Tennessee home for the aged license: Tier 1 through DDA, Tier 2 through the HFC

Two tiers, two agencies, and a line that moved twice

A Tennessee “home for the aged” is a home held out to the public as one that primarily accepts aged persons for relatively permanent, domiciliary care, with room, board and personal services.⁠¹ “Aged” means 55 or older, and the HFC rule reads “primarily” as 51% or more of the home’s population.⁠⁹ Older Tennessee materials call it a residential home for the aged, or RHA.

Until mid-2024 there was one license, issued by the state health facilities board to any such home serving four or more nonrelated people.⁠⁹ Public Chapter 984 of 2024, effective July 1, 2024, split the category: a home housing three or fewer nonrelated persons became a Tier 1 home, licensed by the department now named the Department of Disability and Aging (DDA), and a home housing four or more became a Tier 2 home, licensed by the Health Facilities Commission.⁠² Public Chapter 973 of 2026, passed April 20, 2026 and effective when it became law, moved the line: five or fewer nonrelated persons is now Tier 1, and six or more is Tier 2.⁠¹

The agencies’ published materials follow the 2026 statute. DDA’s Tier 1 page describes a home of “up to 5 unrelated people,” age 55 and up, and says the Commission licenses Tier 2 homes of six or more.⁠³ HFC’s application packet (revised May 2026) says Tier 1 homes have five or fewer residents and are licensed through DDA, and that its application “applies solely to Tier 2 Residential Homes for the Aged with six (6) or more beds.”⁠⁷

The rule books lag behind. DDA’s Tier 1 chapter, effective February 16, 2026, still says the governing body must keep “no more than three (3), unrelated residents” in a home.⁠⁴ HFC’s chapter 0720-21 still defines the home as serving four or more and still lists a $390 fee for homes under six beds.⁠⁹ Where a rule conflicts with the statute, the statute controls, but if you are planning a four- or five-resident home, ask DDA’s Office of Licensure in writing how it is licensing that size while its rule still reads three. The rule text and DDA’s web page therefore disagree on the cap for homes of four or five, and the sources reviewed do not show an amended rule.

Licenses you might confuse with this one

• Assisted-care living facility (ACLF). HFC rules bar a home for the aged from admitting or keeping anyone who needs professional medical or nursing observation or care on a continual or daily basis; those residents must be transferred to a hospital, nursing home or assisted-care living facility.⁠⁹ If your model includes daily nursing or medication administration as a core service, read the Tennessee assisted-care living facility license guide.
• Adult Care Home - Level 2. This HFC license covers a single-family residence with no more than five residents, but only residents who are ventilator dependent or have a traumatic brain injury.⁠¹⁰ It is not a general small-home license for older adults.
• Adult day services. If residents go home at night, you are in day services, licensed by the Department of Human Services.⁠¹¹
• In-home care. Personal care delivered in clients’ own homes is a separate agency license, not a home for the aged license. A home for the aged may use a home care organization to handle medications for residents who cannot self-administer.⁠⁹

Tier 1: the DDA route for five or fewer

DDA describes Tier 1 as a housing option for older adults on fixed or declining incomes who need some help with daily living.⁠³ On its “Fact Sheet – Individually Licensed Locations” you select “Tier 1 – Home for the Aged.”⁠³

1. Assemble the initial application packet

   DDA lists four forms: the Initial Application, a Financial Statement, the Board of Directors-Advisory Board form, and the Fact Sheet – Individually Licensed Locations, found under “Initial Application Packet” on the Office of Licensure page.⁠³ The rule also requires you to prove the ability to meet the financial needs of the home.⁠⁴

2. Plan for fire protection before you sign a lease

   DDA warns that a home housing more than three persons “will likely require a sprinkling system.”⁠³ The Tier 1 rule requires fire-safety policies under DDA’s life safety chapter, with smoke detectors, fire extinguishers and two alternate means of escape from sleeping rooms, plus staff training in evacuation.⁠⁴

3. Pay the invoice

   DDA invoices after it approves the packet: $200 for a home with up to three persons, $280 for four or five, as published on 2026-10-12.⁠³ Those amounts match DDA’s general residential fee table (2-3 beds $200; 4-10 beds $280), which also lists a $50 inspection or re-inspection fee, a $100 change-of-status fee (name, executive director, bed capacity or life safety classification) and a $300 relocation fee; fees are due within 30 days of the invoice and are non-refundable.⁠⁵

4. Pass the initial licensure survey

   DDA surveyors visit the home in person.⁠³ If they cite deficiencies, you submit a plan of corrective action that the Office of Licensure must accept, and DDA considers the application once the deficiencies are fixed.⁠⁴

5. Wait for the license before admitting anyone

   No resident may be admitted, and you may not advertise as a home for the aged, until the license is issued.⁠⁴

What the Tier 1 rule requires

Chapter 0465-02-21 is short, and much of it is about residents’ independence rather than facility systems.

