Michigan Assisted Living Regulations and Licensing Rules

Michigan assisted living regulations don’t actually use the term “assisted living.” The Department of Licensing and Regulatory Affairs (LARA), through its Bureau of Community and Health Systems, licenses these facilities under one of two frameworks: Adult Foster Care (AFC) homes or Homes for the Aged (HFA). Which set of rules applies depends mostly on the size of the facility and who lives there.¹

The Two License Types

Adult Foster Care homes serve adults who are aged, mentally ill, developmentally disabled, or physically disabled and need ongoing supervision but not continuous nursing care.² They come in three sizes:

Family homes with up to 6 residents, usually in a private residence
Small group homes with 7 to 12 residents
Large group homes with 13 to 20 residents

Homes for the Aged are larger. They serve 21 or more unrelated people who are at least 55 years old and need room, board, and supervised personal care. HFAs fall under Part 213 of Michigan’s Public Health Code rather than the AFC Act, though LARA oversees both.

Neither type may provide continuous nursing care. There is one exception written into the AFC Act: a resident enrolled in a licensed hospice program is not treated as requiring continuous nursing care, so hospice patients can remain in place.² Residents in either facility type can also receive services from a licensed home health agency.

Building and Fire Safety Rules

Group homes must comply with Michigan building codes and with the National Fire Protection Association’s Life Safety Code (NFPA 101, 2006 edition), which the AFC administrative rules adopt by reference.³ Homes serving seven or more residents also need a fire safety plan approved by the Bureau of Fire Safety.

Smoke detectors are required on every level, including basements but not crawl spaces or unfinished attics. Emergency lighting must meet applicable standards. The first floor must have at least two separate, independent exits leading directly outside, and any basement used for resident activities needs two acceptable exits as well. Every occupied floor and the basement must have at least one 5-pound multipurpose fire extinguisher, and exits must be kept clear at all times.³

Facilities with a private water supply or septic system need environmental health inspections from the local health authority every two years.⁴

Staffing Requirements

The staffing rules split along license type.

AFC Large Group Homes

A large AFC group home must keep at least one direct care staff member on duty for every 15 residents during waking hours and one for every 20 residents during normal sleeping hours. The state can require a higher ratio if resident acuity calls for it.⁵ When the licensee or administrator is away, a designated substitute with authority to act must be identified in writing and known to all staff.

Homes for the Aged

HFA rules don’t set a numeric ratio. Instead, the home must have enough staff on duty at all times, awake, fully dressed, and capable of meeting resident needs. Each shift must have a designated supervisor of resident care who is awake, fully dressed, and on the premises. That supervisor is responsible for seeing that residents are treated respectfully, protected from accidents, and kept safe in emergencies.⁶

Background Checks and Training

Every employee, independent contractor, or person granted clinical privileges who has direct access to residents or their records must pass a state and federal fingerprint-based criminal history check before starting work. “Direct access” reaches a resident’s property, financial information, medical records, and treatment information. Over 80% of these checks clear within 48 hours of fingerprinting, but cases needing manual processing can take up to 30 days.⁷ Volunteers and students are exempt unless they are granted clinical privileges.

Direct care staff must be at least 18. Required training covers first aid, CPR, personal care techniques, fire safety, communicable disease prevention, resident rights, and reporting duties, both at hire and on an ongoing basis.

Care Planning and Medications

Every resident must have a written assessment plan in place at or before admission, reviewed at least yearly and sooner if their health changes significantly. The plan identifies what services, activities, and care the person needs and takes their preferences into account.⁸ A written resident care agreement must also be reviewed with the resident or their representative at least once a year.

Prescription medications, including dietary supplements and special medical procedures, may be given only as prescribed by a licensed physician or dentist. Drugs must stay in the original pharmacy container, be labeled for the specific resident, and be stored in a locked cabinet or drawer. Anything needing refrigeration must be refrigerated. The licensee, administrator, or direct care staff must supervise the giving or applying of prescription medication unless the resident’s physician has stated in writing that the resident may self-administer.⁹

Resident Rights and Discharge Protections

At admission, the facility must give every resident or their representative a written copy of resident rights and explain them. Those rights cover:

Constitutional protections including the right to vote, practice the religion of their choice, move freely, and associate with anyone they choose
Private communications and consultations with a physician, attorney, or any other person, and treatment with dignity and respect for personal privacy
Freedom from discrimination in the provision of services based on race, religion, color, national origin, sex, age, disability, marital status, or source of payment¹⁰¹¹

