Ohio residential care facility license: how ODH licenses assisted living

Which Ohio license your project needs

Ohio law defines a residential care facility as a home that provides either:

• accommodations for 17 or more unrelated individuals, plus supervision and personal care services for 3 or more of them, or
• accommodations for 3 or more unrelated individuals, personal care for at least 3, and any of the skilled nursing care allowed by ORC 3721.011 for at least one.⁠¹

A “home” in Chapter 3721 provides accommodations for more than 24 hours, paid or not, to 3 or more unrelated people who depend on others’ services.⁠¹ ODH calls these facilities “Residential Care Facilities (Assisted Living).” The Bureau of Regulatory Operations licenses about 720 of them.⁠¹⁸

The two tests leave a gap that catches many first-time founders. Suppose you want to open a 6-, 10- or 16-bed home that helps with bathing, dressing and medication reminders but does no nursing. That home is not an RCF. Ohio treats housing, supervision and personal care for 3 to 16 unrelated adults as a Class Two residential facility, licensed by the Ohio Department of Behavioral Health, and ORC 5119.34 excludes ODH-licensed RCFs from that category.⁠²³ See the Class Two residential facility guide. The moment that same small home gives skilled nursing care to one resident, even routine care such as administering medication, it falls under ODH’s RCF definition.⁠¹⁠²

Two exemptions from ODH’s rules matter when you plan the model:⁠⁶

• Personal care for fewer than three residents needs no RCF license.
• A building of any size that offers only housing, housekeeping, laundry, meals, activities, maintenance, security and transportation, with no personal care and no skilled nursing, needs no license either. That covers many “independent living” and senior apartment projects.

If you plan to send aides or nurses into residents’ own apartments instead of running the care yourself, that is home care. It needs ODH’s nonmedical home health services license or skilled home health services license, not an RCF license. A building that combines an RCF and a nursing home is licensed as a “home for the aging.”⁠¹ Only the nursing home side needs a certificate of need. ODH’s application asks for a CON file number for nursing homes only.⁠²¹

How much nursing an RCF may provide

The skilled-care limits shape your admission policy, your staffing and your marketing, so settle them before you design the building. Under ORC 3721.011 (last amended by Senate Bill 196, effective March 20, 2025), an RCF may:⁠²

• supervise special diets, apply dressings, and administer medication;
• provide other skilled nursing care on a part-time, intermittent basis for no more than 120 days in any 12-month period for each resident;
• go past 120 days only under a written agreement signed by the resident or sponsor and the resident’s physician, certified nurse practitioner, clinical nurse specialist or certified nurse-midwife. The skilled care provider signs too when that clinician does not oversee the care, and a licensed hospice program signs for hospice patients. Except for hospice patients, the clinician must have found the needed care “routine.”

An RCF “may not admit or retain an individual requiring skilled nursing care that is not authorized by this section.”⁠² Each resident receiving skilled care under the 120-day rule must be evaluated at least every seven days to decide whether they should move to a nursing home.⁠² Under the long-term agreement, redeterminations happen at least every 30 days, or every 15 days for hospice patients.⁠¹⁴

The rule tells you how to count the 120 days. Only days on which skilled care is actually performed count. Therapy by licensed physical, occupational or speech therapists does not count. The count runs “regardless of any transfer or discharge and readmission.”⁠¹⁴ The skilled care can come from a Medicare-certified home health agency, a licensed hospice, or your own staff who are authorized to provide it.⁠¹⁴ Providing it does not turn the RCF into a nursing home.⁠²

Medication is the line most RCFs cross. A resident who needs medication may be admitted or kept only if their physician, nurse practitioner, clinical nurse specialist or (where authorized) nurse-midwife has found in writing that they can self-administer, or if a Medicare-certified home health agency, a licensed hospice or a qualified member of your staff gives it. The statute lists, for staff, an RN, an LPN with a Board of Nursing-approved medication course working at an RN’s or physician’s direction, a certified medication aide, or a physician.⁠² Any staff member may help with self-administration: reminding the resident, bringing the medication from locked storage, opening the container.⁠²

