Pennsylvania assisted living residence license: Chapter 2800, special care units and fees

What makes a residence an ALR

Chapter 2800 defines an assisted living residence as “any premises in which food, shelter, assisted living services, assistance or supervision and supplemental health care services are provided for a period exceeding 24-hours for four or more adults who are not relatives of the operator.”⁠¹ The four-adult, non-relative headcount matches Article X’s personal care home definition.⁠³ The difference is supplemental health care, which the chapter defines as any health care service the residence provides “directly or through contractors, subcontractors, agents or designated providers,” except services that the Health Care Facilities Act reserves to licensed health care facilities.⁠¹

That one word changes what kind of business you are running. Article X defines a personal care home by food, shelter and personal assistance or supervision for adults who do not need a licensed long-term care facility; supplemental health care is not part of it.⁠³ An ALR must show DHS it can provide or arrange those services, and § 2800.220(e) lists what it must offer: hospice, occupational and physical therapy, skilled nursing, behavioral health, home health services, escort to medical appointments, and specialized cognitive support.⁠¹ For the personal care home side of the comparison, including the PCH fee table and the 100-hour course in detail, see our Pennsylvania personal care home license guide.

Chapter 2800 does not cover personal care homes, domiciliary care homes, independent living communities or commercial boarding homes.⁠¹ A statement of policy effective October 20, 2018 also excludes two arrangements. The first is premises whose real-property owner has no ownership, control or affiliation with the home care provider serving residents there. The second is independent living units on a continuing care retirement community campus whose residents can get personal assistance from an unaffiliated home and community-based provider.⁠¹ If you plan to rent apartments to older adults and let an outside home care agency or home health agency serve them, that policy is the line to read before you decide you need Chapter 2800.

The name is regulated

Section 2800.11(d) bars any person, organization or program from using “assisted living” in a name or written material unless it holds a Chapter 2800 license. It also stops a corporation whose subsidiaries hold ALR licenses from using the term to market its unlicensed programs.⁠² DHS’s January 2026 prospective licensee guide counts about 1,000 personal care homes and 100 ALRs in the state.⁠⁸

Aging in place, and where it stops

Chapter 2800 opens by calling assisted living “a significant long-term care alternative to allow individuals to age in place.”⁠¹ Several rules carry that idea:

• Nursing-home-level residents may stay. Adults who need a licensed nursing facility’s services, including those with mobility needs, may live in an ALR if appropriate supplemental health care is provided and the building, staffing and operation allow safe emergency evacuation.⁠¹
• Discharge needs accommodation first. Before starting a transfer or discharge, the residence must make “reasonable accommodation for aging in place,” which may include outside providers, and document its attempts in the support plan. The notice period is 30 days in most cases.⁠¹
• Informed consent agreements. A competent resident who wants to direct care in a way that creates risk can negotiate a written informed consent agreement with the licensee, and the ombudsman is notified for residents who are not competent.⁠¹⁠³

There are hard limits. Section 2800.229 bars admitting, retaining or serving anyone who is ventilator dependent, has stage III or IV decubiti or vascular ulcers that are not healing, needs continuous IV fluids, has a nasogastric tube, needs physical restraints, needs continuous 24-hour skilled nursing, or has a reportable infectious disease requiring isolation.⁠¹ The residence can ask DHS for an exception for a named individual. DHS reviews the request with a physician or certified registered nurse practitioner, answers in writing within 5 business days, and decides case by case, never facility-wide.⁠¹ A second list, covering gastric tubes, tracheostomies, sliding-scale insulin, intermittent IV therapy, catheters, oxygen and inhalation therapy, generally needs a DHS determination only when the resident cannot self-manage and no licensed or qualified person handles the care; for a tracheostomy, only independent self-care avoids the determination.⁠¹

Living units and the building

This is where most PCH-to-ALR plans succeed or fail. Article X requires ALR rules that “meet or exceed” the personal care home rules and that give each resident a private bathroom, living and bedroom space, kitchen capacity and a lockable door.⁠³ Chapter 2800 turns that into numbers:⁠¹

Source: ⁠¹

DHS may grant exceptions to the unit size at its discretion.⁠¹ Sharing is voluntary only: two residents may agree in writing, in each resident’s contract, to share a unit, the licensee may not require it, and no unit may hold more than two residents.⁠¹ The rule ties the larger sizes to “new construction of residences” after January 18, 2011 and the smaller ones to facilities “in existence prior to” that date. It does not say which column applies to a building put up after that date as a personal care home and converted later, so ask BHSL before you design units in such a building.⁠¹

Each living unit also needs:⁠¹

• its own bathroom with a flush toilet, sink with mirror, tub or shower, grab bars, and an emergency notification system;
• a telephone jack and individually controlled heating and cooling thermostats;
• entrance and interior doors that are accessible or adaptable for wheelchair use;
• a door with a lock, with the administrator holding a master key, except where a lock in a special care unit would be unsafe;
• a window with natural light, an average ceiling height of at least 7 feet, and an emergency notification system in the unit.

