Vermont assisted living residence license: units, Level III rules and steps

An apartment standard on top of a Level III license

Vermont licenses two kinds of residential care setting under one rule book, the Residential Care Home and Assisted Living Residence Licensing Regulations, effective April 1, 2025.⁠¹ Residential care homes come in Level IV and Level III. Both levels provide room and board, help with personal care, general supervision and/or medication management, and Level III homes add nursing overview.⁠¹ The assisted living residence is a third license that sits on top of Level III. The rules say DLP “will not issue an assisted living residence license to an applicant unless all of the applicable requirements of the Residential Care Home Licensing Rules for a Level III home are met,” apart from a short list of exceptions.⁠¹

What turns a Level III home into an ALR is the unit. Statute defines assisted living units as offering “at a minimum, a private bedroom, private bath, living space, kitchen capacity, and a lockable door.”⁠⁴ The rules add that DLP will not license an ALR “unless all residence units within the facility meet the definition.”⁠¹ A building with a wing of shared rooms therefore cannot hold an ALR license for the whole building. Those rooms belong under a residential care home license. That route also suits small homes: a residential care home is any place giving room, board and personal care to three or more residents unrelated to the operator.⁠⁴

The ALR chapter exempts an ALR from these residential care home subsections:⁠¹

• Eligibility, 5.1(a) and (b). ALR admission rules in section 13.4 replace them.
• Uniform consumer disclosure and admission agreements, 5.2(a) and (h).
• Physician services, 5.8(a).
• Level of care and nursing services, 5.9(b) and (e). These are the residential care home limits on IV therapy, feeding tubes and similar care, and on home health use.
• Residents’ rooms, 9.2(a), (b), (c)(2), (g), (h) and (i). The exception to 9.2(c)(2) does not apply if a unit is rented furnished or is being converted from a Level III unit.
• Toilet, bathing and lavatory facilities, 9.3(b).

The name is protected

Under rule 1.8, no facility may use “assisted living,” “assisted living residence” or “words to that effect” in its title, brochures, admission agreement or other promotional materials without a DAIL license for that type.⁠¹ A senior apartment building that brings in outside services cannot market itself as assisted living. The statute bars operating an ALR without a license.⁠⁵ Knowingly violating the licensure requirements carries a fine of up to $500, up to six months in prison, or both.⁠⁸

Who an ALR may admit and keep

Admission is wider than in a residential care home. An ALR may accept and keep anyone 18 or older, “including those whose needs meet the definition of nursing home level of care if those needs can be met by the assisted living residence.”⁠¹ A residential care home needs a written variance from DLP to admit or keep a nursing-home-level resident under section 12.1. The ALR chapter has no such variance step.⁠¹

The ALR may not admit someone with a serious acute illness that needs hospital care. It also may not admit anyone who needs a ventilator, has a stage III or IV pressure ulcer, needs nasopharyngeal, oral or tracheal suctioning, or needs two people to transfer or walk.⁠¹ A current resident who develops one of those needs, or a terminal illness, may stay as long as the licensee can safely meet the needs or an appropriate licensed provider meets them.⁠¹

The mandatory aging-in-place scope

Section 13.4.c sets the floor of care you must be ready to give. Through personal care and supportive services, which may include nursing, you must meet the needs of residents assessed at or below these levels:⁠¹

1. Mobility

   Mobility, ambulation and transfer needs that one staff person can meet.

2. Cognition

   A cognitive impairment “at a moderate or lesser degree of severity.”

3. Behavior

   Behavioral symptoms that “consistently respond to appropriate intervention.”