The building: occupancy, fire and space rules

ODH will not open your file without four building documents. The rule requires a floor plan with beds, a certificate of occupancy showing use group R-4, I-1 or I-2, a fire inspection report from the State Fire Marshal or an approved local fire department, and a heating inspection report.⁠⁷ ODH’s instructions specify the floor plan as an 8½ x 11 inch schematic. It must show bath and toilet rooms, room numbers, room dimensions and the beds in each room. The heating document is a “current central heating system inspection letter.”⁠²⁰ The certificate of occupancy comes from your local certified building department, or from the Department of Commerce where there is none.⁠¹⁵ ODH sets your maximum licensed capacity based on the building, your staffing, residents’ needs and the occupancy Commerce has approved.⁠⁷

The fire and life-safety rules in OAC 3701-16-13 apply to every RCF, whatever its size:⁠¹⁵

• Automatic sprinkler and fire alarm systems meeting the Ohio building and fire codes, with installation, testing and maintenance records.
• Carbon monoxide detectors under section 915 of the Ohio Fire Code.
• A written disaster preparedness plan, kept on site and electronically. It must cover evacuating residents with impaired mobility and transporting everyone to a predetermined receiving facility, plus fire watch, missing residents and tornado shelter areas.
• Twelve fire drills a year, one on each shift every three months, plus two disaster drills, one of them a tornado drill held between March and July.
• A recorded monthly fire safety self-inspection kept for three years, and annual fire-prevention training given by the fire marshal or the local fire department.
• Written transfer agreements with facilities that can take residents whose health or safety is at risk.

Space standards for any building converted to or first licensed as a facility after December 22, 1964:⁠¹⁶

Every bedroom needs an outside or atrium window. Residents who cannot walk must be housed on a floor that exits at ground level unless you have an elevator.⁠¹⁶ Indoor temperatures must stay between 71°F and 81°F. You need written policies, developed with a physician or other health professional, for when they don’t, plus standing arrangements for emergency electrical and HVAC repair.⁠¹⁷

One license covers one building, unless several buildings sit on the same lot and form one facility. Since April 1, 2007, buildings separated by a public road cannot share a license. No building may hold two RCFs.⁠⁷

Administrator and owner qualifications

The license goes to the operator, and ODH screens the operator before it inspects. The director issues a license only if the applicant:⁠⁴

• has no felony or moral-turpitude conviction;
• is not violating ODH rules or orders;
• has had no prior license revoked for endangering residents, and no long-standing pattern of harmful violations;
• is “suitable financially and morally to operate a home.”

The application repeats the conviction question for every partner, member and officer. It also asks for everyone holding a 5% or greater ownership interest in the operator or the building, any HUD loan on the property, and every care facility the operator or administrator has owned or worked for in the past five years.⁠⁷⁠²¹ A revocation for any reason other than unpaid fees bars a new application for one year.⁠⁷

The administrator must be at least 21 and meet one of these routes at hire:⁠¹¹

1. Nursing home administrator license

   under ORC Chapter 4751.

2. Experience

   3,000 hours of direct operational responsibility for a senior housing facility, health care facility, residential care facility, adult care facility or other state-licensed group home.

3. Education

   100 credit hours of post-high-school education in gerontology or health care.

4. Degree

   Any bachelor’s degree.

5. Licensed health professional

   as defined in OAC 3701-17-07.1.