• Staff. An identified responsible attendant at least 18 years old, enough employees to meet residents’ needs, background and registry checks under Rule 0465-02-06-.04 and T.C.A. § 52-2-1002 before hiring, and First Aid and CPR training for employees.⁠⁴ Employees must be screened or tested for tuberculosis under Department of Health procedures.⁠⁴
• Health access. You must help residents locate dental, medical, nursing and pharmacy care, and provide or arrange an annual physical and an annual dental screening to the extent each resident wants them.⁠⁴
• Daily living. Personal services exclude nursing and medical care and must be given by the home’s employees. Residents get free access to the kitchen, at least three meals a day, assigned storage for their own food, laundry access and a telephone usable 24 hours a day.⁠⁴ If you admit someone whose hearing loss means the standard alarm will not wake them, you must provide a mechanical, non-staff means of waking them to evacuate.⁠⁴
• Money and records. A resident may ask, verbally or in writing, for help managing money; a verbal request must be written down and signed by the resident or two witnesses, the funds kept separate, and an accounting given at least quarterly.⁠⁴ Resident files are kept one year after discharge and must list personal property worth over $50.⁠⁴
• Reporting. Abuse must be reported to the Office of Licensure within five working days and to Adult Protective Services immediately.⁠⁴
• Discharge. Residents get 30 days’ written notice before transfer or discharge unless a physician orders a higher level of care.⁠⁴

DDA’s life safety chapter sets standards for one- and two-family dwellings serving one to three persons: at least 200 square feet of gross occupiable space per person, bedrooms of 80 square feet for one person or 60 square feet per person when shared, a battery smoke detector in each occupied bedroom and living room, a 2A-10B,C extinguisher, monthly fire drills at unexpected times, and no one who needs a mobility aid sleeping above or below the ground floor.⁠⁶ Those standards cover homes of one to three persons. The same chapter’s board-and-care occupancy section (Rule 0465-02-04-.06) is defined as four or more persons not related to the operator, and the chapter is written for DDA’s disability-service licensees, so DDA has not published which section governs a four- or five-resident home for the aged.⁠⁶ Ask the Office of Licensure which occupancy standard it will apply, and whether a sprinkler system is expected, before you sign a lease.

Tier 2: the HFC route for six or more

The administrator certificate

Every Tier 2 home needs an administrator certified by the Board, unless the administrator holds a Tennessee nursing home administrator license.⁠⁹ To be certified you must be at least 18, a high school graduate or GED holder, and free of any conviction for abuse or intentional neglect of an elderly or vulnerable person.⁠⁹ The fee is $180 for issuance and again for each renewal; certificates expire every two years on June 30.⁠⁹ Renewal requires proof of 24 classroom hours of Board-approved continuing education covering the home for the aged rules, health care management, nutrition and food service, financial management and healthy lifestyles; courses from the National Association of Residential Care Facilities and the National Association of Nursing Home Administrators are deemed approved, and others need approval before you attend.⁠⁹ HFC posts administrator forms on a separate “RHA/ACLF Admin Applications” page.⁠⁸

The licensee itself must be at least 18, of reputable and responsible character, and financially able to cover residents’ room, board and personal services, and must name in writing a person to act in its absence.⁠⁹

The building comes before the survey

The HFC procedure runs in this order:⁠⁷

1. Submit the notarized application and fee

   The application asks for total bed capacity, the administrator’s certificate number, every owner, partner or director, any parent or holding company, any management contract, other health facilities the owners hold, and proof of ability to meet the facility’s financial needs.⁠⁷ It asks whether the administrator has been convicted of a crime involving harm to persons or financial or business management. For the owners’ other health care facilities and any management firm, it asks about the last five years: a denied, suspended or revoked license, a health-program conviction, a federal exclusion, Medicare or TennCare suspension or termination, a fraud settlement, a corporate integrity agreement, a bankruptcy, or a civil money penalty of $250,000 or more.⁠⁷ The notarized signature certifies that employees are told of their duty to report abuse or neglect under T.C.A. § 71-6-103.⁠⁷

