New Hampshire assisted living residence license: He-P 804 and He-P 805 explained

Two licenses, chosen by how your residents get out in a fire

New Hampshire’s statute does not use the term “assisted living facility.” RSA 151:9, VII tells DHHS to license residential care at different levels along a continuum of care. Two of those levels are the ones assisted living founders use:⁠⁴

• Residential care, which “requir[es] a minimum of regulation” and provides help with personal and social activities in a home or home-like setting. DHHS licenses this level as an Assisted Living Residence–Residential Care (ALR-RC) under He-P 804.⁠⁴⁠⁵
• Supported residential health care, which provides social or health services as needed from trained or licensed people, but not nursing complex enough to need 24-hour nursing supervision. DHHS licenses this level as a supported residential health care facility (SRHCF) under He-P 805.⁠⁴⁠⁶

The practical dividing line is evacuation. An ALR-RC may admit or keep a resident only if the resident is and stays mobile, can self-evacuate, and does not need special equipment to transfer to or from a bed or chair.⁠⁵ “Self evacuate” means the resident can get from anywhere in the building to an exit with no help from staff beyond verbal or physical prompting.⁠⁵ He-P 805 was written for people who may not be capable of self-preservation. Its fire safety section sends those residents into a building, or a separated part of one, built to the health care occupancy chapter of the state fire code.⁠⁶

So decide on your resident population before you choose a building. A farmhouse that works for six mobile residents under He-P 804 may never qualify for residents who use lifts.

When you need a license, and when you don’t

RSA 151:2, I(e) requires a license for residential care facilities “whether or not they are private homes or other structures built or adapted for the purpose,” that offer services beyond room and board to 2 or more individuals, whether or not the residents are elderly or disabled.⁠¹ Covered services include supervision, medical monitoring, help with daily living, protective care, and monitoring and supervision of medications.⁠¹ The name you use doesn’t matter. The law covers rest homes, board and care homes “or any other location, however named,” for profit or not.⁠¹

The statute exempts:⁠¹

• Facilities run only for people related to the owner or manager by blood or marriage within the third degree.
• Facilities providing only room and board.
• Facilities that care for 3 or fewer people and are certified by the commissioner under RSA 126-A:19 and 126-A:20.
• Facilities run by a church solely for ordained clergy or members of religious orders.

He-P 804 also excludes entities owned or operated by the state, residential care facilities authorized and inspected by the U.S. Department of Veterans Affairs that serve 3 or fewer individuals, and homes with no more than 3 licensed or certified beds where every resident is served under a DCYF license or in a certified community residence under RSA 126-A:20.⁠⁵

The one- and two-resident gap

New Hampshire also has an adult family care residence (AFCR), which is a certification, not a license. Under He-P 813 it is a dwelling where adult family care is provided for one or 2 residents.⁠⁹ RSA 151:9, VIII directs DHHS to certify settings serving fewer than 3 people as an alternative to nursing facility care.⁠⁴ The two statutes overlap at exactly 2 residents, and He-P 813 is built around Medicaid waiver residents. If you plan a privately paid home for 2 people, ask the licensing unit in writing which route applies before you sign a lease. He-P 813 applies only to adult family care services reimbursed through the CFI waiver, and the statutory exemption for 3 or fewer residents covers only homes certified under RSA 126-A:19 and 126-A:20.⁠¹⁠⁹ Read together, a privately paid home for 2 residents falls under the RSA 151:2, I(e) license, but none of the sources addresses that case directly, so get DHHS’s answer in writing.

No certificate of need, no moratorium

New Hampshire’s moratorium on new licenses and added capacity applies to nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities.⁠¹ Residential care is not on that list, and no certificate of need applies. Facilities licensed for residential care also may not advertise services they are not licensed to provide.⁠¹ He-P 804 sets a $500 fine for doing so.⁠⁵

Your building: town sign-offs and the fire code chapter

Four local approvals come first

Your application packet must include written approvals from four local officials. If your town lacks one of these officials, the board of selectmen or the mayor signs instead:⁠⁵

1. Health officer

   Local health, drinking water and wastewater requirements.

