New York assisted living: the adult care facility certificate and ALR license

Two layers: a facility certificate, then the ALR license

New York splits assisted living into two approvals, and the order between them is fixed.

The first layer is an operating certificate for an adult care facility (ACF) under Article 7 of the Social Services Law. DOH says ACFs give “long-term, non-medical residential services” to adults who cannot live fully on their own. Residents may not need the continual medical or nursing care of a hospital or nursing home.⁠¹ Running an ACF without DOH’s prior written approval is a class A misdemeanor.⁠⁸ Anyone without a certificate is also barred from advertising that it offers “accommodations and services for dependent, aged or disabled adults.”⁠⁸

The second layer is the Assisted Living Residence (ALR) license under Public Health Law Article 46-B. Section 4656 says no entity may operate, offer or advertise “assisted living … or by a similar term” without both the ACF approval and the Article 46-B approval.⁠¹² Section 4653 states the prerequisite directly: “an operator shall be licensed as an adult home or enriched housing program.”⁠¹⁰ An ALR licensee must also provide daily food service, 24-hour on-site monitoring, case management and an individualized service plan (ISP) for each resident.⁠⁹ The ALR application has to cover every adult home or enriched housing bed on the certificate or in the same building. Assisted living program beds are the one exception.⁠¹⁴

The ALR layer is optional. An adult home that never calls itself assisted living, and keeps no residents who need enhanced care, falls outside Article 46-B.⁠⁹ It still runs under the Title 18 adult care rules. On top of the ALR you can add two more certifications:

• Enhanced Assisted Living Residence (EALR) lets you admit or keep residents who want to age in place and who chronically need another person’s physical help to transfer, walk or use stairs, depend on medical equipment and need more than occasional help from medical personnel, or have chronic unmanaged urinary or bowel incontinence.⁠⁹
• Special Needs Assisted Living Residence (SNALR) is required for any residence that “advertises or markets itself as serving individuals with special needs,” including people with dementia or cognitive impairment.⁠¹¹ You may not market specialized services until DOH approves the SNALR certificate.⁠¹³

You can apply for the ACF certificate and the ALR license at the same time. You do not have to open as a plain adult home first.⁠¹²⁠¹⁴

Which facility type you are building

The Social Services Law defines each ACF type by what it provides. Your choice decides which Title 18 rulebook applies and whether public need review applies.

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Sources: ⁠¹⁠⁷⁠¹⁰⁠²⁵

Five residents is the line. Below it, a home caring for 4 or fewer unrelated adults is a family type home for adults, which has its own certification process. See our New York family type home for adults guide.⁠⁷

The ALR definition also excludes several things founders sometimes confuse with it: nursing homes, hospice residences, naturally occurring retirement communities, independent senior housing, and HUD or state housing for older adults that does not provide or arrange home care or 24-hour supervision.⁠⁹

Public need: the test that can end an adult home application early

In New York, approval for a new adult home is not automatic, even for a qualified operator. Social Services Law section 461-b lets DOH approve an operator only if it shows good moral character, financial responsibility, and “that there is a public need for the facility.” In judging need, DOH must consider “the relative concentration of such facilities in the area.”⁠⁸ For adult homes and residences for adults, DOH must also consider the advice of the state health planning agency.⁠⁸

Rule 485.6 sets out the adult home need factors:⁠¹⁹

• certified and occupied adult home beds per 1,000 people aged 65 or older in the service area, compared with the statewide average;
• the number of people aged 65 or older and of SSI recipients living in adult homes in the area;
• occupancy of existing adult home beds, and how many people are waiting for placement;
• recommendations from the county department of social services and the local office for the aging;
• alternatives available, including family type homes and home care;
• bed supply and resident movement in the contiguous counties.

