Tennessee Assisted Living 2026, Costs, Rules, and Funding

Two things have changed about Tennessee assisted living since most online guides were written. First, regulation moved from the Tennessee Department of Health to the new Tennessee Health Facilities Commission (HFC), and the rules were renumbered from Tenn. Comp. R. & Regs. 1200-08-25 (the chapter most third-party sites still cite) to Chapter 0720-26. Second, costs are still meaningfully below the national average. The CareScout 2025 Cost of Care Survey (released March 2026) puts the national assisted living median at $6,200/month. Tennessee's statewide median runs roughly $4,200–$5,300/month, about 70 to 85 percent of the national figure.

This guide explains what assisted living actually means in Tennessee in 2026: the five different licensure types families often confuse for assisted living, what 2026 costs look like by metro, the five practical sources of funding (private pay, long-term-care insurance, VA Aid & Attendance, TennCare CHOICES Group 2, and family contribution), and how to evaluate a facility before signing a contract.

By Brevy Care Team · Last verified May 3, 2026

The Five TN Licensure Types Families Confuse for Assisted Living

Tennessee licenses five different residential-care models that consumers, marketers, and even some referral services often lump together as assisted living. The differences matter for cost, level of care, and regulatory protection.

1. Assisted-Care Living Facility (ACLF), Chapter 0720-26

This is TN's mainstream assisted living license. ACLFs provide:

• Room and board
• 24-hour staffing
• Personal-care assistance with activities of daily living (bathing, dressing, toileting, transferring)
• Medication assistance and administration (oral, topical, suppository, non-IV injection per physician order)
• Limited medical services
• Licensed nurse on call (not necessarily on-site at all hours)

ACLFs serve primarily aged residents who need help with ADLs but don't require the skilled nursing care of a nursing facility. The vast majority of TN purpose-built assisted living buildings are licensed as ACLFs.

2. Residential Home for the Aged (RHA), Chapter 0720-21

Often called a Home for the Aged. Distinct from an ACLF in one critical way: an RHA provides personal and protective services only, no nursing or medical care. Staff observe residents and intervene in crisis but do not deliver clinical care, do not administer medications, and do not assess level of care.

If an aging parent needs medication management, an RHA is generally not appropriate. The RHA license is closer to a residential boarding model.

3. Adult Care Home (ACH), Tenn. Code §68-11-201

A single-family residence licensed for five or fewer unrelated adults who are elderly or disabled. The provider must live on-site or employ a live-in resident manager. Sometimes called a personal care home or board and care colloquially.

ACHs are smaller, often family-owned, and more residential in feel than ACLFs. Quality varies enormously. The HFC license is required, and inspection history is publicly searchable.

4. Critical Adult Care Home (CACH)

A TennCare-specific subset of the ACH model: an Adult Care Home with up to four residents and an on-site healthcare professional. CACHs are eligible for TennCare reimbursement under CHOICES Group 2 or Group 3 as a residential setting. Most families won't encounter this category unless they're specifically working through TennCare-paid AL options.

5. Continuing Care Retirement Community (CCRC), Title 68, Chapter 11, Part 5

Sometimes called a life plan community. A CCRC offers a continuum of care on one campus: independent living, assisted living, memory care, and skilled nursing facility, all licensed separately. Residents typically pay a substantial entrance fee plus monthly fees in exchange for guaranteed access to higher levels of care as their needs change.

CCRCs are regulated under a separate statute with consumer-protection elements around the entrance-fee model. This article focuses on stand-alone ACLFs; if you're considering a CCRC, get the CCRC contract reviewed by an elder-law attorney before signing.

ACLF vs. RHA: The Clinical-Capacity Dividing Line

The critical practical difference between an ACLF and an RHA is whether the facility can administer medications and provide limited medical services.

If your loved one takes regularly scheduled medications, has any medical management needs, or could foreseeably need limited medical services, you want an ACLF, not an RHA. RHAs make sense for relatively independent older adults who need housing, meals, and a safety net but not clinical support.

What 2026 Assisted Living Costs in Tennessee

The CareScout 2025 Cost of Care Survey (formerly Genworth) reports a national assisted living median of $6,200 per month ($74,400/year), up about 5 percent year-over-year. Tennessee runs meaningfully below national.

TN statewide and metro medians (2025–2026)

Floorplan-based medians from A Place for Mom for TN: studio approximately $4,250, one-bedroom approximately $5,295, two-bedroom approximately $6,050.