An involuntary discharge is allowed only when one of the following applies:⁠¹

• the resident is a serious threat to themselves that care planning cannot resolve, and cannot enter a negotiated risk agreement
• the resident is a serious threat to others that interventions cannot manage
• a court orders it
• the resident has not paid
• the resident refuses to follow the admission agreement
• the resident’s needs exceed the section 13.4.c scope

You may not discharge a resident because an informed choice they make puts only themselves at risk.⁠¹ In that situation section 13.7 requires a negotiated risk process. You notify the resident verbally and in writing, tell them they are not required to sign an agreement, and give them the State Long-Term Care Ombudsman’s contact details. Any agreed plan is put in writing, dated, signed by both parties and attached to the care plan.⁠¹

The building: unit and common-space standards

These are the details that decide whether a site works. Section 13.9 requires the following in every unit:⁠¹

Studio apartments qualify if the one large room gives a private bedroom, living space and kitchen capacity, with a private bathroom.⁠¹

Converting an existing building

DLP may grant a variance for pre-existing structures. The terms are printed on the license, and you must repeat them in your uniform disclosure.⁠¹ The rules allow three kinds of variance:⁠¹

• Community kitchen. Units may lack private kitchen space if the building has a resident kitchen with a refrigerator, sink, storage cabinets, stove or microwave, and a food preparation area. It cannot be the kitchen staff use to cook resident or employee meals or to store goods. Residents get unlimited access and their own storage space in it.
• 160 square feet of clear living space, for units in pre-existing buildings that were not previously licensed residential care homes. The figure excludes the bathroom, closets, alcoves and vestibules.
• 100 square feet, for a building licensed as a residential care home continuously since before July 1998.

Common space

The residence needs at least two wheelchair-accessible common areas for socializing and recreation, and one of them must be open to residents at any time. You also need access to outdoor recreation space, at least one accessible public restroom near the common areas, and accessible dining space outside the units big enough for residents.⁠¹ The residential care home rules that still apply add a written disaster plan. If the home is within 10 miles of a nuclear power plant, the plan must cover a nuclear emergency. Each floor needs a working telephone with emergency numbers posted, and in warm months resident areas may not exceed 81°F.⁠¹

Fire Safety comes first

Rule 9.10 makes Department of Public Safety, Division of Fire Safety requirements the building standard.⁠¹ DLP’s new-facility packet tells you to send floor plans or blueprints to your regional Fire Safety office before construction starts. After Fire Safety approves them, you send DLP a copy of the approved floor plan, without specifications.⁠² That plan must show the location and square footage of:⁠²

• resident bedrooms, with beds and in-room features
• staff and resident kitchens
• community spaces
• nurse and manager offices
• medication storage
• exits, stairs and elevators
• laundry rooms

Water and sewage systems need Department of Environmental Conservation approval as well.⁠¹⁠²

Who runs it: licensee, manager and nurse

Each home is organized under one authority, which may be an individual, corporation, partnership or other entity. It must appoint a qualified manager who runs daily operations and is in the home an average of 32 hours or more per week.⁠¹ When the manager leaves the premises, authority passes to a competent staff member at least 18 years old.⁠¹ A manager hired under the 2025 rules needs a high school diploma or equivalent and a state-approved certification course, plus one of the following:⁠¹

• an associate degree in human services and two years of administrative experience in adult residential care
• four years of residential care experience, two of them in management, supervision or administration
• a current Vermont nurse or nursing home administrator license
• other healthcare or healthcare-management qualifications, such as a licensed or certified social worker, approved case by case by DLP

Because the license is Level III underneath, a registered nurse is part of the operation from day one. Medication management in a Level III home happens “only under the oversight of a registered nurse.”⁠¹ Unlicensed staff may do nursing tasks and give medications only under delegation from an RN the home employs.⁠¹ For residents who need nursing overview, medication administration or nursing care, the RN completes the DAIL assessment instrument within 14 days of admission and writes the person-centered care plan.⁠¹ The resident’s ability to manage medications must be assessed within 24 hours of admission, and every resident is reassessed annually and after any significant change.⁠¹ The license application asks you to name the director of nursing, or the RN or agency providing medication delegation, with a license number.⁠²

Rule 5.9(e) limits how residential care homes use home health agencies. A Level III home may use one for nursing overview only by contract, and may not charge the cost to Medicare or the resident. Section 13.2 exempts ALRs from 5.9(e).⁠¹ An ALR must still provide or arrange social services, including coordination with home health, hospice and transportation, so residents can age in place. It also needs the capacity to run a daily activity program and a full meal and snack program.⁠¹ Skilled home health agencies are regulated separately and are outside this license.