DOH may deny an application “solely on the basis of a determination of lack of public need” before it looks at character, architecture or finances.⁠¹⁹ It may also hold a public hearing on a proposed adult home at its discretion.⁠¹⁹ Without a need review, it can approve up to 9 additional beds in an existing adult home or residence for adults in any five-year period. Replacing an existing facility bed for bed in the same area is also exempt.⁠¹⁹ DOH’s training deck lists need as a Part I review component “for Adult Homes only.” Expect to document unmet need, together with statements of support from local officials and community organizations, when you apply.⁠⁴⁠¹⁹

Need is a DOH decision. Section 461-b gives the written approval to “the department.”⁠⁸ Section 4656 says the same for the ALR layer, and its approval criteria contain no need test: an adult home or enriched housing certificate, good standing, adequate finances, compliant building and staff, and any other required permits.⁠¹² The Public Health and Health Planning Council comes in only for the Assisted Living Program, where a licensed home care agency component needs its written approval.⁠²⁵

Instead of a need test, the ALR layer has public comment. DOH must “solicit and consider public comment with respect to all applications submitted,” and it posts pending ALR, EALR and SNALR applications for comment. The applications can be viewed through NYSE-CON.⁠¹⁴⁠²⁷

Who may own the operator

Section 461-b limits who can hold an ACF operating certificate:⁠⁸

• natural persons, and partnerships made up only of natural persons;
• not-for-profit and public corporations, social services districts and other government agencies;
• business corporations, but not one whose shares are publicly traded, a subsidiary of one, or a corporation any of whose stock is owned by another corporation;
• LLCs, provided that any corporate, LLC or partnership member is itself owned only by natural persons.

The Department of State may not file articles of organization for an LLC whose purposes include running an adult home, residence for adults or enriched housing program unless DOH’s written approval is attached.⁠⁸ For an ALR, each business-corporation shareholder signs an affidavit of sole beneficial ownership. Stock certificates must state that no one may own shares or voting rights without DOH approval.⁠¹⁴ DOH’s training materials require at least seven board members for a not-for-profit applicant.⁠⁴

Every principal goes through a character and competence review. If anyone has been an operator, director, owner or similar principal of a licensed health, mental hygiene or residential program in any state within the past 10 years, DOH must find “by substantial evidence” that each of those facilities gave “a substantially consistent high level of care.”⁠⁸ Schedule 2 asks each principal for a notarized personal qualifying statement and a personal financial statement covering 10 years. Schedule 2D goes to the licensing agency in every other state where an affiliate operates.⁠⁴

After licensure, any transfer of 10% or more of an operator’s interest needs DOH’s prior approval. Smaller transfers need notice 90 days ahead, and DOH may bar them.⁠⁸

Filing the ACF Common Application through NYSE-CON

One form set covers adult home or enriched housing establishment, ALR licensure, EALR and SNALR certification, and ALP beds.⁠⁴ Since July 1, 2019, DOH accepts ACF licensure and certification applications only through the New York State Electronic Certificate of Need system (NYSE-CON). Paper applications are “returned unreviewed.”⁠⁶ If you do not use DOH’s Health Commerce System, you reach NYSE-CON through a my.ny.gov account. The original signature pages and any fee check still go by mail to the Bureau of Licensure and Certification, 875 Central Avenue, Albany, NY 12206.⁠⁶ Questions about applications go to [email protected].⁠²

A new ACF or ALR uses Schedules 1 through 6.⁠⁵ Review runs in two parts, which can overlap:⁠⁴

1. Part I, central office

   Schedule 1 covers the project and, for ALR applicants, the fee calculation (Schedule 1D). Schedules 2 to 5 cover character and competence, legal documents, finances and architecture. The financial schedules need start-up projections for two years reaching 90% occupancy, plus a 12-month operating budget at 90% occupancy. DOH has said the budget may run to 90% occupancy or to the point of sustainability.⁠³⁠⁴ A registered architect or professional engineer signs and notarizes the architectural certification (Schedule 5B).⁠⁴

