Many older adults retire in Tennessee due to the state’s lack of income tax and lower-than-average costs for health care and utilities. The Volunteer State also has historic landmarks, four seasons, and affordable housing. This guide provides an overview of some of Tennessee’s most common senior living options and the regulations designed to protect assisted living community residents operating within the state. It also details the wellness resources and legal services available to older adults in Tennessee.

Assisted Living Facility (ALF) Definitions

The Tennessee Department of Health, Board for Licensing Health Care Facilities licenses two types of facilities: assisted care living facilities and residential homes for the aged. These facilities provide services to older persons who require assistance with personal care. Assisted care facilities provide higher care than residential homes for the aged, including some medical services.

The state licenses and administers family homes in a program for up to five adults who are frail, disabled, or victims of abuse. The Department of Health Adult Protective Services Program also licenses Level 2 adult care homes (ACHs) for five or fewer adults.

An assisted care living facility is licensed to provide room, board, and services to enable residents to age in place. The services that the assisted care facility provides include medical services. Residential homes for the aged provide room, board, and personal care services to four or more non-related residents.

Resident Agreements and Disclosures

Both residential care homes for the aged and assisted care living facilities must provide a written agreement for how resident transfers and discharges will be handled.

Before admission, assisted living care facilities must disclose whether the facility has liability insurance and who the insurance carrier is. Facilities with secured units must provide an annual report to the Department. The report includes resident assessments, the number of deaths, hospitalizations, incidents, staffing patterns and ratios, and daily group activities provided to the residents.

Assisted Living Admission and Retention

Assisted care living facilities may not admit or retain individuals whose needs cannot be met. These facilities may not admit or retain residents with Stage 3 or 4 decubitus ulcers, require continuous nursing care, require physical or chemical restraints (not including psychotropic medications prescribed for a mental disorder), or have an infectious disease requiring isolation. The facility may not admit or retain residents who exhibit aggressive behavior that could pose a threat to themself or to other residents.

The facility may not admit but may retain residents who require nasopharyngeal or tracheotomy suctioning, nasogastric feedings, gastrostomy feedings, or intravenous treatment or feedings. These residents cannot be retained if they require these treatments for three 21-day periods per year, except for those receiving the treatment as part of hospice services.

Residents can be admitted with late-stage Alzheimer’s disease only after a team assesses that care and safety can be provided.

Residential homes for the aged cannot admit or retain residents who are unable to self-administer their medications, require continual or daily observation by a medical or nursing professional, pose a danger to other residents, cannot safely evacuate the facility in 13 minutes, or require chemical or physical restraints.

Assisted Living Services and Service Planning

Assisted care living facilities and residential homes for the aged provide personal services, including protective care, assistance with activities of daily living (ADLs), laundry services, dietary services, safety, and the ability to intervene if a crisis arises. Facilities may provide and oversee medical services. The medical services they may provide include medication administration, intermittent nursing care, podiatry, medical social services, and hospice services.

Within 72 hours of admission to an assisted care living facility, a direct care staff member must complete an assessment of the resident. A service plan must be developed based on this assessment within five days of admission. The assessment is reviewed at least annually and based on the resident’s needs. The care plan includes:

• Personal care and medical services the resident needs, including how much assistance is required and who will perform the service.
• Requirements and arrangements for visits with health care providers.
• Recreational and social activities.
• Dietary needs.
• Provisions of an advance care directive and any individual named as health care power of attorney.

Assisted care living facility residents can receive hospice services if the facility is capable of sustaining this level of care. Residents may contract with licensed and qualified home care organizations and licensed staff of a nursing home to provide medical services.

Assisted Living Food and Dietary Provisions

Assisted living facilities and residential homes for the aged must provide three meals daily, including prescribed diets. The food must be adapted to the resident’s preferences, habits, and physical abilities. The time between meals cannot exceed 14 hours. Assisted care facilities are required to provide snacks to residents with dietary needs or upon request.

Assisted Living Staffing Requirements

Assisted care living facilities must have a certified administrator or a licensed nursing home administrator responsible for the facility’s operations and care of the residents. The facility must have a licensed nurse available as needed and a designated attendance who is awake when on duty and responsible for providing residents personal services. There are no staff ratio requirements, but they must have sufficient staff to meet the needs of residents.