Administrators need nine hours of continuing education each year in gerontology, health care, business administration or RCF operations.⁠¹¹ The administrator must work at least 20 hours a week in the facility between 8 a.m. and 6 p.m. When they cannot, they must name an acting administrator who is at least 21.⁠¹⁰ In a home of 16 or fewer beds, an administrator who meets the personal care staff qualifications counts toward staffing. In a home of 17 to 35 beds, they count only once their 20 weekly hours are met. In a home of more than 35 beds, they never count.⁠¹⁰

Staffing and training without a fixed ratio

Ohio’s RCF rules contain no residents-per-staff ratio. Instead OAC 3701-16-05 requires the following:⁠¹⁰

• At least one staff member qualified to give personal care on duty at all times. At night that person may be on call while physically present, if the resident call system meets the rules. When only one staff member is on duty, a second qualified person must be on call.
• Enough additional staff to meet each resident’s assessed needs in a timely way, to carry out the evacuation plan for residents who cannot walk, and to provide activities.
• At least one staff member with current first-aid training present at all times.
• If you provide skilled nursing beyond diets, dressings and medication, an RN, employed or contracted, who spends enough time on site to supervise it, and a licensed nurse on call when none is present.
• If you admit residents with late-stage dementia, dementia with behaviors, or serious mental illness, a psychologist or physician experienced in their care, unless the resident has a private one.

Personal care staff must be at least 16 and supervised on site if under 18. Staff who help with self-administration must read, write and understand English.⁠¹¹ Each paid employee needs a health examination within 30 days before starting or on the first day.⁠¹¹ Training for personal care staff (licensed health professionals excepted):⁠¹¹

• Before giving personal care unsupervised: training from an RN, or an LPN under RN direction, in personal care techniques, observation and communication. Completing a state-approved nurse aide training and competency program, or Medicare home health aide training, also satisfies this.
• Within 60 days of hire: first aid (American Red Cross, American Heart Association, or an equivalent course taught by a qualified instructor).
• Within 14 days: two hours on dementia care or serious mental illness if you serve those residents (four hours if you serve both), then four hours (or eight) a year.
• Every year: at least eight hours of continuing education, plus annual residents’ rights training.

Every staff member gets orientation, and fire control and evacuation training, within three working days of starting. Nobody may be left alone with residents before completing both.⁠¹¹⁠¹⁵

For any position involving direct care of adults 60 and older, you must request a criminal records check from Ohio’s Bureau of Criminal Identification and Investigation, with fingerprints, and pay its fee. Conditional hiring is allowed while the results are pending.⁠⁵ You may not employ someone with a disqualifying offense (unless hired under ODH’s personal character standards), someone who refuses fingerprinting, or someone with an abuse, neglect or misappropriation finding on a nurse aide registry.⁠¹¹

The application packet and fee

ODH’s forms page carries an Initial License Application Packet, application, instructions and Notice of Readiness, each dated April 2026. It also has a change-of-operator application (April 2026), a renewal form (August 2018), a nurse staffing waiver application, and capacity increase and decrease instructions.⁠¹⁹ The application is a paper filing, mailed with a check or money order made payable to “Treasurer, State of Ohio.”⁠²⁰

The statute sets the fee at $320 for each 50 persons or part of 50 of licensed capacity, for both the application and the annual renewal.⁠³ Fees are nonrefundable.⁠⁷ The optional expedited initial inspection adds a nonrefundable $2,250. ODH must then start the inspection within 10 business days after it deems the application complete. Inspections are scheduled in the order requests become complete, and only new facilities may use this option.⁠⁸⁠²⁰ If you are not ready on inspection day, ODH may deny the license.⁠⁸

What the packet asks you to submit or attest to:⁠⁷⁠²⁰⁠²¹

• Projected opening date, building use group, bed count, for-profit or nonprofit status, and whether the building is new or converted.
• Operator, statutory agent, officers and 5% owners, and building owners.
• A zoning statement. The rule requires one, and the application’s attestation covers zoning compliance.
• Financial capacity. OAC 3701-16-03 calls for a solvency statement signed by a certified public accountant showing reserves for at least three months of operation. The April 2026 application instead has the operator attest to reserves for at least four months, and neither the application nor ODH’s instructions mention a CPA form. The sources do not say whether ODH still collects the CPA-signed form. Ask the Licensure Unit ([email protected]) before filing which solvency document it wants, and plan reserves for the longer four-month figure.
• A checklist of specialized programs, such as Alzheimer’s care, hospice, dialysis, or an adult day program on site.
• The Notice of Readiness, giving the date the home will be ready for inspection.

