your tenants’ rights statement, a promise of 90 days’ notice before any planned closure, and your admission and transfer criteria ⁠².
• You must give tenants a managed risk policy along with the agreement ⁠².
• Keep agreements for three years after they end and give the current version to anyone who asks ⁠¹. Iowa’s uniform residential landlord and tenant act, chapter 562A, applies to elder group homes ⁠¹.

481 IAC 67.2 also requires written policies on: incident reporting and dependent adult abuse; tenant evaluation, including a copy of your evaluation tools; service plans; medical needs; food service; transportation; staffing and training; emergencies and evacuation; managing risk; sexual relationships involving staff or tenants with dementia beyond GDS Stage 5; CPR; and narcotics reconciliation and destruction ⁠³.

Applying to DIAL, in order

1. Confirm zoning and any local spacing limit

   The home must be in a single- or multiple-family zone or in an unincorporated area, and local codes apply ⁠¹⁠⁵⁠⁶.

2. Get building and fire approval

   Submit to DIAL’s building code bureau and fire safety bureau and pay the $10-per-bed fire inspection fee. DIAL needs both approvals before it can decide ⁠²⁠⁴. If you are building or remodeling, the statute also sets a $900 blueprint plan review fee and a $500 optional preliminary plan review fee ⁠¹.

3. Get the application packet

   481 IAC 68.3 points to the DIAL health facilities division website (dia-hfd.iowa.gov), or the Adult Services Bureau, 6200 Park Avenue, Des Moines, Iowa 50321, telephone 515.281.7272 ⁠².

4. Assemble the application

   It must include: names, addresses and ownership shares of officers, directors, trustees and anyone with more than a 10 percent equity interest in the real estate owner or lessor, the lessee and any management company; a statement on felony, aggravated or serious misdemeanor convictions and child or dependent adult abuse findings; a statement on past ownership of facilities closed for loss of licensure or involuntary Medicare or Medicaid termination; your occupancy agreement and attachments; current licenses of any home health agency, mental health center or health care facility you contract with for care; the state license of whoever provides food service; and the $750 fee ⁠². Everything you submit is a public record ⁠¹.

5. File at least 30 calendar days before you plan to open

   ⁠².

6. Provisional certification

   Once DIAL has all documents, including fire safety and structural and evacuation approvals, and finds the home meets the requirements, it issues a provisional certificate. You may then begin operating and accept tenants ⁠².

7. First monitoring within 180 days

   DIAL monitors the home within 180 calendar days of the provisional certificate. If it finds deficiencies, you submit a plan of correction ⁠²⁠³.

8. Final decision

   DIAL notifies you within 10 working days after the monitoring report is final or it accepts your plan of correction. A full two-year certificate is dated from the original provisional certificate ⁠².

DIAL can deny a certificate for substantial or repeated noncompliance, fraud or false information, founded dependent adult abuse, or an owner’s or manager’s past interest in a closed facility in any state ⁠¹.

Fees as published on 2026-10-12

Monitoring, renewal and ownership changes

• Monitoring. DIAL monitors every certified program at least once in each 24-month period ⁠³. Display your certificate, and make your latest monitoring report, fire safety report and food establishment inspection report available on request ⁠².
• Recertification. File the full application and the $1,000 fee at least 90 calendar days before expiration. Include documentation that the heating, cooling, water heater, electrical, plumbing, sewage, lighting and ventilation systems have been inspected and maintained to manufacturer and national standards. If you have them on site, include the garbage disposal, kitchen appliances, washers, dryers and elevators too ⁠². A home in good standing gets a new two-year certificate dated from the previous expiration ⁠².
• Ownership changes. A certificate may transfer unless it is conditional, suspended or revoked. The new owner files an application at least 30 days before the change, and DIAL may monitor within 90 days afterward ⁠². Report changes in the ownership list within 10 working days ⁠².
• Closing. Give DIAL and the tenant advocate 90 days’ written notice and a plan for moving every tenant safely ⁠².
• Penalties. Civil penalties can reach $10,000 for noncompliance creating imminent danger, $5,000 for failing to correct problems or for retaliation, and $1,000 for interfering with DIAL ⁠³.

Medicaid and other public payment

Public funds can go only to a home with a current certificate ⁠¹. If your home receives Iowa Medicaid payments, you must ask each tenant within 30 days about veteran status, report possible veterans to the Iowa Department of Veterans Affairs, and bill the VA or another third party before Medicaid ⁠². Iowa’s Medicaid provider rules for the HCBS elderly waiver, 441 IAC 77, name DIAL-certified assisted living programs as providers but do not mention elder group homes ⁠⁸.

The sources reviewed do not say whether any Iowa Medicaid program pays elder group homes directly or instead pays separately enrolled providers who serve EGH tenants. Ask DIAL and Iowa HHS Medicaid provider services which applies to your home before you promise tenants that Medicaid will cover their stay.

What changed recently

• New elder group home rules, effective March 11, 2026. DIAL readopted 481 IAC 68 (ARC 0064D, published February 4, 2026). The chapter’s scheduled rescission date is March 11, 2031 ⁠².
• Fire rules moved to DIAL. The former 661 IAC fire chapters were rescinded effective September 10, 2025. Fire control administration, including the elder group home inspection fee, is now in 481 IAC 280, which adopts the 2024 International Fire Code ⁠⁴.

Sources

1. 1
   Iowa Legislature, Iowa Code chapter 231B: Elder Group Homes (2026) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Iowa Legislature, Iowa Administrative Code, Iowa Administrative Code 481—Chapter 68: Elder Group Homes Checked 12 Oct 2026 · Back to text ↑
3. 3
   Iowa Legislature, Iowa Administrative Code, Iowa Administrative Code 481—Chapter 67: General Provisions for Elder Group Homes, Assisted Living Programs, and Adult Day Services Checked 12 Oct 2026 · Back to text ↑
4. 4
   Iowa Legislature, Iowa Administrative Code, Iowa Administrative Code 481—Chapter 280: Fire Control Administration Checked 12 Oct 2026 · Back to text ↑
5. 5
   Iowa Legislature, Iowa Code section 414.31: Elder group homes (city zoning) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Iowa Legislature, Iowa Code section 335.33: Elder group homes (county zoning) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Iowa Department of Inspections, Appeals, and Licensing, Health Facilities Checked 12 Oct 2026 · Back to text ↑
8. 8
   Iowa Legislature, Iowa Administrative Code, Iowa Administrative Code 441—Chapter 77: Conditions of Participation for Providers of Medical and Remedial Care Checked 12 Oct 2026 · Back to text ↑

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