Discharge carries its own rules. A facility must give a resident 30 days’ written notice before discharge, stating the reasons, with copies to the designated representative and the responsible agency. A facility cannot move a resident from one home to another without written approval from the resident or their representative.¹²

Early discharge without the 30-day notice is allowed only when there is a substantial risk or actual occurrence of self-destructive behavior, serious physical assault, or destruction of property. Even then, the facility must notify the resident’s representative and responsible agency within 24 hours before discharge and follow up in writing.¹²

How to File a Complaint or Get Help

LARA’s Bureau of Community and Health Systems monitors licensed facilities through routine, unannounced inspections and investigates complaints from residents, family members, or anyone else. You can file through the online complaint form on the LARA website or by calling the complaint hotline at 800-882-6006. The identity of a complainant is kept confidential unless a court orders otherwise. When LARA finds a facility out of compliance, it can require a corrective action plan, impose financial penalties, or modify, suspend, or revoke the license.¹³

For an advocate rather than an enforcement agency, Michigan’s Long-Term Care Ombudsman Program (MLTCOP) is free and covers residents of nursing homes, AFC homes, and Homes for the Aged. Ombudsmen investigate and resolve complaints about resident health, safety, welfare, and rights, and they act at the resident’s direction and with the resident’s consent.¹⁴ Reach the program at 866-485-9393 or through the MLTCOP website.

Paying for Care in a Regulated Facility

Costs vary by location, room size, and the level of personal care needed, and the payment rules can surprise families.

Medicare Does Not Cover It

Medicare does not pay for long-term care, including room and board in an assisted living or AFC setting. Most health insurance and Medigap policies don’t cover it either. You pay 100% for non-covered long-term care services.¹⁵ Medicare may still cover certain short-term skilled nursing stays after a hospital admission or specific home health services, but it won’t fund the ongoing custodial care that defines assisted living.

Medicaid Through the MI Choice Waiver

Michigan’s MI Choice Waiver Program lets Medicaid-eligible adults who need nursing-facility-level care receive services in a community setting such as an AFC home. Covered services can include personal care, adult day health, home-delivered meals, community transportation, nursing services, respite care, and personal emergency response systems.¹⁶ Eligibility requires meeting income and asset criteria and demonstrating a need for nursing-facility-level care. To apply, contact the MI Choice Waiver Agency for your region; MDHHS lists agencies on its website.

Medical Expense Deduction

If a resident is in an AFC home or Home for the Aged primarily to receive medical care, the full cost of care including meals and lodging counts as a medical expense for federal income tax purposes. If the primary reason is personal rather than medical, only the portion attributable to medical or nursing care is deductible. Either way, medical expenses are deductible only to the extent they exceed 7.5% of adjusted gross income.¹⁷ To qualify, the care must meet the IRS definition of “qualified long-term care services,” meaning it is required by a chronically ill individual and provided under a plan of care prescribed by a licensed health care practitioner.¹⁸

1
State of Michigan. Adult Foster Care and Homes for the Aged
2
Michigan Legislature. Adult Foster Care Facility Licensing Act 218 of 1979
3
Department of Licensing and Regulatory Affairs. Adult Foster Care Facilities Administrative Code Rules
4
State of Michigan. Get Licensed as an Adult Foster Care Group Home
5
Cornell Law School. Michigan Admin Code R 400.15206 – Staffing Requirements
6
Cornell Law School. Michigan Admin Code R 325.1931 – Employees General Provisions
7
State of Michigan. Workforce Background Check
8
Cornell Law School. Michigan Admin Code R 400.14301 – Resident Admission Criteria, Resident Assessment Plan
9
Cornell Law School. Michigan Admin Code R 400.14312 – Resident Medications
10
Cornell Law School. Michigan Admin Code R 400.14304 – Resident Rights, Licensee Responsibilities
11
Cornell Law School. Michigan Admin Code R 400.1409 – Resident Rights
12
State of Michigan. Licensing Rules for Adult Foster Care Family Homes
13
State of Michigan. Community and Health Systems
14
MLTCOP. Michigan Long Term Care Ombudsman Program
15
Medicare.gov. Long Term Care Coverage
16
State of Michigan. MI Choice Waiver Program
17
Internal Revenue Service. Publication 502 – Medical and Dental Expenses
18
Office of the Law Revision Counsel. 26 USC 7702B – Treatment of Qualified Long-Term Care Insurance