Send the packet to ODH Revenue Processing #3212, PO Box 15278, Columbus, Ohio 43215, by USPS. Couriers deliver to 246 N. High St., 5th Floor. ODH notes that depositing your check does not mean it has accepted the application.⁠²⁰

From filing to license, in order

1. Confirm the license type

   Check bed count and whether you will give any skilled nursing (the tests above). If personal care only and 16 or fewer beds, this is the wrong license.⁠¹⁠²³

2. Secure the building approvals

   Get the R-4, I-1 or I-2 certificate of occupancy, a fire inspection from the State Fire Marshal or an approved local department, and a heating inspection letter.⁠⁷⁠²⁰

3. Hire a qualified administrator

   and write the policies the Notice of Readiness lists. These include residents’ rights, advance directives, smoking, risk agreements, dietary services, infection control and a tuberculosis control plan, medication handling, resident finances, transfer agreements, the disaster plan and temperature policies.⁠²¹⁠²⁴

4. File 60 to 180 days before opening

   with the fee and, if you want it, the $2,250 expedited request.⁠²⁰

5. Answer ODH’s questions

   The director may request more information at any time, and you must respond within 60 days unless told otherwise.⁠⁷

6. Pass the pre-licensing inspections

   by ODH and the fire authority.⁠³ ODH says it will try to schedule its inspection within eight weeks of receiving a complete application and Notice of Readiness.⁠²¹ Until you are licensed you may admit no more than two residents.⁠²¹

7. Post the license

   in a conspicuous place.⁠⁷ If ODH denies the license, you can appeal under ORC Chapter 119.⁠⁴

Before each admission you must search the Ohio sex offender registry for the applicant.⁠¹² Each resident needs a written health assessment within 48 hours of admission and at least once a year after that.⁠¹³

Renewal, inspections and changes

An Ohio RCF license does not expire. It stays in effect until revoked or voided at the operator’s request, but the annual renewal fee is due in January. From February 1, an unpaid fee adds a $100 late fee for each week or part of a week, and if neither fee is paid by February 15 the director may begin revocation under Chapter 119.⁠⁴ The renewal application updates your solvency, ownership and fire inspection information.⁠⁷

After licensure ODH inspects at least every 15 months, and at least one of those inspections must be unannounced.⁠³⁠⁹ ODH may stretch the interval to 30 months if your two most recent inspections found no substantiated violations, no complaint investigations substantiated anything in that period, and nothing is outstanding.⁠³ The fire authority inspects every 15 months.⁠³

Changes with deadlines:⁠⁷

• Report changes in application information within 10 days. Changes of operator, owner, administrator or management firm also go in writing to residents and the regional long-term care ombudsman within 10 days.
• File a change-of-operator application at least 60 days before a sale. A change in majority ownership of the operator counts as a change of operator.
• Give 60 days’ notice before filling new or relocated beds, and wait for ODH’s written approval.
• Give at least 60 days’ notice of a planned closure (90 days where practicable), or 24 hours’ notice of an unplanned one, with a relocation plan for residents.

Medicaid: the Assisted Living waiver and memory care

Ohio’s Medicaid-funded assisted living service is open only to providers holding a current RCF license from ODH. The Ohio Department of Aging then certifies each provider for either the basic service or the basic service plus memory care (OAC 173-39-02.16, effective July 1, 2024).⁠²² Certification adds standards beyond licensure:⁠²²

• Each waiver resident’s unit must be single occupancy (shared only by the resident’s choice). It must have its own bathroom with toilet, sink and shower or tub, plus a seating area separate from the bed.
• Common dining and activity areas.
• Your website must state your certification type and whether you are accepting people enrolling through the assisted living program or MyCare Ohio.
• An RN or LPN must contact each waiver resident at least quarterly.
• Initial staff training on the principles of assisted living, aging and related topics.