2. Building official

   State building code and local building ordinances.

3. Zoning officer

   Local zoning.

4. Fire chief

   The state fire code. For an ALR-RC this means at least the One and Two Family Dwelling chapter or the Residential Board and Care chapter of the life safety code, plus local fire ordinances.

For an existing building, these approvals must be dated no more than 90 days before you submit. For a building under construction, you submit approvals based on the officials’ plan review, then again when construction is complete.⁠⁵ DHHS offers a Local Approval Form, but calls it a suggested form. Towns may use their own form, a certificate of occupancy, or an email.⁠⁷ The He-P 805 fire chief approval is different: the chief verifies compliance with the fire code “for a health care facility.”⁠⁶

Life safety code chapter by resident count

For an ALR-RC, the threshold is between 3 and 4 residents. With 3 or fewer residents, the One and Two Family Dwelling chapter applies. With 4 or more, the Residential Board and Care Occupancy chapter applies.⁠⁵ Moving from 3 to 4 residents puts you under a different chapter. He-P 804 treats that as a change that needs an inspection before you operate under it.⁠⁵

Every ALR-RC needs interconnected smoke detectors on every level and in every bedroom, either hardwired or wireless as approved by the state fire marshal. It also needs a carbon monoxide monitor on every level.⁠⁵ Only the state fire marshal can grant fire code variances.⁠⁵

Construction and renovation

Submit construction documents, including architectural, sprinkler and fire alarm plans, to DHHS 60 days before work starts. Sprinkler and fire alarm plans also go to the state fire marshal.⁠⁵ DHHS approval is not required before you build, but if you go ahead without it, you do so “at their own risk.”⁠⁵ Facilities newly built or rehabilitated after the 2022 rule amendments must meet the 2018 FGI Guidelines for Design and Construction of Residential Health, Care, and Support Facilities (Residential Healthcare chapter). DHHS acts as the authority having jurisdiction for those guidelines.⁠⁵

Rooms

He-P 805 sizes rooms differently by facility size. A facility licensed for 16 or fewer needs at least 80 sq ft for a single room and 160 sq ft for a double. A facility licensed for 17 or more needs 100 sq ft per resident in a private room and 80 sq ft per resident in a semi-private room.⁠⁶

The administrator

He-P 804 requires every ALR-RC administrator appointed after the 2022 rule amendments to be at least 21 years old and to meet one of these combinations:⁠⁵

• A bachelor’s degree and 1 year of experience working in a health care facility.
• An NH RN license and 6 months of health care facility experience.
• An associate’s degree and 2 years of health care facility experience.
• An NH LPN license and 1 year of health care facility experience.

The administrator must work at least 35 hours a week at the residence, designate a stand-in in writing, and complete 12 hours of continuing education each licensing year.⁠⁵ If the administrator will be gone for more than 30 consecutive days, you must give DHHS the interim administrator’s name and credentials.⁠⁵ When you replace an administrator, notify DHHS at least 5 days ahead. Send the new administrator’s resume, licenses, NH Department of Safety criminal records check, signed criminal attestation and BEAS registry check. DHHS then decides whether that person qualifies.⁠⁵

He-P 805 sets higher bars that depend on size. With 17 or more beds, the options are a bachelor’s degree plus 2 years of health care experience, an RN plus 2 years, an associate’s degree plus 4 years, or an LPN plus 4 years. With 16 or fewer beds, the options are a bachelor’s degree plus 1 year, an RN plus 1 year, an associate’s degree plus 2 years, an LPN plus 2 years, or a high school diploma or GED. The diploma or GED route requires 6 years of health care experience, including 2 years of direct care in long-term care within the last 5 years.⁠⁶

Staff: overnight coverage, checks and training

Staffing levels. He-P 804 sets no numeric ratio. You must have enough qualified staff to meet each resident’s needs “as determined by each Cares Tool.”⁠⁵ The overnight rule depends on licensed beds:⁠⁵

• 17 or more beds: at least one awake staff member on duty at all times, including overnight.
• 16 or fewer beds: you may have a sleeping staff member overnight only if all of these are true:
  • Residents can wake that staff member through a UL-listed intercom or similar system.
  • If any resident has a history of exit seeking, a working wander prevention system will wake the staff member.
  • Every resident needs no more than occasional cueing and only verbal prompting to move and evacuate, has no acute or ongoing nursing needs, and has no history of verbal or physical abuse.