Staffing and training

The rules do not set a fixed staff-to-resident ratio. They set these floors, and DLP may require specific staffing levels for your residents’ needs:⁠¹

• Always on duty: at least one staff member in charge at all times. In homes with more than 15 residents, one responsible staff member must be awake at all times.
• Nursing-home-level residents: if any live in the home, at least one caregiver is awake at all times. With six or more, at least two caregivers work each shift, though the second overnight caregiver need not be awake.
• Nurse coverage: a home with nursing-home-level residents needs at least one licensed nurse on the premises or on call 24 hours a day, 7 days a week.
• Staffing record: a record of the staff on duty, with names, titles, dates and hours.

Every direct-care worker needs at least 12 hours of training on hire and every year.⁠¹ The training must cover:⁠¹

• resident rights
• fire safety and evacuation
• emergency response and first aid
• mandatory abuse, neglect and exploitation reporting
• respectful interaction with residents
• infection control
• general supervision and care
• communication, person-centered care, challenging behaviors and understanding dementia
• cultural and identity sensitivity
• trauma-informed care

The ALR chapter adds training in “the philosophy and principles of assisted living” for all staff. Staff who regularly interact with residents also need dementia training and dementia-specific communication skills.⁠¹ Staff who assist with medications, without administering them, must first be trained by a licensed nurse.⁠¹

Background checks

You may not employ anyone, including the manager, with a substantiated charge of abuse, neglect or exploitation, or a conviction involving bodily injury, theft, misuse of funds or property, or another crime harmful to the public welfare.⁠¹ You check references, the Vermont abuse registries, and criminal records through the Vermont Crime Information Center or a national vendor. You recheck the Vermont criminal and abuse registries at least annually, and other states’ records if a worker has lived or worked there.⁠¹ If you hire someone with a disqualifying-type offense on record, you must keep a written decision explaining why they pose no foreseeable risk.⁠¹ As a condition of occupancy, a resident who privately hires a personal care worker not employed by a licensed or certified agency must run the same registry and criminal checks.⁠¹

What DLP wants with the application

You can apply by mail to DLP at HC 2 South, 280 State Drive, Waterbury, VT 05671-2060.⁠¹ The new-facility packet instead directs initial applications to [email protected]. Its listed phone and fax numbers are (802) 241-0480 and (802) 241-0343.⁠² The packet is also linked from DLP’s application packet page.⁠³ On the form, an ALR states its number of units and maximum occupancy. It also says whether it will have a designated special care unit or a “floating” license.⁠²

DLP’s checklist for ALRs, as published on 2026-10-12, lists:⁠²

• the signed application, with all final permits
• a signed tax certification under 32 V.S.A. § 3113. Without tax good standing, the license is denied or revoked.⁠¹
• proof of workers’ compensation and insurance
• the approved floor plans
• evidence of zoning compliance, or a town clerk’s statement that the town has no zoning code⁠¹
• DEC water and wastewater approval
• an emergency plan covering evacuation and sheltering in place
• three reference letters for the licensee or operating entity, not the manager, from unrelated people who can attest to experience in residential care, assisted living or health care management, and to character⁠¹
• the Fire Safety certificate of occupancy
• the manager’s qualifications or résumé
• the admission agreement
• the ALR uniform disclosure
• a statement of aging in place
• policies and procedures on discharges, medications, grievances, nursing overview, assessment and care planning, level of care, and staff training. If you will manage medications, the policies must also cover self-administration assessment, RN delegation, controlled drugs, psychoactive drug monitoring and PRN use.