2. Part I decision

   Rule 485.6 gives DOH 90 days from receipt of all required information, including recommendations from local and state agencies, to decide Part I.⁠¹⁹

3. Part II, regional office

   Schedule 6 goes to the DOH regional office for your county. It must be uploaded no later than 90 days after Part I approval. The emergency and disaster plan, personnel qualifications, admission and residency agreements, and any waivers are reviewed before approval.⁠⁴⁠¹⁹ For applications filed or revised after January 11, 2026, Schedule 6 must include admission policies with a non-discrimination statement and a reasonable accommodation policy.⁠²⁹ DOH publishes model admission and residency agreements, plus EALR and SNALR addenda, on its application page.⁠²

4. Construction

   Within 90 days of Part II approval you notify DOH of your start and completion dates. Construction must finish within 18 months of Part II approval, with progress reports every 90 days.⁠¹⁹ If you want to build before Part I approval, Schedule 5E asks DOH for early commencement at your own risk; it must be filed with the Part I application, and DOH approval is required. DOH answers within 60 days of receiving all required application information.⁠³⁠⁴

5. Final inspections

   At least 30 days before you plan to admit anyone, you request a final architectural inspection and then a final facility inspection. DOH will not inspect until fire protection systems work, your administrator (and, if required, case manager and activities director) has been approved, staff are hired, and you can document compliance with local codes.⁠¹⁹

Final approval of both parts is required before admitting residents.⁠³ When DOH requests missing ALR information, you have 60 days to supply it or the application can be withdrawn and the fees forfeited.⁠¹⁴ An approved ALR that is not licensed and operating within one year is treated as abandoned.⁠¹⁴ For new construction, DOH says that “Processing an application for new construction may take anywhere from 18 months to 2 years to receive full approval,” local permits included.⁠³

Operators already in good standing can use Schedule 8 and attestations for the legal and financial components when opening a like facility, as section 461-b requires DOH to offer.⁠³⁠⁸

Fees as published

Public Health Law section 4656(6) sets the ALR fees, and DOH prints the same arithmetic on Schedule 1D and the renewal form. As published on 2026-10-12:⁠¹²⁠⁵⁠²⁶

The per-resident fee counts occupied beds when you apply; at renewal, DOH-5301 counts residents 90 days before expiration.⁠²⁶ You pay it for every resident whose income you have not documented as at or below 400% of poverty. Medicaid and SSI recipients are presumed to be at or below that line.⁠¹⁴ If the building is still under construction when you apply, you pay the $500 base fee up front and the per-resident amount is set when the license is approved.⁠¹⁴ All fees are nonrefundable and must be paid before DOH processes the application.⁠¹⁴ Make checks payable to the New York State Department of Health.⁠⁵

Schedule 1 marks the application fee as “for ALR and EALR and/or SNALR only.”⁠⁵ Section 4656(6), however, describes the ALR fee as “in addition to the fee charged by the department for certification as an adult care facility.”⁠¹² Neither DOH’s application pages nor its forms publish a separate fee for the adult home or enriched housing certificate itself, so ask the Bureau of Licensure and Certification whether one applies before you budget.

Building rules that drive site selection

For an adult home, Schedule 5 requires compliance with the Existing Building Code of New York State and the environmental standards in 18 NYCRR 487.11.⁠⁴ Key adult home space rules:⁠²³

• bedrooms above grade, lockable by the resident, and limited to single or double occupancy;
• at least 100 square feet for a single bedroom and 160 for a double, not counting closets and toilet rooms;
• one toilet and one sink for every 6 residents, and one tub or shower for every 10;
• at least 15 square feet of dining space and 20 of leisure space per certified bed;
• a centralized emergency call system in bedrooms, toilets and bathing areas for facilities certified after September 1, 1984.