Background and registry checks. Before hiring, you must obtain an NH Department of Safety criminal records check for each:⁠⁵

• Applicant for employment.
• Volunteer.
• Independent contractor who gives direct or personal care or works unaccompanied.
• Household member.

Nurses licensed by the NH Board of Nursing are exempt from this check. You must also check names against the BEAS state registry and the NH nursing assistant registry.⁠⁵ A felony, a conviction for violent or sexual crimes, fraud, theft, abuse, neglect or exploitation, or an agency finding for any of those disqualifies the person unless DHHS grants a waiver.⁠⁵

Health screening. Before contact with residents or food, staff need a physical exam or health screening and a 2-step TB test. Both must be dated within 12 months before hire.⁠⁵ Direct care staff must be at least 18, unless they are licensed nursing assistants or students working under a nurse.⁠⁵

Training.

• Orientation before contact with residents or food covers resident rights, complaint procedures, emergency and evacuation procedures, infection control, food safety and mandatory abuse reporting.⁠⁵
• Annual in-service training repeats rights, infection control, the emergency plan and reporting.⁠⁵
• Medication assistance course. Unlicensed staff who assist with medication need at least 4 hours of training taught by a nurse, licensed practitioner or pharmacist.⁠⁵
• Dementia training under RSA 151:47-49: at least 6 hours initially and 4 hours each calendar year for covered administrative and direct service staff.⁠⁵

DHHS reminds facilities that keep personnel files off site that the files must be produced within two hours of a surveyor’s arrival.⁠⁷

Who you can admit, and the CARES Tool

RSA 151:5-a requires every residential care facility to confirm, before admission and every 6 months, that a person’s needs match the facility’s services.⁠³ You may not accept a new resident whose needs your license cannot meet. If a resident’s needs outgrow your license, you must either apply for the right license or help place the resident elsewhere.⁠³ He-P 804 fines $1,000 for admitting a resident whose needs exceed the license and $500 for failing to transfer one.⁠⁵

In an ALR-RC, this determination is made with the CARES Tool (January 2022):⁠⁵

• Timing. Complete it no more than 30 days before or within 24 hours after admission. Repeat it every 6 months and after any significant change.
• Who completes it. Staff trained by DHHS or by trainers from the associations named in RSA 151:5-a, III.⁠³⁠⁵
• Nursing assessment. If the CARES Tool flags one, it must be done within 72 hours. An LPN’s assessment must be co-signed by the supervising RN or physician. If the nursing assessment finds the resident cannot safely evacuate, the resident is ineligible for the ALR-RC.
• Care plan. If the tool calls for one, write it within 24 hours of the CARES Tool, or within 24 hours after the nursing assessment when one is required.

There is one exception to the mobility rule. A resident who needs hospice after admission may stay and receive services from a licensed home hospice provider. You must be able to evacuate that resident without endangering others, and you must have a written 24/7 evacuation plan.⁠⁵

Each resident also needs a health exam by a licensed practitioner within 30 days before or 72 hours after admission, then every 12 months unless the practitioner sets another schedule.⁠⁵ A resident who develops a stage 2-4 pressure ulcer, needs lift transfers or needs ongoing nursing points toward He-P 805. That rule requires specific staffing for each of these needs, including nursing personnel 24 hours a day for residents who need continuing nursing care or monitoring.⁠⁶

The application, step by step

1. Settle the level and the building. Choose He-P 804 or He-P 805 based on your planned residents. Match the building to the right life safety code chapter. If you are building or renovating, file plans with DHHS and the fire marshal 60 days before work starts.⁠⁵⁠⁶