Memory care certification requires a direct-care staffing ratio at least 20% higher than your basic-service ratio. A memory-care-only building with no benchmark available needs at least one direct-care staff member per 10 residents and one on each memory care floor. Memory care staff also need dementia-specific training.⁠²² A provider whose residents averaged at least 50% Medicaid enrollment in the prior state fiscal year can qualify for ODA’s higher critical access rate by answering ODA’s annual June survey.⁠²²

Because the waiver unit standards are stricter than the ODH space rules, decide before construction whether you will serve Medicaid residents. A shared 160-square-foot room passes OAC 3701-16-14 but does not qualify as a waiver unit.⁠¹⁶⁠²²

Recent and pending changes

• July 12, 2024: ODH’s RCF rules (OAC 3701-16-01 to 3701-16-18) took effect in their present form. Their next five-year review date is July 2, 2029.⁠¹⁰⁠¹⁷
• July 1, 2024: ODA’s assisted living certification rule, including the memory care tier and critical access rate, took effect.⁠²²
• March 20, 2025: Senate Bill 196 amended ORC 3721.011. As amended, the text lets certified nurse-midwives, clinical nurse specialists and certified nurse practitioners make the self-administration and skilled-care determinations, and names certified medication aides among those who may administer medication.⁠²
• April 30, 2026: ODH reissued the initial license packet, application, instructions and Notice of Readiness.⁠¹⁹⁠²¹

Questions about an application go to the ODH Bureau of Regulatory Operations Licensure Unit at [email protected] or (614) 466-7713.⁠¹⁹

Sources

1. 1
   Ohio Legislative Service Commission, Ohio Revised Code 3721.01 (Definitions) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Ohio Legislative Service Commission, Ohio Revised Code 3721.011 (Skilled nursing care in residential care facilities) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Ohio Legislative Service Commission, Ohio Revised Code 3721.02 (Licensing, inspections, fees) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Ohio Legislative Service Commission, Ohio Revised Code 3721.07 (License application and issuance) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Ohio Legislative Service Commission, Ohio Revised Code 3721.121 (Criminal records checks for direct-care applicants) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-02 (General provisions and prohibitions) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-03 (License applications; fees; issuance; revocation; notice) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-03.1 (Expedited initial licensure inspections) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-04 (Inspections and investigations) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-05 (Personnel requirements) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-06 (Qualifications and health of personnel) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-07 (Resident agreement; risk agreements) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-08 (Resident health assessments) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-09.1 (Skilled nursing care) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-13 (Building, plumbing, fire and carbon monoxide safety) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-14 (Space requirements) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-16 (Temperature regulation) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Ohio Department of Health, Residential Care Facilities - Assisted Living Checked 12 Oct 2026 · Back to text ↑
19. 19
    Ohio Department of Health, Residential Care Facility - Assisted Living Applications, Forms, and Instructions Checked 12 Oct 2026 · Back to text ↑
20. 20
    Ohio Department of Health, Bureau of Regulatory Operations, Residential Care Facility Initial Application Instructions Checked 12 Oct 2026 · Back to text ↑
21. 21
    Ohio Department of Health, Bureau of Regulatory Operations, Residential Care Facility Initial License Packet (April 30, 2026) Checked 12 Oct 2026 · Back to text ↑
22. 22
    Ohio Legislative Service Commission, Ohio Administrative Code 173-39-02.16 (ODA provider certification: assisted living service) Checked 12 Oct 2026 · Back to text ↑
23. 23
    Ohio Legislative Service Commission, Ohio Revised Code 5119.34 (Residential facilities) Checked 12 Oct 2026 · Back to text ↑
24. 24
    Ohio Legislative Service Commission, Ohio Administrative Code 3701-16-12 (Infection control; tuberculosis control plan) Checked 12 Oct 2026 · Back to text ↑

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