Kitchen capacity depends on the building’s history. New construction after January 18, 2011 needs a food storage cabinet, a small bar-type sink with hot and cold water, and outlets for a microwave and small refrigerator in each unit. A facility that converts to an ALR after that date needs the outlets in each unit, plus access to a common resident kitchen with a sink, a stovetop and a prep area that is separate from the staff kitchen.⁠¹ Either way, the residence must ask each new resident whether they want a cooking appliance or small refrigerator and supply it if so.⁠¹

Air conditioning is required. New construction after January 18, 2011 must have central air. Older facilities must provide central air, or window units if central air is not feasible or is cost prohibitive, with written justification to DHS.⁠¹ Common space is also sized: at least two wheelchair-accessible common rooms, lounge space of 15 square feet per living unit up to 50 units (750 square feet total above 50), and dining space of 15 square feet per person at each sitting.⁠¹

Fire safety

Before a license is issued you need written fire safety approval from the Department of Labor and Industry, the Department of Health or the local building authority. It must be renewed at least every 3 years, and resubmitted within 15 days after any structural renovation.⁠¹ DHS’s guide adds that a certificate of occupancy is required before any PCH or ALR can be licensed.⁠⁸ Every living unit needs its own smoke detector. With nine or more residents, detectors must be interconnected or there must be an interconnected alarm system. With five or more residents with mobility needs, the alarm must connect to the fire department or an approved 24-hour monitoring service where one exists.⁠¹

The administrator

The ALR administrator rules are stricter than the PCH rules at every step. Section 2800.53 has no high-school-diploma route. The administrator must be 21 or older and hold one of these:⁠¹

• a Pennsylvania RN license, an LPN license, a nursing home administrator license, or an associate’s degree or 60 credits in a human services field, each with 1 year of direct care or administrative experience in a health care or human services field within the prior 10 years;
• an associate’s degree or 60 credits in an unrelated field, with 2 years of such experience within the prior 10 years.

Before starting the job, the candidate completes a DHS orientation, the 100-hour standardized administrator course and a competency test.⁠¹ DHS’s training page adds a supplemental 15-hour course designed for ALRs and a separate ALR administrator orientation. Since July 1, 2024, the candidate must pass the ALR administrator competency test before registering for that orientation.⁠¹⁰ A licensed nursing home administrator hired after January 18, 2011 must still pass the ALR test, and every administrator needs 24 hours of training a year after the first year.⁠¹

Time on site is the other big difference. The ALR administrator must be in the residence an average of 36 hours a week in each calendar month, at least 30 of them during normal business hours.⁠¹ During temporary absences, a written administrator designee takes over. The designee needs 3,000 hours of direct operational responsibility for a licensed senior housing, health care, residential care or adult daily living facility, a passing score on the administrator test, and direct care staff qualifications.⁠¹ DHS’s licensing page links a BHSL administrator change form for reporting a new administrator.⁠⁶

Staffing beyond the PCH minimums

The base hours match Chapter 2600: direct care staff must be available to give at least 1 hour of assisted living services a day to each mobile resident and 2 hours to each resident with mobility needs, with 75% during waking hours. A direct care staff person aged 21 or older must be present whenever a resident is home.⁠¹ Chapter 2800 then adds:⁠¹

• Every direct care worker awake. All direct care staff on duty must be awake at all times, whatever the size of the residence.
• A licensed nurse. An LPN or RN, employed or under contract, must be in the building or on call at all times.
• A dietitian. On staff or under contract, for residents whose support plans call for special diets.
• First aid and CPR. At least one trained, certified staff person for every 35 residents must be present.
• One staffing pool across buildings. When one license covers several buildings on the same premises, the staffing minimums apply at all times residents are present, whatever the distance between buildings.

