Starting a care business in Connecticut

Assisted living in Connecticut is not a building license. DPH licenses the assisted living services agency (ALSA) that provides nursing and help with daily living. An ALSA may serve only residents of a managed residential community (housing primarily for people 55 and older) or of a HUD-assisted elderly housing complex. A managed residential community either gets its own ALSA license or contracts with a licensed one. The ALSA license costs $500 per site, lasts two years and needs no certificate of need. A DPH working group is studying whether managed residential communities should be licensed too, with a report due February 1, 2027.

Smaller homes for adults face a higher bar. Connecticut has no adult family home license. Any home that gives food, shelter and services to two or more people unrelated to the owner needs a residential care home license from DPH, however few beds it has. Before DPH will license a new home, the Department of Social Services (DSS) must review it under its certificate of need program, starting with a letter of intent. DSS does not say on its page whether it is approving new homes, so ask when you send that letter.

In-home care splits by the kind of help you give. Companionship, cooking, cleaning, laundry and help with personal hygiene, with even one worker, need a homemaker-companion agency registration from DCP. It costs $375 a year and every registration expires on October 31. Nursing plus at least one other service, available 24 hours a day, needs a DPH home health care agency license, which is exempt from certificate of need. Hands-on aide care under a registered nurse's supervision, without skilled nursing, is a separate DPH homemaker-home health aide agency license, covered in the same guide. New agencies also cannot enroll in Medicare while the nationwide federal moratorium that began May 13, 2026 is in effect.

Child care licensing turns on head count and setting. A family child care home in your own residence costs $40 for a four-year license and allows up to 6 children, or up to 9 with an OEC-approved assistant or substitute. Seven to 12 children outside a family home is a group child care home, and more than 12 is a child care center; both licenses last four years and cost $250 and $500. A pilot endorsement for 12-child family homes runs until June 30, 2029, but only providers licensed before June 30, 2025 can use it.

Adult day care has no state license. State law directs DSS to set certification rules for adult day health care facilities, and a 2011 legislative report says centers are certified by the Connecticut Association of Adult Day Centers. The 2011 report ties certification to receiving state per-participant payments. We found no statute that requires a license or certification for a center that takes no state funding, but confirm with DSS before you open and before you plan around state funding.