The ALR layer adds safety features under 10 NYCRR 1001.13:⁠¹⁷

• Sprinklers. An ALR with 5 to 16 beds needs an NFPA 13R or NFPA 13 system. An ALR with 17 or more beds, and an EALR or SNALR of any size, needs NFPA 13.
• Detection and alarms. Supervised smoke detection throughout the building, including bedrooms, attics and basements, with alarms connected directly to the fire department or a 24-hour central station.
• Occupancy class for new buildings. New ALR buildings outside New York City follow Occupancy Group I-1, Condition 2. Residences of 5 to 16 beds may use R-4, Condition 2 instead. Inside the city, I-1 applies, with R-2 allowed for 5 to 16 beds.
• EALR and SNALR with 17 or more beds. Each floor needs at least two smoke compartments. A new multi-story building also needs an elevator that can carry a stretcher.
• SNALR units of any size. Self-contained “household units” with their own dining and leisure space, delayed-egress doors and monthly fire drills. In wood-frame (Type V) buildings, SNALR areas must sit at grade or one level above.

Dedicated SNALR beds must be in a fixed area of the building. EALR beds may “float,” as long as the number in use never exceeds the certified number.⁠¹⁴

The administrator and minimum staffing

DOH must approve the administrator before you designate one. The administrator must be at least 21 and have three recent letters of recommendation. The education and experience required rise with capacity:⁠²²

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In a home of 25 or more beds, the administrator is on duty at least 40 daytime hours a week. In a home of 24 or fewer, the minimum is 20 hours, and up to 10 of those hours may go to hands-on tasks. Administrators need 60 hours of DOH-approved continuing education every two years, unless they hold a New York nursing home administrator license.⁠²²

Adult home staffing floors under rule 487.9:⁠²²

• Supervision, on site 24 hours a day: 1 staff member for 1 to 40 residents, 2 for 41 to 80, 3 for 81 to 150, 4 for 151 to 200, and 1 more for each additional 60 residents.
• Personal care: at least 3.75 staff hours per resident per week, spread across day and evening shifts.
• Housekeeping: 1 staff hour per resident per week.
• Food service: 2 staff hours per resident per week and never less than 35 hours, plus a dietitian or dietetic technician as consultant.
• First aid: someone qualified in first aid on duty at all times.

An ALR keeps those staffing floors and adds its own.⁠¹⁶ A qualified case manager must be on site at least 20 hours a week below 25 beds, adding 1 hour per bed above 24, up to 40 hours from 45 beds. Resident aides need 40 hours of initial training and 12 hours of in-service each year. An EALR, or a SNALR that also holds EALR certification, must provide enough nursing staff, either employed or under contract, to meet residents’ health needs.⁠¹⁶

Who you can admit, and when EALR or SNALR is needed

An adult home may not admit or keep anyone who needs continual medical or nursing care, is chronically bedfast, has chronic unmanaged incontinence, or is dangerous to themselves or others. People who depend on medical equipment are also excluded unless strict conditions are met.⁠²¹ You also cannot refuse someone because of a mobility impairment. You must make reasonable accommodations.⁠²¹ An ALR applies the same standards. Each resident needs a medical evaluation within 30 days before admission and at least every 12 months. The ISP is developed on admission, implemented within 30 days and reviewed every six months.⁠¹⁵

Above those limits, you need EALR certification. With it you may admit or retain residents who are chairfast, who need one or more people to help them transfer, walk or use stairs, who depend on medical equipment, or who have unmanaged incontinence.⁠¹⁵ The EALR application must include a plan covering services, staffing levels, training, staff experience and environmental changes. The SNALR application needs a parallel special needs plan.⁠¹⁴ A resident who comes to need 24-hour skilled nursing must normally be discharged. In an EALR, the resident may stay if they hire the extra nursing, medical or hospice staff, their physician and home care agency document that they can be cared for safely, and you agree to coordinate that care.⁠¹¹⁠¹⁵