2. Form the entity. If the owner is a corporation or LLC, or uses a trade name, you need a Certificate of Authority, Certificate of Formation or Certificate of Trade Name from the NH Secretary of State.⁠⁵

3. Collect the four local approvals within the 90-day window. If you are on a private well, test the water. If you are on public water, include a water bill.⁠⁵

4. Run criminal records checks. You need NH Department of Safety checks for the applicant, the licensee if different, the administrator and household members. Under He-P 805, add the medical director and household members 17 or older, plus a non-conviction attestation and adult services registry check for the administrator and medical director.⁠⁵⁠⁶

5. File the packet. The ALR-RC packet includes:⁠⁵

   • The “Application for Residential, Health Care License, or Special Health Care Services” form, signed by the applicant or 2 corporate officers. He-P 804 cites the January 2022 edition; He-P 805 cites an August 2025 edition.⁠⁶
   • A floor plan.
   • The administrator’s resume and licenses.
   • The fee, in cash or by exact-amount check or money order payable to “Treasurer, State of New Hampshire.”

   Mail or hand-deliver the packet to DHHS, Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301. DHHS will notify you in writing of any missing items.⁠⁵ The DHHS licensing page does not say which edition is current, so ask the licensing unit for the form it expects before you file.⁠⁷

6. Prepare for the inspections. At the initial inspection, have your admission agreement and standard disclosure form on hand.⁠⁵ DHHS performs both a clinical inspection and a life safety code inspection. It issues the license only if you are in full compliance.⁠⁵

7. Respond promptly. If you are not in full compliance after the first inspection and at most 2 follow-ups, DHHS denies the application. DHHS also denies it if you don’t respond within 3 months after being told the application is complete and an inspection needs to be scheduled.⁠⁵

Neither rule states a processing time for an initial license, and the DHHS licensing page does not publish one.⁠⁵⁠⁷

Documents residents must receive

When a person applies for admission, give them a residential service agreement under RSA 161-J. You can skip it if your admission agreement includes all of its provisions.⁠⁵ At admission, the admission agreement must state:⁠⁵

• The basic daily, weekly and monthly fee.
• The core services the basic rate covers.
• How and when rates increase.
• The criteria a resident must meet to stay.
• House rules.
• Grounds for immediate termination.
• Policies on resident funds, bed holds, transportation and third-party services.

The core services He-P 804 requires include:⁠⁵

• 24-hour protective care and oversight.
• Emergency response.
• Help taking and ordering medications.
• 3 meals plus snacks.
• Housekeeping and laundry.
• Activities.
• Help arranging medical and dental appointments and transportation to them.

Basic hygiene supplies such as soap, toothpaste and toilet paper must be included in the basic rate.⁠⁵ Give 30 days’ written notice of a rate increase. Exceptions are Medicaid residents and residents whose costs are set by the Choices for Independence program.⁠⁵

You must post:⁠⁵

• The license.
• The last 12 months of inspection reports.
• The patients’ bill of rights.
• Your complaint procedure, including the DHHS address, the 1-800-852-3345 number and long-term care ombudsman contact information.
• Your evacuation floor plan.

Fees and fines as published on 2026-10-12

A licensing fee cannot be transferred to another application.⁠⁵ He-P 805 uses a parallel fine schedule.⁠⁶

Fire drills and emergency planning

ALR-RCs built to the One and Two Family Dwelling or Residential Board and Care chapter must run at least 6 fire drills a year, every other month, with at least 2 at night while most residents are asleep. Each drill must actually evacuate all residents to the assembly point.⁠⁵ Every new resident gets an individual fire drill walk-through within 5 days of admission.⁠⁵ A staff member who has never taken part in a drill may not be the only staff member on duty.⁠⁵

He-P 804 also requires:⁠⁵

• An emergency management committee.
• A written emergency management program.
• 2 logged drills a year, at least one of which rehearses a mass casualty response with emergency services or disaster receiving stations.