2. Get plans approved and local sign-off

   Plans signed and sealed by an architect or Tennessee-licensed engineer go to HFC’s Plans Review Section, with approval from local zoning, building and fire safety authorities for custodial care.⁠⁷ The statute bars HFC from licensing a Tier 2 home that local zoning, building and fire authorities have not approved for residential custodial care.⁠² Homes with 12 or more beds, or with residents above the ground floor, must be sprinklered and must submit sprinkler plans.⁠⁷ An existing single-family home licensed for six beds needs only one set of schematic drawings rather than sealed plans.⁠⁷ HFC’s Plans Review Submittal form is PH-4096.⁠⁸

3. Request the life safety and health surveys

   After construction or renovation is complete, send the request to the HFC regional office. Under Public Chapter 1019 of 2024, the life safety inspection must be done within 10 days of HFC receiving the request.⁠⁷

4. Health survey

   The program survey follows 30 to 45 days after the life safety survey. If you are not ready, rescheduling will likely take 30 days or more.⁠⁷

5. Initial approval letter

   The surveyor’s recommendation goes through the regional director to the Central Office Licensure Unit in Nashville, which sends an initial approval letter. You may not admit residents before that letter.⁠⁷

6. Commission ratification

   The application goes to the next regular Commission meeting; once ratified, the license arrives in 7 to 10 days. If the Commission does not ratify, the initial authorization ends and you receive instructions for review.⁠⁷

HFC’s licensure office is in the Andrew Jackson Building in Nashville, (615) 741-7221.⁠⁸

Physical plant

New construction and major alterations follow the International Building Code, NFPA 101 Life Safety Code, the FGI Guidelines, the U.S. Public Health Service Food Code and the ADA Standards; where local codes conflict, the most stringent rule applies.⁠⁹ Plans are drawn at 1/8 inch to the foot, and HFC’s approval holds if construction starts within 180 days.⁠⁹ With your plans you declare residents’ evacuation capability under NFPA, and that declaration drives the design and construction requirements.⁠⁹

The Tennessee Department of Environment and Conservation must approve the water supply before the home is used.⁠⁹ Space heaters, open flames and extension cords are prohibited, and every resident room needs a door to the outside or to a corridor leading directly to an exit, always unlockable by the resident.⁠⁹

Who you can admit and keep (Tier 2)

The HFC rule draws the resident line tightly:⁠⁹

• A “home for the aged resident” is ambulatory, able to find a way to safety in an emergency without physical help (a cane, wheelchair or verbal prompting is allowed).
• Residents who cannot evacuate within 13 minutes may not be admitted or kept, except in areas designated under the building and fire codes.
• No one who needs physical or chemical restraint.
• No one who needs continual or daily professional nursing or medical care. A resident with a temporary illness or injury may stay if licensed professionals can safely give the short-term care there.
• Medications are self-administered. Staff may read labels, open bottles, remind and observe; a licensed nurse employed by the home may administer.⁠⁹ Residents who cannot self-administer may stay only if a home care organization or physician handles their medications. The 2024 statute allows a Tier 2 home to administer medications only through an employed or contracted physician, APRN, physician assistant, LPN or RN.⁠²
• A person in the early stages of Alzheimer’s disease may be admitted only after an interdisciplinary team (at minimum a physician experienced in Alzheimer’s care, a social worker, a registered nurse and a family member or advocate) finds the home appropriate, with quarterly reviews. A secured unit needs an awake attendant on the unit 24 hours a day and annual dementia training for all unit staff.

Before admission or contract, you must disclose in writing whether you carry liability insurance and name the primary carrier, and give the resident a written admission agreement, a written fee and services statement, and a signed copy of the resident’s rights.⁠⁹ Fee increases need 30 days’ notice, and so does a transfer or discharge unless a physician orders a higher level of care.⁠⁹ On admission each resident receives the Adult Protective Services number, 888-277-8366.⁠⁹

Running a Tier 2 home day to day

• Staffing. No numeric ratio; you need a responsible attendant aged 18 or older, enough employees to meet residents’ needs, and an awake attendant on the premises at all times. Check the state abuse registry before hiring anyone.⁠⁹
• Food. Three meals a day, no more than 14 hours between the evening and morning meals, hot food at 140°F or above and cold at 41°F or below, and a 48-hour food supply on hand.⁠⁹
• Infection control. An annual influenza program offering free vaccination to staff, with signed declinations; resident flu vaccination by November 30 each year, and pneumococcal vaccination offered to residents 65 and older.⁠⁹
• Postings. An 11 by 17 inch sign at the main entrance stating whether you carry liability insurance and naming the carrier; Adult Protective Services and district attorney contact signs; a charity care statement; “No Smoking” signs at every entrance.⁠⁹
• Fire drills. Quarterly for each shift, including one per quarter during sleeping hours, with written evaluations kept three years. Fires that bring a fire department response must be reported to HFC within seven days.⁠⁹
• Disaster plans. Written fire, tornado, bomb threat, flood (if applicable), extreme heat and cold, and earthquake plans, each exercised annually, with signed staff training logs and documented contact with the county Emergency Management Agency. A generator, if you install one, needs 24 hours of fuel and a 30-minute monthly test under load.⁠⁹
• Records. Resident files are kept one year after discharge; fire, building and HFC inspection reports and safety-equipment maintenance records are kept in one file for 36 months and shown to prospective residents before any money changes hands.⁠⁹ A violation of a resident’s right to be free from abuse must be reported to the department within five working days and to Adult Protective Services immediately; Rule 0720-21-.10 also points to T.C.A. § 68-11-211 for incident reporting, so confirm with HFC where to file.⁠⁹

