Missouri
A license is required for any premises that provides 24-hour care to three or more residents who are not related to the operator. RCFs provide shelter, board and protective oversight (and may manage medications), and residents must be able to reach safety unassisted. ALFs add help with activities of daily living and physician-directed health supervision under a home-like 'social model'. An enhanced ALF may admit or keep residents who cannot evacuate safely with minimal help if it meets extra staffing requirements.
License categories
Residential care facility (RCF)Assisted living facility (ALF)
Key laws
RSMo ch. 198 (definitions ยง 198.006)
Convalescent, Nursing and Boarding Homes — official text
19 CSR 30-86
Residential Care Facilities and Assisted Living Facilities — official text
Key requirements
- Licensure threshold: 24-hour care to 3 or more unrelated residents (RSMo 198.006)
- RCF residents must be able to make a path to safety unassisted; standard ALFs admit only residents who need minimal help to evacuate
- RCF administrator must be a licensed nursing home administrator, or at least 21 and complete department-approved continuing education each year (19 CSR 30-86.042)
- At least one employee aged 18+ on duty at all times; the rule sets minimum on-duty staff by census (e.g., 1 employee per 40 residents for protective oversight and fire safety)
- Direct care staff caring for residents with dementia need at least 3 hours of dementia training
Sources
- https://revisor.mo.gov/main/OneSection.aspx?section=198.006
- https://health.mo.gov/providers/nursing-homes-other-long-term-care/level-licensure-long-term-care-facilities
- https://health.mo.gov/senior-disability-services/nursing-homes/licensing-and-certification
- https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-86.pdf
- https://health.mo.gov/sites/health/files/media/pdf/2026/04/19CSR30-86.047.pdf
- https://moapss.health.mo.gov/