The Assisted Living Program: the Medicaid route

The Assisted Living Program (ALP) is New York’s Medicaid-funded version of assisted living. It is not a level of the ALR license. Article 46-B expressly excludes ALPs from the ALR definition, and ALP beds do not need EALR certification.⁠⁹⁠¹³ An ALP serves people who are “medically eligible for placement in a residential health care facility” but can be served safely in a less intensive setting.⁠²⁵ It provides personal care, home health aide and nursing services, therapies and RN case management.⁠¹

To run one, the same owners must hold an adult home or enriched housing certificate and a home care license: a licensed home care services agency, certified home health agency or long-term home health care program.⁠²⁵⁠⁵ Residences for adults and family type homes cannot be the ACF half.⁠²⁵ An ALP that is not itself a CHHA or long-term program must contract with one for nursing and therapy, and no more than one unless DOH approves more for good cause. It also needs transfer agreements with nursing facilities.⁠²⁴ Schedule 1E asks for letters on the need for ALP beds from the county department of social services and the county office for the aging.⁠⁵ Medicaid enrollment starts only after full approval, because enrollment requires the operating certificate.⁠⁴ The home care half has its own licensing route; see our licensed home care services agency guide and certified home health agency guide.

How ALP beds become available changed in 2025. DOH’s Q&A still says ALP beds come out through periodic competitive solicitations.⁠³ Section 461-l now states that beginning April 1, 2025, additional ALP beds “shall be approved on a case by case basis” whenever DOH finds public need. The need review weighs regional ACF and ALP occupancy and how many Medicaid recipients the project will serve.⁠²⁵ Existing ALP providers in good standing can add up to 9 beds without major construction through an expedited review that certifies them within 90 days of a satisfactory application.⁠²⁵

Renewal and reporting after you open

An adult care facility certificate runs for no more than four years.⁠¹⁸ An ALR operating certificate is issued for two years, and the ALR license fee is paid every two years.⁠¹³⁠¹² File the renewal 45 to 90 days before expiration. A late filing can bring civil penalties, and not filing at all counts as surrendering the certificate.⁠²⁰ DOH emails the administrator about three months before expiration with a link to the electronic renewal platform. The renewal uses form DOH-5301, which includes the ALR fee calculation and proof of workers’ compensation coverage.⁠³⁰⁠²⁶

Closing also needs approval. An adult home must give the regional office 120 days’ written notice with a closure plan.⁠¹⁸ An ALR, or an operator dropping EALR or SNALR certification, must give 90 days’ notice.⁠¹³

Quality posting rules since 2025

Governor Hochul signed an amendment adding paragraph 7 to section 4656 on February 14, 2025.⁠²⁸ Every ALR, EALR and SNALR must now report annually on quality measures. Each must post its starting monthly service rate, starting rent range, approved residency agreement and a consumer summary of all service fees on its website and in a public space in the building.⁠¹² DAL DACF 26-13 (January 12, 2026) set three measures from January 1, 2026: substantiated complaints, direct caregiver staffing levels, and food service violations at the last recertification survey. DOH posts each facility’s results against the statewide average.⁠²⁸ The same letter required operators to submit the posting form by January 31, 2026, and to publish the approved residency agreement, addenda and consumer summary on the facility website.⁠²⁸ Residences scoring in the top quartile get “advanced standing” on their survey schedules.⁠¹² The posting duty covers every ALR, so a new residence needs its approved agreement and fee summary posted once it is licensed.⁠¹²