Fees as published on 2026-10-12

HFC fees are non-refundable.⁠⁷ Rule 0720-21-.02 still lists $390 for homes under six beds, a tier HFC no longer licenses.⁠⁹⁠⁷ Tier 1 fees are $200 or $280 as described above.⁠³

Renewal, ownership changes and enforcement

Both licenses expire each year on the anniversary of issuance, cover only the named licensee and premises, cannot be transferred, and require a separate license for each home you operate.⁠⁴⁠⁹ Renewal means periodic inspections plus a renewal form and fee before expiration. Under both chapters, renewing within 60 days after expiration costs a $100 late penalty for each month or part month, capped at twice the renewal fee; after 60 days you must reapply and be inspected again.⁠⁴⁠⁹ Moving to a new building requires a new license and an inspection before residents move in.⁠⁴⁠⁹

For Tier 2, a change of ownership, including a change in controlling interest, must be reported to HFC at least 30 days ahead, with a new application and fee; HFC posts a separate CHOW application.⁠⁹⁠⁸ A lease of operations, a partnership change, or a management agreement that hands over ultimate authority counts as a change of ownership; corporate stock transfers do not.⁠⁹ The Commissioner can suspend new admissions while a hearing is pending, the order must be posted on the entrance doors, and the Board can appoint special monitors whose fees the home pays.⁠⁹

What changed recently

• July 1, 2024: Public Chapter 984 created Tier 1 (then three or fewer) and Tier 2 homes and moved Tier 1 licensing to the disability department.⁠²
• August 22, 2025 and February 16, 2026: DDA filed its Tier 1 rules as emergency rules on August 22, 2025, and the permanent Chapter 0465-02-21 took effect February 16, 2026.⁠⁴
• March 18, 2026: an amendment to HFC Rule 0720-21-.13 (disaster preparedness) took effect.⁠⁹
• 2026: Public Chapter 973 raised the Tier 1 ceiling to five nonrelated persons, and HFC’s application was revised in May 2026 to match.⁠¹⁠⁷

Both agencies’ rule chapters still carry the pre-2026 thresholds, so expect further rulemaking from DDA and HFC.⁠⁴⁠⁹

Sources

1. 1
   Tennessee Secretary of State, Division of Publications, Public Chapter 973 (2026), Senate Bill 2083: amends T.C.A. § 68-11-201(23)(A) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Tennessee Secretary of State, Division of Publications, Public Chapter 984 (2024), House Bill 2261: tiered homes for the aged, T.C.A. § 68-11-201(23) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Tennessee Department of Disability and Aging, Office of Licensure, Tier 1 Homes Licensing Checked 12 Oct 2026 · Back to text ↑
4. 4
   Tennessee Department of Disability and Aging, Chapter 0465-02-21, Minimum Program Requirements for Tier 1-Homes for the Aged (effective February 16, 2026) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Tennessee Department of Disability and Aging, Chapter 0465-02-02, Licensure Administration and Procedures (Rule 0465-02-02-.05, Fees) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Tennessee Department of Disability and Aging, Chapter 0465-02-04, Life Safety Licensure Rules Checked 12 Oct 2026 · Back to text ↑
7. 7
   Tennessee Health Facilities Commission, Homes for the Aged Tier 2: Procedures and Application for Initial Licensure, Form HFC-3504 (rev. 5/2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Tennessee Health Facilities Commission, Licensure Applications Checked 12 Oct 2026 · Back to text ↑
9. 9
   Tennessee Health Facilities Commission, Chapter 0720-21, Standards for Homes for the Aged (March 2026 revision) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Tennessee Health Facilities Commission, Chapter 0720-37, Standards for Adult Care Homes - Level 2 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Tennessee Department of Human Services, Adult Day Services Checked 12 Oct 2026 · Back to text ↑

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