The form also asks for these, under rule 4.1:⁠¹⁠²

• owners with direct or controlling interest; for a corporation or LLC, its directors
• whether any person or organization with 5% or more controlling interest has a conviction or a substantiated abuse finding
• the building owner, if the licensee does not own it, and the building owner’s agreement to keep the plant safe and code-compliant
• an attestation of the financial stability to cover building costs, utilities, salaries and food “for a reasonable period of time going forward”
• Vermont Secretary of State registration

DLP can deny a license for financial incapacity, “including capitalization.” It can also deny one for a disqualifying conviction or substantiated abuse, or because the proposed facility does not fit the license type requested.⁠¹ Incomplete or untruthful information is grounds for automatic denial.⁠¹

ALR-specific documents

The uniform consumer disclosure is completed on DLP’s form. It must describe every service package, tier and rate, the public programs you accept, your policies on how long a resident can stay, and any variance from the section 13.9 unit standards.⁠¹ Your marketing materials must say prominently that the disclosure is available. If you run a dementia program, the disclosure and the admission agreement need a written philosophy and mission and a description of how you meet those residents’ needs.⁠¹ You also need policies on the following:⁠¹

• unexplained absences
• behavioral symptoms such as wandering or resistance to care
• declining cognition, including when and how a guardian is obtained
• the negotiated risk process
• resident use of the community kitchen and other common areas

Pricing rules you write before opening

Section 13.6 shapes your rate sheet:⁠¹

• Occupancy charges. Rent and utilities may not vary with a resident’s care needs. They may vary with unit size, amenities, or a published sliding scale or subsidy system.
• Care charges. Personal care is billed only as bundled daily, weekly or monthly rates, with tiers clearly defined and measurable.
• Basic care package. You must set a basic care package covering residents below the Nursing Home Level of Care Guidelines. You may also offer an independent package.
• Nursing-home-level residents. For those within the mandatory scope you need two tiers of services and rates.
• À la carte services. You may charge per service only for services the rules do not require, such as extra transportation or housekeeping, hairdressing or garage space.

Residents may refuse any service or buy it elsewhere. You may require a lease in addition to the admission agreement.⁠¹

The opening sequence

1. Get Fire Safety plan approval

   at your regional office before construction or renovation, and get DEC approval for water and wastewater.⁠¹⁠²

2. Confirm zoning

   in writing with the municipality, or get the clerk’s statement that the town has no zoning code.⁠¹

3. Request final inspections at least 90 days before the projected opening

   Request them from every agency that reviewed your plans, and make any changes they require.⁠¹ DLP will not inspect until Fire Safety has inspected the building and unconditionally approved occupancy.⁠²

4. Hire the manager and RN,

   run background checks, and finish the policies, uniform disclosure and admission agreement.⁠¹⁠²

5. Submit the application

   with the checklist items to DLP.⁠²

6. Pass DLP’s walkthrough

   DLP expects the building to be “move-in ready,” with construction and installations complete, when its final inspection is scheduled.⁠²

7. Receive the license

   and post it where people entering the home can see it, with any conditions posted beside it.⁠¹

DLP’s packet warns new facilities not to promise residents a move-in date until all inspections, including DLP’s, are complete. It says DLP “cannot be responsible for accommodating facility time frames.”⁠² Neither the rules nor the packet commit DLP to a decision deadline on an initial application.

As of 2026-10-12, no fee appears in the rules, in 33 V.S.A. chapter 71 or in DLP’s application form for an ALR. The sources do not say whether DLP charges one, so ask DLP in writing about any initial or renewal fee before you budget.

Certificate of need

Vermont’s certificate-of-need law, run by the Green Mountain Care Board, covers a “health care facility.” It is triggered by projects over $10,000,000 and by changes in licensed bed counts.⁠⁹ The definition covers institutions offering “diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons” and lists nursing homes and home health agencies. It does not name assisted living residences.⁠¹⁰ No official source reviewed says whether an ALR project needs a certificate of need, so ask the Green Mountain Care Board for a written determination before committing capital. The statute also lists offering any home health service as a new health care project, which matters if you plan to add one.⁠⁹

Medicaid: ACCS and Enhanced Residential Care

The rules and the application refer to two Medicaid programs:

• Assistive Community Care Services (ACCS) is a Medicaid State Plan service. It pays for a bundle of health care services for Medicaid beneficiaries in participating Level III homes.⁠¹ DLP’s packet says ACCS is open to homes “licensed or applying for license as Level 3 RCH or ALR.”⁠² You need a Level III license, rule compliance and Medicaid provider enrollment. You then send DLP a letter of interest with your proposed start date, amended admission agreement and policies, and a statement that every ACCS service will be provided.⁠¹ DLP answers in writing within 14 days. After approval, you give affected residents 30 days’ notice of rate and agreement changes. Leaving the program requires 90 days’ notice.⁠¹ The ACCS admission agreement must state the room and board rate and the personal needs allowance. It must also say whether you will keep a private-pay resident who later relies on SSI or ACCS.⁠²
• Enhanced Residential Care (ERC) providers must deliver the services in their ERC provider agreement with the state.⁠¹ The reapplication section of the form asks residential care homes and ALRs whether they are enrolled in ERC and how many residents receive the benefit.⁠²

Participation in ACCS is renewed each year with the license reapplication.⁠¹

Running the license: inspections, renewal and changes

• Term and renewal. By statute the license expires one year after issuance, and you reapply every year on DLP’s form.⁠⁶⁠⁷ Send the completed reapplication at least 45 days before expiration. If you applied completely and on time and DLP has not acted, your current license stays in effect.⁠¹ DLP may issue a shorter license when compliance is poor.⁠¹
• Temporary licenses may be issued for up to one year at a time with conditions. Under statute no home may run on temporary licenses for more than 36 months in total.⁠¹⁠⁷
• Inspections. DLP inspects every home annually and may inspect at any other time.⁠¹
• Ownership and location changes. The license covers only the named persons and premises and cannot be transferred.⁠⁷ A change of ownership, licensee or location requires a new application at least 90 days ahead. The new licensee must issue new disclosures and admission agreements.⁠¹
• Significant changes. Give residents and DLP 90 days’ written notice before changing services, rates, retention policies or the physical plant in a way that significantly expands or limits aging in place.⁠¹
• One license per home, even under common ownership.⁠¹
• Added services. Running adult day care or a senior meal site in the building needs DLP’s advance approval. Adult day care must also meet DAIL’s adult day standards.⁠¹
• Special care units. A memory care unit needs prior DLP approval of a proposal covering philosophy, the residents served, the physical environment (including secured areas), admission and discharge criteria, and staffing ratios per shift. Staff in a dementia unit need at least 8 hours of training before working alone with residents and at least 2 hours of dementia training a year. You may not advertise a special care unit without approval.⁠¹
• Quality improvement. An ALR keeps a quality improvement committee made up of the director, an RN, another direct-care worker and a resident. It meets at least quarterly and reviews an annual resident satisfaction survey.⁠¹

Decisions can be appealed to a Commissioner’s hearing, then to the Human Services Board.⁠¹

Sources

1. 1
   Vermont Department of Disabilities, Aging and Independent Living, Residential Care Home and Assisted Living Residence Licensing Regulations (effective April 1, 2025) Checked 12 Oct 2026 · Back to text ↑
2. 2
   DAIL Division of Licensing and Protection, Licensing Residential Care Home and Assisted Living Residence (new facility packet and license application) Checked 12 Oct 2026 · Back to text ↑
3. 3
   DAIL Division of Licensing and Protection, Online RCH and ALR Application Packet Checked 12 Oct 2026 · Back to text ↑
4. 4
   Vermont General Assembly, 33 V.S.A. § 7102 (Definitions) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Vermont General Assembly, 33 V.S.A. § 7103 (License) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Vermont General Assembly, 33 V.S.A. § 7104 (Application) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Vermont General Assembly, 33 V.S.A. § 7105 (License requirements) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Vermont General Assembly, 33 V.S.A. § 7116 (Criminal penalty) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Vermont General Assembly, 18 V.S.A. § 9434 (Certificate of need; general rules) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Vermont General Assembly, 18 V.S.A. § 9432 (Definitions) Checked 12 Oct 2026 · Back to text ↑

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