Rhode Island adult supportive care homes: 2 to 5 residents, existing providers only
Rhode Island licenses small homes that give lodging, meals and personal assistance to two to five unrelated adults as adult supportive care homes, under R.I. Gen. Laws chapter 23-17.24. The Department of Health issues the license, but only to an operator that already holds a RIDOH license as a home nursing care provider, nursing facility, assisted living residence or adult day program. As of 2026-10-12 the department had published no rules, application form or fee for these homes.
Contents12 sections
Key takeaways
- An adult supportive care home serves two to five adults who are not related to the licensee or manager; six or more makes it an assisted living residence.18
- The operator must already be a licensed home nursing care provider, nursing facility, assisted living residence or adult day services provider. A newcomer cannot start with this license.1
- The day-to-day manager must be a licensed healthcare professional approved by RIDOH, and a qualified staff member over 18 must be on the premises whenever residents are there.12
- As of 2026-10-12 RIDOH had published no rule Part, application form or fee for these homes; the statute is the only written standard.91011
- The license has no expiry date, but the home is inspected at licensure and at least every 18 months, and willful, continuing violations carry fines of $300 to $3,000 each.3
Quick facts
| Agency | Rhode Island Department of Health (RIDOH), Center for Health Facilities Regulation |
|---|---|
| Capacity | 2 to 5 adults unrelated to the licensee or manager |
| Who can hold it | Only an existing RIDOH-licensed home nursing care provider, nursing facility, assisted living residence or adult day services provider |
| Manager | A licensed healthcare professional designated by the licensee and approved by RIDOH |
| Staffing floor | A qualified on-duty staff person over 18 on site whenever residents are present |
| License fee | None listed in RIDOH's fee rule (216-RICR-10-05-2) as published on 2026-10-12 |
| Term and inspections | Valid until surrendered, suspended or revoked; inspected at least every 18 months |
Figures from R.I. Gen. Laws chapter 23-17.24 and 216-RICR-10-05-2, checked 2026-10-12. RIDOH has not adopted rules specific to these homes.
A small-home license reserved for existing providers
Many states let an individual open a licensed care home in a house with a handful of residents. Rhode Island’s version, the adult supportive care home, works differently. The Adult Supportive Care Residence Act (R.I. Gen. Laws chapter 23-17.24, enacted in 2009) defines the home in two parts. It is a residence that provides personal assistance, lodging and meals to two to five adults, and it “shall be” a licensed home nursing care provider or nursing facility licensed under chapter 23-17, an assisted living residence provider licensed under chapter 23-17.4, or an adult day services provider licensed under chapter 23-1.1
So the license works as an add-on for an organization RIDOH already licenses, not as a first license. If you have no RIDOH facility or agency license today, you have two options. You can open an assisted living residence, which needs six or more residents.8 Or you can first get one of the qualifying licenses below and then apply for a supportive care home.
No one may operate an adult supportive care home without a RIDOH license.2 The statute’s section histories list only the two 2009 public laws that created it, so the chapter has stood unchanged since then.123
Two to five residents, and what falls outside
Three tests decide whether a home falls under chapter 23-17.24:1
- Headcount. At least two and no more than five residents. The statute does not cover a single resident. At six, the home meets the definition of an assisted living residence, which covers “six (6) or more adults who are unrelated to the licensee or administrator.”8
- Relationship. Only adults unrelated to the licensee or the manager count.
- Services. The home provides personal assistance plus lodging and meals, directly or through contracts or arrangements.
The definition excludes privately operated facilities licensed under chapter 23-17. It also excludes any facility licensed by or under the jurisdiction of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), the Department of Children, Youth and Families, or any other state agency.1 A group home for adults with developmental disabilities or a behavioral health residence licensed by BHDDH therefore stays under that department, not RIDOH.
“Personal assistance” has a set meaning. It covers help with bathing, dressing, grooming, eating, toileting, mobility and transfer; help with self-administered medication, or medication given by appropriately licensed staff; arranging health and supportive services; monitoring residents’ health, safety and well-being on the premises; and reasonable recreational, social and personal services.1
Which license you need first
Your route depends on which qualifying license you already hold or are willing to get. The prerequisite licenses are not equally easy to obtain.
| Qualifying license | Statute | What getting it involves |
|---|---|---|
| Home nursing care provider | Chapter 23-17 | Until June 12, 2026, a certificate of need was required before establishment and initial licensure. P.L. 2026, ch. 84, Article 12 struck home nursing-care providers from the certificate-of-need statute on that date, but RIDOH’s rule and page still describe a Letter of Intent, a certificate of need application and Health Services Council review, so ask RIDOH which process it applies.121317 See the home nursing care provider guide. |
| Nursing facility | Chapter 23-17 | Licensed under 216-RICR-40-10-1.9 |
| Assisted living residence | Chapter 23-17.4 | Six or more residents. Annual fee of $330 base plus $70 per licensed bed, as published on 2026-10-12.811 |
| Adult day services provider | Chapter 23-1 (§ 23-1-52) | A comprehensive nonresidential program built around individual plans of care.14 |
The list does not include a home care provider, Rhode Island’s license for agencies that send aides and homemakers into homes. Read literally, the statute names a “home nursing care provider,” the separately licensed agency that sends its own nurses and therapists into homes.112 A home care provider license alone does not appear to qualify you.