Sources

1. 1
   New York State Department of Health, Adult Care Facility Services Checked 12 Oct 2026 · Back to text ↑
2. 2
   New York State Department of Health, Adult Care Facility and Assisted Living Common Application Checked 12 Oct 2026 · Back to text ↑
3. 3
   New York State Department of Health, Questions and Answers, Adult Care Facility Common Application Checked 12 Oct 2026 · Back to text ↑
4. 4
   New York State Department of Health, Adult Care Facility Common Application training presentation Checked 12 Oct 2026 · Back to text ↑
5. 5
   New York State Department of Health, ACF Common Application, Schedule 1 (General Information), DOH-5093 Checked 12 Oct 2026 · Back to text ↑
6. 6
   New York State Department of Health, Dear Administrator Letter #19-16: NYSE-CON Transition Checked 12 Oct 2026 · Back to text ↑
7. 7
   New York State Senate, Social Services Law section 2 (definitions) Checked 12 Oct 2026 · Back to text ↑
8. 8
   New York State Senate, Social Services Law section 461-b (establishment of adult care facilities) Checked 12 Oct 2026 · Back to text ↑
9. 9
   New York State Senate, Public Health Law section 4651 (Article 46-B definitions) Checked 12 Oct 2026 · Back to text ↑
10. 10
    New York State Senate, Public Health Law section 4653 (licensure procedures for assisted living) Checked 12 Oct 2026 · Back to text ↑
11. 11
    New York State Senate, Public Health Law section 4655 (enhanced and special needs certification) Checked 12 Oct 2026 · Back to text ↑
12. 12
    New York State Senate, Public Health Law section 4656 (general requirements, fees, quality reporting) Checked 12 Oct 2026 · Back to text ↑
13. 13
    New York State Department of Health, 10 NYCRR 1001.4: Operating certificates and additional certifications Checked 12 Oct 2026 · Back to text ↑
14. 14
    New York State Department of Health, 10 NYCRR 1001.5: Applications for ALR licensure and EALR/SNALR certification Checked 12 Oct 2026 · Back to text ↑
15. 15
    New York State Department of Health, 10 NYCRR 1001.7: Admission and retention standards Checked 12 Oct 2026 · Back to text ↑
16. 16
    New York State Department of Health, 10 NYCRR 1001.11: Personnel Checked 12 Oct 2026 · Back to text ↑
17. 17
    New York State Department of Health, 10 NYCRR 1001.13: Structural and environmental standards Checked 12 Oct 2026 · Back to text ↑
18. 18
    New York State Department of Health, 18 NYCRR 485.5: Operating certificates Checked 12 Oct 2026 · Back to text ↑
19. 19
    New York State Department of Health, 18 NYCRR 485.6: Application Checked 12 Oct 2026 · Back to text ↑
20. 20
    New York State Department of Health, 18 NYCRR 485.7: Renewal Checked 12 Oct 2026 · Back to text ↑
21. 21
    New York State Department of Health, 18 NYCRR 487.4: Admission standards (adult homes) Checked 12 Oct 2026 · Back to text ↑
22. 22
    New York State Department of Health, 18 NYCRR 487.9: Personnel (adult homes) Checked 12 Oct 2026 · Back to text ↑
23. 23
    New York State Department of Health, 18 NYCRR 487.11: Environmental standards (adult homes) Checked 12 Oct 2026 · Back to text ↑
24. 24
    New York State Department of Health, 18 NYCRR 494.3: Assisted living program, general provisions Checked 12 Oct 2026 · Back to text ↑
25. 25
    New York State Senate, Social Services Law section 461-l (assisted living program) Checked 12 Oct 2026 · Back to text ↑
26. 26
    New York State Department of Health, Application for Renewal of Operating Certificate and Assisted Living Residence Biennial Fee, DOH-5301 (03/20) Checked 12 Oct 2026 · Back to text ↑
27. 27
    New York State Department of Health, Opportunity for Public Comment on Pending Assisted Living Residence Applications Checked 12 Oct 2026 · Back to text ↑
28. 28
    New York State Department of Health, DAL DACF 26-13: Assisted Living Residence Quality Bill Posting Requirements Checked 12 Oct 2026 · Back to text ↑
29. 29
    New York State Department of Health, DAL #26-12: Revision to ACF Common Application Schedule 6 Checked 12 Oct 2026 · Back to text ↑
30. 30
    New York State Department of Health, Adult Care Facility Operating Certificate Renewal Process Checked 12 Oct 2026 · Back to text ↑

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