Massachusetts
An entity that provides room and board plus help with activities of daily living to three or more unrelated adults for pay must be certified as an Assisted Living Residence under M.G.L. c. 19D. Under c. 19D, ALRs may now provide certain 'basic health services', such as injections, simple dressings, oxygen management and home diagnostic tests; revised 651 CMR 12.00 took effect July 31, 2026. Rest homes are a separate category licensed by DPH (105 CMR 150): 24-hour supervised, supportive living for ambulatory residents who do not need routine nursing care, and SSI can be used to pay.
License categories
Assisted living residence (ALR), certifiedRest home (Level IV resident care facility)
Key laws
M.G.L. c. 19D
Assisted Living Residences — official text
651 CMR 12.00
Certification Procedures and Standards for Assisted Living Residences — official text
105 CMR 150.000
Standards for Long-Term Care Facilities (includes Level IV rest homes) — official text
Key requirements
- ALR certification is for a two-year term (651 CMR 12.03)
- ALRs must have on-site staff 24 hours a day (651 CMR 12.04)
- Under the 2026 ALR rules, a registered nurse develops and updates each resident's service plan and assesses residents before basic health services begin
- Rest homes: a responsible person must be on the premises at all times; in facilities under 20 beds, at least 1 responsible person per 10 residents during waking hours (105 CMR 150.007)
- Rest homes with no licensed nurse on duty must have a consultant nurse for 4 hours per month per unit
Sources
- https://www.mass.gov/assisted-living-residences
- https://malegislature.gov/Laws/GeneralLaws/PartI/TitleII/Chapter19D/Section1
- https://www.mass.gov/regulations/651-CMR-1200-certification-procedures-and-standards-for-assisted-living-residences
- https://www.mass.gov/doc/651-cmr-12-certification-procedures-and-standards-for-assisted-living-residences/download
- https://maseniorcare.org/member-resources/e-news-updates/updated-alr-regulations
- https://maseniorcare.org/member-resources/e-news-updates/amendments-assisted-living-residence-regulations
- https://www.mass.gov/doc/105-cmr-150-standards-for-long-term-care-facilities/download
- https://www.mass.gov/info-details/learn-more-about-rest-homes