For the details of two prerequisites, see the guides to the assisted living residence license and the adult day care program license. RIDOH’s home nursing care provider page explains the certificate of need route.13
The manager and the on-site staffing rule
The statute sets two personnel requirements and authorizes RIDOH to add more.
A licensed healthcare professional as manager. The manager is whoever runs the home day to day. The manager “must be a licensed healthcare professional designated by the licensee and approved by the department.”1 The statute does not say which professions qualify. It also does not require the assisted living residence administrator license that RIDOH requires for residences of six or more.18 Expect RIDOH to ask who your manager is and what license that person holds.
Someone on duty whenever residents are home. The home must have “a qualified on-duty staff person over the age of eighteen (18) on the premises at all times that any supportive care residents are on the premises.”2 In practice that means 24-hour coverage, because residents live there. The statute does not define “qualified.” Rhode Island has no published staffing ratio, training hour count or awake-overnight rule for these homes.
The statute authorizes the Director of Health to write rules on the following:2
- minimum requirements for managers
- staffing and staff training
- assessments and service plans
- food service, housekeeping and laundry
- physical and environmental standards
- resident rights and records
- residents’ capacity for self-preservation
- residency agreements
- quality assurance
It also allows special care rules for homes serving people with dementia or behavioral health diagnoses.2 As of 2026-10-12 none of these rules existed. RIDOH’s facility-regulation subchapter (216-RICR-40-10) has Parts for nursing facilities, assisted living residences, adult day care, and home nursing and home care providers, but none for adult supportive care homes.9
Who can live in the home
The statute defines a resident as someone who does not need acute medical or skilled nursing care but needs personal assistance, lodging and meals, and may need medication administered.1 It rules out:1
- people who need medical or skilled nursing care, including daily professional observation and evaluation
- people who are bed bound
- people who need more than one person’s help to walk
There are two exceptions. An established resident with a temporary illness or injury may receive daily skilled nursing or therapy from a licensed provider for up to 45 days, and RIDOH may approve more days. A resident may also stay under the care of a licensed hospice, as long as the home takes responsibility for making sure the care is received.1 The statute treats a resident’s written agent or legal guardian as the “resident” for its purposes,1 so they can act for the resident under the Act.
Self-preservation and the fire code. Residents must be able to take appropriate action on their own in an emergency. The one exception is a home that meets the stricter life safety code set out in the assisted living statute.1 That provision lets a residence that elects a higher life safety code, approved by the state division of fire safety, admit residents who cannot self-preserve.7 In assisted living rules, this is the difference between F2 licensure (residents can self-preserve) and F1 licensure (more stringent Life Safety Code).8 If you might serve people who cannot get out unaided, bring the State Fire Marshal’s office into the building plans early. The sources reviewed do not say which life safety code occupancy classification the State Fire Marshal applies to a two-to-five resident adult supportive care home; ask the Fire Marshal’s office and RIDOH before you design the building.
Background checks for every hire
Chapter 23-17.24 applies the assisted living background-check law to anyone seeking a job at an adult supportive care home.2 Under it:
- Anyone with routine contact with residents, or access to their belongings or funds, must have a national, fingerprint-based criminal records check. The fingerprints go to the FBI through the Attorney General’s Bureau of Criminal Identification (BCI). The check must be processed before employment starts or within one week of it.4
- The employee pays for the check.4
- If BCI finds disqualifying information, it tells the applicant what it is. It tells the employer only that something was found. The applicant may share the report, and the administrator then decides on continued employment.4
- You must keep evidence on file that each check was started, along with the results. Failing to keep it is grounds to revoke the employer’s license.4
- If an applicant had a statewide check within the previous 18 months, you may ask BCI or local police for a letter saying whether disqualifying information was found, and keep that letter on file.5
Disqualifying convictions include murder and manslaughter; first-, second- and third-degree sexual assault; assault on persons 60 or older; patient abuse, neglect or mistreatment; burglary; first-degree arson; robbery; felony drug offenses; felony embezzlement or false pretenses; abuse, neglect or exploitation of adults with severe impairments; exploitation of elders; and felony larceny.6 A nolo contendere plea with probation, or a deferred sentence agreement with the Attorney General, counts as a conviction.6
Applying when there is no form or fee
On 2026-10-12, RIDOH’s published materials offered no application route for this license:
- RIDOH’s assisted living licensing page lists initial applications only for assisted living residences and assisted living residence administrators.10
- RIDOH’s fee rule (216-RICR-10-05-2), as published on 2026-10-12, has fee lines for assisted living residences, adult day care programs, home nursing care providers and nursing facilities. It has none for adult supportive care homes.11
- No rule Part exists in the facility-regulation subchapter.9
The statute still requires a license before you operate, and it requires an inspection “at the time of licensure.”23 The office that licenses the qualifying facilities is RIDOH’s Center for Health Facilities Regulation, 3 Capitol Hill, Room 306, Providence, RI 02908, 401-222-2566.8 Ask that office in writing how it wants an adult supportive care home application submitted, and keep its answer. The statute, RIDOH’s licensing page and its fee rule give no application form, document list or fee for this license, so ask RIDOH what it requires and what it charges before you apply.