Assisted Living Staff Training Requirements

Administrators of both types of facilities must be certified and recertified every two years.

Assisted Living Housing Requirements

Tennesse does not require apartment-style private apartments in either type of facility. No more than two residents can share a bedroom and privacy screens or curtains must be provided when requested. Bathrooms must serve no more than six residents.

What Is Included With Assisted Living Care In Tennessee?

There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident’s health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.

State Mental Health Resources

The Department of Mental Health & Substance Abuse Services operates the Older Adult Program, which provides essential mental health services to Tennessee residents ages 50 and older. Available services include screenings, referrals to community resources, and supportive care.

Some Tennessee cities and counties also have their own programs, such as the mental health services offered by the Knoxville-Knox County Community Action Committee. Participants have access to crisis services, geriatric assessments, and other services to help them improve their mental health. For older adults in other areas of the state, Tennessee 2-1-1 offers referrals to local mental health resources.

Health Care Services

In Tennessee, assisted care living facilities must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 49% of communities providing skilled nursing. Many have health care specialists and on-site services, with 46% of communities offering dental care. In addition, 62% of ALFs have hospice services. 

Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Tennessee, 82% of communities conduct depression screenings, and 58% offer mental health counseling. Social work programs are also found in 54% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all the resources they need.

Activities of Daily Living (ADLs) Assistance Services

A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores. 

Residents in Tennessee’s assisted living facilities often receive help with their ADLs. In Tennessee, 17% of residents need help eating. Other commonly used services include bed transfer (21%), toileting (37%), and walking (55%). Caregivers in ALFs help 47% of residents dress and 61% of residents bathe.

Cost Of Assisted Living Care In Tennessee

The average cost of assisted living care in Tennessee is $4,105. This cost is $395 lower than the monthly national average of $4,500 per month. The cost of living in Tennessee is less than the national average by 11.0%, with health care costs less than the national average by 8.8% and housing costs less than the national average by 20.7%.

The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $3,215 in the Clarksville area to a high of $4,835 per month in the Cleveland area of Tennessee.

How Costs Compare In Nearby States

If you live close to one of Tennessee’s borders, you may find assisted living in a neighboring state is an affordable option. The monthly average cost of assisted living in all eight of Tennessee’s bordering states are lower than that of Tennessee. The average monthly cost in North Carolina is slightly less, at $4,010 per month. Arkansas’s average is within $500 of Tennessee’s, at $3,760. Georgia, Alabama, and Mississippi’s monthly average assisted living costs are within $1,000 of Tennessee’s, at $3,535, $3,503, and $3500, respectively. Missouri has the lowest of all neighboring state’s average monthly assisted living costs, at $3,000.

How to Pay for Assisted Living

Tennessee Assisted Living Oversight

The Tennessee Department of Health oversees assisted living at the state level. Along with issuing licenses, the agency is responsible for enforcing the regulations outlined in Chapter 1200 of the Rules and Regulations of the State of Tennessee. Specifically, 1200-08-25 contains regulations pertaining to resident admissions, building standards, resident safety, disposal of hazardous waste, resident records, and resident rights. These regulations aim to keep residents safe and ensure they have access to the services they need to stay healthy and avoid isolation.

The Department of Health also conducts inspections and publishes information about federal and state complaints received about assisted living communities operating in Tennessee. Older adults and their family members can use the complaint listing to narrow down their assisted living options.

Legal Resources

Many older adults need legal assistance to get their financial affairs in order or access the benefits available through the Medicare and Medicaid programs. Unfortunately, some people also need legal help to address physical, psychological, and financial abuse. As a result, the elder law field is growing rapidly.

The Tennessee Senior Law Alliance (TSLA) operates a toll-free helpline for low-income Tennessee residents aged 60 and older. The focus of the program is to help older adults address their basic needs and improve their quality of life. TSLA partners with agencies throughout the state to ensure individuals have access to competent legal assistance, eliminating some of the barriers to resolving legal matters. Legal Assistance for the Elderly, a program of the East Tennessee Human Resource Agency, delivers educational presentations on legal matters and provides legal services and referrals to residents aged 60 and older.

People who want to learn more about Social Security, Supplemental Security Income (SSI), pensions, veterans’ benefits, tax relief, and other relevant topics can also download a copy of The Legal Handbook for Tennessee Seniors, a resource published by the Tennessee Bar Association.