Direct care staff must be 18 or older and hold a high school diploma, a GED or active nurse aide registry status.⁠¹ Before giving unsupervised services they need 18 hours of training, including the DHS direct care course and competency test, and first aid and CPR certification. After that, they need 16 hours of training a year.⁠¹ All staff, including administrators, housekeepers and volunteers, need 4 hours of dementia-specific training within 30 days of hire and 2 hours a year after that.⁠¹ Unlicensed staff who give medications need the DHS medication administration course and test within the past 2 years. For insulin, they also need a DHS-approved diabetes education program within the past 12 months.⁠¹⁠¹⁰

Clinical judgment is built into admissions. The initial assessment must be done by the administrator, the designee, an RN, or an LPN supervised by an RN. An RN, or an LPN supervised by an RN, must review and approve the preliminary support plan.⁠¹

Services, packages and the resident contract

Every ALR must offer two core service packages. The Independent Core Package is for residents who do not need help with ADLs. It includes 24-hour supervision and emergency response, meals, housekeeping, laundry, daily activities, basic cognitive support, and help with unanticipated ADLs for a defined recovery period. The Enhanced Core Package adds ongoing ADL help, transportation, and medication assistance or administration.⁠¹

Supplemental health care must be “packaged, contracted and priced separately” from the resident-residence contract, a requirement that comes straight from Article X.⁠¹⁠³ You may require residents to use supplemental health care providers you approve, but only if that is prominently stated in the written admission agreement, and residents keep the right to choose their own primary care physician.⁠¹ The contract runs month to month. A resident can end it with 14 days’ notice, the residence must give 30 days, and the resident may rescind within 72 hours of signing.⁠¹

Before admission, each applicant gets written disclosures, including a resident handbook that DHS must approve and the number of living units that comply with the Americans with Disabilities Act.⁠¹

Special care designation for dementia and brain injury units

A special care designation is DHS’s designation of a licensed residence, or a distinct part of one, as capable of providing cognitive support services to residents with severe cognitive impairments. Chapter 2800 recognizes two kinds of special care unit. One serves Alzheimer’s disease or other dementia. The other provides intense neurobehavioral rehabilitation after brain injury (INRBI) for residents with severely disruptive and potentially dangerous behaviors.⁠¹ Only a licensed ALR can apply, and the application fee in § 2800.11(f) is $150.⁠² DHS’s checklist folds this into a $450 initial application fee for an ALR that opens with a special care unit, against $300 without one.⁠⁵

Section 2800.239 requires the application at least 60 days before you open a unit, add one, raise its capacity, or change its locking system, exit doors or floor plan. DHS must inspect and approve the unit before it operates.⁠¹ The application lists 22 items. They include a building and unit description, a sample 2-week staffing schedule, proof of the added training, the manufacturer’s statement on the locks, the lock approval or variance, the name of the fire alarm monitoring service, the activity standards, the consent form, and floor plans of the whole residence and of the unit with its outdoor area and exercise space.⁠¹

Operating rules for a dementia unit:⁠¹

• Locks. Locks that prevent immediate exit need written approval from Labor and Industry, the Department of Health or the local building authority. The manufacturer must confirm they release on fire alarm, power failure and keypad override. Fire alarms must be interconnected with the fire department or an approved 24-hour monitoring service.
• Space. Indoor and outdoor exercise space, and no more than two residents per living unit regardless of its size.
• Admission. A medical evaluation within 60 days before admission documenting the dementia diagnosis and the need for the unit, and a cognitive preadmission screening within 72 hours before admission, done with a physician or geriatric assessment team. The resident or family must agree in writing.
• Plans. A support plan within 72 hours of admission, reviewed at least quarterly. Each resident is also reassessed quarterly for continued need for the unit.
• Staffing and training. Every resident in the unit counts as having mobility needs, so the 2-hour daily minimum applies to all of them. Direct care staff need 8 hours of initial dementia training within 30 days of hire and 8 hours a year, on top of the standard 16.
• Program. Six types of activity at least weekly: gross motor, self-care, social, crafts, sensory and memory, and outdoor.
• Spouses. A spouse, friend or relative without the diagnosis may live in the unit if the resident wants, provided they can work the keypads.

INRBI units add a rehabilitation plan reviewed monthly, an onsite behavioral specialist and cognitive rehabilitation therapist, and consulting physiatry, neuropsychology and psychiatry.⁠¹ Special care designation rules are on the list of Chapter 2800 requirements that DHS may not waive.⁠¹

Converting or adding to a personal care home

Many Pennsylvania ALRs start as personal care home operators. The rules give three paths:

1. Dual licensure in one building

   A licensed PCH may apply for dual licensure when the PCH and the ALR are each in a distinct part of the same building, such as a separate wing or floor. The facility may not segregate residents or move them between the two licenses based on payment source.⁠² It may ask DHS to let one administrator cover both by waiving the § 2800.56 hours rule, but the administrator must meet the ALR qualifications.⁠² Article X requires dual-licensed facilities to be inspected by a team that includes both PCH and ALR surveyors.⁠³

2. Several buildings, one license

   Multiple buildings on the same premises may apply for a single ALR license.⁠²

3. Moving residents across

   No new initial assessment is required to transfer a resident from a personal care home to an ALR licensed by the same operator, or from a part of the residence without supplemental health care to a part that offers it.⁠¹⁠³

Section 2800.11(g) says only that the PCH “may submit an application”; the DHS application pages reviewed do not say whether that means the full HS 633 packet or a separate form, so ask BHSL. Either way, converted space must meet the living unit, bathroom and air conditioning rules above, which most PCH bedrooms do not.