Before you contact RIDOH, have answers ready on the points the statute already fixes:12
Your qualifying license
Name and number of your home nursing care provider, nursing facility, assisted living residence or adult day services license.
The manager
Who the manager is and what healthcare license that person holds, since RIDOH must approve them.
The address and capacity
The address and how many residents (two to five) you plan to serve.
Coverage
How you will keep a qualified staff member over 18 on the premises at all times.
Self-preservation
Whether every resident will be able to self-preserve, or whether the building will meet the stricter life safety code.
Background checks
How you will run and document fingerprint checks for every hire.
Inspections, a license with no expiry date, and penalties
Most RIDOH facility licenses expire on a set date. An assisted living residence license, for example, runs to December 31 and renews every year.8 An adult supportive care home license “shall remain valid unless voluntarily surrendered, suspended, or revoked.”3 The statute sets no renewal cycle.
Oversight comes through inspections instead. RIDOH inspects the home when it is licensed and at least every 18 months after that. It may also make unannounced inspections at any time.3 If the home is out of compliance, RIDOH must require corrections. It can:3
- order the home to admit no new residents
- order residents transferred to other settings
- suspend the license immediately if conditions pose an imminent danger to residents
A person or corporation that willfully and continually violates the chapter faces a fine of $300 to $3,000 for each violation.3
Medicaid payment: authorized, not built
Rhode Island’s Medicaid long-term care law names adult supportive care homes. Section 40-8.9-9(f) authorizes the Executive Office of Health and Human Services (EOHHS) to pursue payment reforms that increase access to “adult supportive-care homes,” along with homemaker, personal care, assisted living and adult day services.15 Subsection (f)(2) calls for Medicaid certification standards for adult supportive care, as defined in chapter 23-17.24, with an acuity-based, tiered service and payment method. Payment is to be tied to licensure authority, the level of the beneficiary’s needs, the scope of services, and quality and outcome measures.15 That section was last amended by P.L. 2025, ch. 278, effective June 29, 2025.15
The law authorizes these standards, but it does not set a rate. The sources reviewed show no adopted Medicaid certification standards or payment rate for adult supportive care homes; ask EOHHS whether any exist before you build a budget on Medicaid revenue for these beds.
What has changed and what is pending
- Chapter 23-17.24 has not been amended since its 2009 enactment.123
- RIDOH’s fee rule, as published on 2026-10-12, lists no fee for these homes.11
- 2026 S 3153, introduced March 27, 2026 and referred to Senate Finance, would amend section 40-8.9-9, the Medicaid section that mentions adult supportive care homes.16 The legislature’s pages reviewed on 2026-10-12 showed the Senate Finance Committee recommending passage but no enactment, and the bill text keeps the adult supportive care language in subsection (f). Check the General Assembly’s bill status page before relying on it.
If RIDOH adopts a rule Part for these homes, it will cover the areas listed in section 23-17.24-2(b): managers, staffing, training, assessments, service plans, physical standards, resident rights and residency agreements.2 Check the facility-regulation subchapter for a new Part before you plan staffing or renovations.9
Sources
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- 10 Rhode Island Department of Health, Assisted Living (licensing page) Checked 12 Oct 2026 · Back to text ↑
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- 13 Rhode Island Department of Health, Home Nursing Care Providers Checked 12 Oct 2026 · Back to text ↑
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Related guides
Rhode Island and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Rhode Island (this guide) | Adult Supportive Care Home license | 2 to 5 unrelated adults; only existing licensed providers may operate | None listed in RIDOH's fee rule (216-RICR-10-05-2) as published on 2026-10-12 |
| Connecticut | Residential Care Home (RCH) license | Food, shelter and services for 2 or more unrelated residents; no set maximum | $565 per site + $4.50 per bed |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.