Facilities within 10 miles of a nuclear power plant must also include the elements of the state Radiological Emergency Response Plan.⁠⁵

Getting paid through Choices for Independence

New Hampshire Medicaid pays for assisted living through the Choices for Independence (CFI) waiver. He-E 801.26 covers “residential care facility services” provided by facilities licensed under He-P 804 or He-P 805.⁠⁸ By statute, residential care rules must let you admit residents found eligible for nursing facility care under the waiver and referred to you as an alternative to a nursing home.⁠¹

CFI pays one all-inclusive per diem, and individual services are not billed separately:⁠⁸

• ALR-RC (He-P 804): the base residential care rate.
• Supported residential care (He-P 805): the base rate, unless qualified staff assess the resident on BEAS 3755, the “Resident Level of Care Sheet” (January 2022). A score of 0-8 earns the base rate, 9-17 earns Residential Care Dementia Level 1, and 18-39 earns Level 2.

If you expect to serve residents with dementia on Medicaid, this difference in rates is a reason to consider He-P 805. CFI residents in your facility cannot also receive CFI in-home care, and residential care is excluded from participant-directed services.⁠⁸ He-E 801.26 says the department sets the three per diem rates but does not state dollar amounts, and no official page located lists them, so ask the Bureau of Adult and Aging Services for the current base and dementia rates before you build a budget.⁠⁸

Renewal, changes and closing

A license is tied to the premises and the people named in the application, cannot be transferred, and expires one year after issuance.⁠² File the renewal application at least 120 days before expiration.⁠⁵ Include any waiver renewal requests and any state fire marshal variances. If you use a private water supply, include bacteria and nitrate test results at least every 3 years.⁠⁵ DHHS inspects before renewal. If you miss the renewal deadline entirely, you must reapply as a new applicant and pay a fine.⁠⁵ After any inspection with citations, you have 21 days to submit a plan of correction.⁠⁵

Give DHHS 30 days’ written notice before you change:⁠⁵

• Ownership.
• Location.
• Address.
• Name.
• Licensed beds.
• Services.

A change of ownership, a move, an added bed or a new service requires a new application and license before you operate under the change.⁠⁵ Restructuring that doesn’t transfer the controlling interest is not a change of ownership.⁠⁵ To close, give 60 days’ written notice with a closure plan.⁠⁵

Waivers of specific rules are available by written request. A waiver is permanent unless DHHS sets a time limit, and it cannot be transferred.⁠⁵

Rule status

He-P 805 was readopted with amendments in an adopted rule dated 8/26/25. The readopted text cites an August 2025 application form, requires background checks for a medical director, and sets the size-based administrator standards described above.⁠⁶ He-P 804 was last substantively amended in January 2022 (document #13339). That amendment introduced the post-2022 administrator qualifications and the FGI design requirement. Some of its other sections still carry the November 2017 adoption.⁠⁵ No rulemaking notice for He-P 804 was found as of 2026-10-12, so confirm the current text with the licensing unit before you rely on it.

If your plans also include day services or services in clients’ homes, those need separate licenses: see the New Hampshire adult day program license, the home care service provider agency license and the home health care provider license.

Sources

1. 1
   New Hampshire General Court, RSA 151:2 (Facilities licensed; exemptions; moratorium) Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Hampshire General Court, RSA 151:5 (Duration of license; fees) Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Hampshire General Court, RSA 151:5-a (Needs determination; assuring appropriate care) Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Hampshire General Court, RSA 151:9 (Rulemaking; residential care licensure levels) Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Hampshire Department of Health and Human Services, He-P 804, Assisted Living Residence–Residential Care Licensing Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Hampshire Department of Health and Human Services, He-P 805, Supported Residential Health Care Facility Licensing Rules (adopted rule 8/26/25) Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Hampshire Department of Health and Human Services, Health Facilities Administration (licensing FAQs and fees) Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Hampshire General Court, Office of Legislative Services, He-E 800, Medical Assistance (He-E 801, Choices for Independence Program) Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Hampshire Department of Health and Human Services, He-P 813, Adult Family Care Residence Checked 12 Oct 2026 · Back to text ↑

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