Applying, step by step

1. Decide PCH or ALR, then secure the building

   DHS’s guide starts with that choice and requires a certificate of occupancy before licensure.⁠⁸ Line up the fire safety approval at the same time.⁠¹

2. Hire the administrator

   The administrator must have finished the 100-hour course, the 15-hour ALR course, the test and the ALR orientation before starting.⁠¹⁠¹⁰ BHSL reviews those qualifications before scheduling the inspection.⁠⁹

3. File the HS 633 packet with DHS/BHSL Licensing Administration

   at Forum Place, Harrisburg. Include an affidavit tracing ownership up to natural persons and listing every licensed human services facility any owner has been affiliated with in the past 3 years, approved Department of State filings, the occupancy permit (its address must match the application), and the HS 2126 civil rights form.⁠⁵ The fee goes in as a check or money order payable to the Department of Human Services; DHS does not take initial application fees electronically.⁠⁵⁠⁷ Incomplete packets are returned.⁠⁵

4. Send the pre-inspection documents

   The ALR checklist, revised January 14, 2025, has 18 items. They include criminal history checks (with FBI checks for anyone not resident in Pennsylvania for the past two years) for owners, executives, board members and all hired staff; staffing patterns; a 12-month training plan; floor plans showing every living unit’s size and ceiling height; 18 listed policies; the resident forms; and any management agreements. Item 9 is the special care unit packet if you are opening with one. BHSL also asks for a list of outside consultants who helped prepare the application.⁠⁹ Processing time begins only when DHS finds this review complete.⁠⁵

5. Pass the initial inspection

   No residence may open, operate or admit residents before DHS inspects it and finds it compliant. Any violations need an acceptable plan of correction.⁠²⁠⁸

6. Pay the per-bed fee and receive the license

   The checklist says the per-bed fee is collected when the license is issued.⁠⁵ DHS’s guide tells applicants to expect “a minimum of 90 days from the date of application.”⁠⁸ DHS reinspects within 3 months of initial licensure.⁠²

BHSL’s operator support hotline is (866) 503-3926, and its headquarters is at Forum Place, 555 Walnut Street, 6th Floor, Harrisburg (717-783-3670). Five regional offices handle inspections.⁠¹¹

Fees as published

Sources: ⁠²⁠⁵

The two columns differ because DHS used its § 2800.11(c)(2) authority to lower the fee. A notice at 48 Pa.B. 3493 (June 9, 2018) cut the per-bed fee from $75 to $35 for new and renewal applications from July 1, 2018. DHS said it expected the cut to “encourage growth in assisted living residences.” At the time it was collecting bed fees from 44 ALRs with 2,688 beds.⁠⁴ The rule requires a Bulletin notice whenever the per-bed fee goes up.⁠² No later adjustment notice was found in the Pennsylvania Bulletin, and DHS’s ALR fee payment instructions do not state an amount, so confirm the $35 figure with BHSL before budgeting.

At $35 a bed, a 40-bed residence would pay $300 plus $1,400 at initial licensure, and $1,850 with a special care unit. The per-bed fee is billed again at each annual renewal. DHS issues the renewal packet 130 days before expiration and asks you not to pay the per-bed amount until a fee letter arrives.⁠⁷ Licenses run one year and cannot be transferred. A provisional license lasts up to 6 months and may be renewed three times.⁠³

Inspections, waivers and penalties

DHS inspects every ALR unannounced at least once a year and may visit more often.⁠¹ Article X requires DHS to keep enforcement and licensing staff dedicated solely to assisted living residences.⁠³ Violations carry per-resident daily fines: $20 for Class I (corrected within 24 hours), $5 to $15 for Class II after a 5-day grace period, and up to $3 for Class III left uncorrected after 15 days. Operating without a license costs $500, plus $20 per resident per day if no application is filed within 14 days.⁠¹ Licensing appeals must be filed within 30 days of notice.⁠¹

You can ask DHS to waive a Chapter 2800 requirement only if residents face no jeopardy, an equivalent protection exists and residents benefit. Residents get the request 30 days before you file it, and DHS posts it on its website for 30 days of public comment.⁠¹ Resident rights, training, fire safety, special care designation, assessment and contract requirements cannot be waived.⁠¹ As of 2026-10-12, DHS’s licensing page listed three open ALR waiver requests, on direct care staff education (§ 2800.54(a)(2)), administrator training (§ 2800.64) and a television in the lounge (§ 2800.98(c)).⁠⁶

How ALR care gets paid in Pennsylvania

Chapter 2800 sets no Medicaid rate. The Community HealthChoices (CHC) waiver service definitions DHS posted with its 2026 amendment (January 28, 2026) let Residential Habilitation be delivered in licensed ALRs. But licensed settings serving CHC waiver participants may not exceed a licensed capacity of more than 8 unrelated individuals, and “payment is not made for room and board.”⁠¹² The same document bars Home Adaptations and Chore Services for participants living in ALRs, and Personal Assistance Services may not be provided at the same time as Residential Habilitation.⁠¹² Article X says people whose nursing facility placement is imminent get priority for ALR services funded through a home and community-based waiver.⁠³ The service definitions reviewed contain no separate assisted living service.⁠¹²

DHS’s pre-inspection checklist asks for a policy on accepted payment, naming SSI, private pay, and third-party payment through programs such as Living Independence for the Elderly (LIFE), In Lieu of Services (ILOS) and Residential Habilitation.⁠⁹ If you admit SSI recipients, rent and service charges may not exceed the resident’s monthly income minus the personal needs allowance. Hygiene items, personal laundry and ADL help must then be provided at no extra charge.⁠¹

Recent and pending changes

• July 1, 2018: the per-bed fee dropped from $75 to $35.⁠⁴
• October 20, 2018: the statement of policy excluding unaffiliated home care arrangements and certain CCRC independent living units took effect.⁠¹
• July 1, 2024: passing the ALR administrator competency test became a prerequisite for ALR administrator orientation.⁠¹⁰
• January 14, 2025: BHSL revised the ALR pre-inspection checklist; the revised version asks for policies on voice-controlled devices and location tracking and for the consultant list.⁠⁹
• January 20, 2026: DHS published its prospective licensee guide with the 90-day minimum.⁠⁸

The Pennsylvania Code site reflected changes effective through 56 Pa.B. 5370 (August 8, 2026). Its core text dates from the July 2010 adoption, effective January 18, 2011, with definitions, training and discharge amendments effective June 18, 2016.⁠¹ No proposed Chapter 2800 rulemaking appeared on DHS’s licensing page as of 2026-10-12.⁠⁶

Related Pennsylvania guides: personal care home, older adult daily living center, home care agency and home health agency licenses.

Sources

1. 1
   Pennsylvania Code and Bulletin, 55 Pa. Code Chapter 2800 (Assisted Living Residences) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Pennsylvania Code and Bulletin, 55 Pa. Code § 2800.11 (Procedural requirements for licensure; special care designation and dual licensure) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Pennsylvania Department of Human Services, Article X of the Human Services Code, 62 P.S. §§ 1001-1088 Checked 12 Oct 2026 · Back to text ↑
4. 4
   Pennsylvania Bulletin, Assisted Living Residences Per Bed Fee Adjustment, 48 Pa.B. 3493 (June 9, 2018) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Pennsylvania Department of Human Services, Checklist for the Initial Application for a Certificate of Compliance in a Human Services Setting Checked 12 Oct 2026 · Back to text ↑
6. 6
   Pennsylvania Department of Human Services, PCH & ALR Licensing Checked 12 Oct 2026 · Back to text ↑
7. 7
   Pennsylvania Department of Human Services, Application for Human Services Licensure Checked 12 Oct 2026 · Back to text ↑
8. 8
   Pennsylvania Department of Human Services, Prospective Licensee Guide (January 20, 2026) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Pennsylvania Department of Human Services, Bureau of Human Services Licensing, Pre-Inspection Checklist for New Assisted Living Residences (revised 1/14/25) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Pennsylvania Department of Human Services, PCH & ALR Licensing Training Checked 12 Oct 2026 · Back to text ↑
11. 11
    Pennsylvania Department of Human Services, PCH & ALR Licensing Contact Information Checked 12 Oct 2026 · Back to text ↑
12. 12
    Pennsylvania Department of Human Services, Office of Long-Term Living, Community HealthChoices 1915(c) Waiver Service Definitions (2026 amendment, January 28, 2026) Checked 12 Oct 2026 · Back to text ↑

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