For families currently in higher-cost AL markets, California, the Northeast, the Pacific Northwest, relocating a parent to TN can produce material annual savings, particularly when paired with TN's lack of state income tax. We cover this trade-off in detail in the Tennessee Medicaid programs guide.

What's included in the base monthly fee

Per Tenn. Comp. R. & Regs. 0720-26-.07 (Services Provided), an ACLF base monthly rate typically covers:

• Private or shared room
• Three meals per day plus snacks
• Housekeeping
• Personal laundry (often weekly)
• 24-hour staffing
• Emergency response system
• Basic activities and social programming
• Medication assistance and administration (oral, topical, suppository, non-IV injection per physician order)
• Personal-care assistance with ADLs

What's NOT included (and what families miss in the contract)

Common add-ons that materially raise the monthly cost:

• Tiered level-of-care charges, most TN ACLFs assess level of care at admission and reassess periodically. Higher acuity = higher monthly fee, often $300–$1,500 above base
• Community fee / move-in fee, typically $1,000–$5,000 one-time at admission, may be partially refundable
• Incontinence supplies, sometimes billed separately if used heavily
• Medication management premium, for residents on complex regimens
• Second-occupant fee, for couples sharing a unit
• Transportation, some included; longer trips, evening trips, and medical appointments often extra
• Beauty salon / barber, generally not included
• Annual rate increases, typically 5–10 percent per year in TN; ask explicitly about historical increase pattern

Insist on a written breakdown of base fee vs. all add-ons before signing. The advertised monthly figure is not the all-in figure.

Memory Care in TN ALFs

A critical regulatory point: memory care is not a separate license type in Tennessee. Secured/Alzheimer's units operate as a special-services unit within an ACLF or RHA license, with extra requirements:

• Annual reporting to HFC covering resident assessments, deaths, hospitalizations, incidents, staffing patterns, training, and group activities
• Interdisciplinary team membership: physician with dementia experience, social worker, registered nurse, and a family member or patient advocate
• Annual in-service training for all staff working in the secured unit (basic disease facts, behavioral management, communication skills)
• No pre-hire dementia training required by rule

Cost premium for TN memory care typically runs $850–$1,150/month above standard assisted living, putting average TN memory care in the $5,500–$7,000/month range.

When evaluating a TN memory care unit, ask for: the unit's annual report submitted to HFC; documentation of the interdisciplinary team; staff dementia in-service training records; the facility's specific protocols for behavioral management, wandering, and end-of-life care; resident-to-direct-care-staff ratios on day, evening, and night shifts.

How to Pay for Assisted Living in Tennessee

Most TN families fund AL through some combination of five sources. Here they are in order of how they typically come into play.

1. Private pay

Social Security income, pensions, savings, CDs, and home sale proceeds. The home sale is often the largest single source, particularly for widowed parents downsizing into AL after a fall or hospitalization. Average private-pay duration before Medicaid spend-down is roughly 22 months nationally per HHS/ASPE LTSS data (TN-specific figure not separately published).

At TN median rates of approximately $50,000–$60,000 per year, a $200,000 home sale plus Social Security can fund 4–5 years of standalone AL, longer if Social Security covers a meaningful share of monthly costs.

2. Long-term care insurance

If your loved one purchased a long-term care policy years ago, dust off the paperwork. Typical LTCI policies cover assisted living after a 60–90 day elimination period, paying a daily or monthly maximum (commonly $4,000–$7,000/month) for a benefit period of 2–6 years.

Tennessee Partnership for Long-Term Care: TN participates in the Long-Term Care Partnership program. A qualified Partnership policy provides dollar-for-dollar Medicaid asset disregard equal to the insurance benefits paid out, plus estate-recovery protection for the disregarded assets. If you're considering buying a policy now (most relevant for adult children planning ahead), verify it's a Partnership-qualified policy.

3. VA Aid & Attendance (Veterans Pension)

Wartime veterans and their surviving spouses who meet income, asset, and disability/care-needs criteria can receive Aid & Attendance as part of the VA pension program. The benefit can be used for assisted living. 2026 maximum monthly figures (verify against va.gov/pension/veterans-pension-rates/ for the official numbers):

The benefit is paid as the difference between the MAPR cap and countable family income (after unreimbursed medical-expense offsets, AL fees attributable to care typically count). 2026 net worth limit is approximately $163,699.

TN access: through the Nashville VA Regional Office, Tennessee Department of Veterans Services county service officers (every county has one), or VA-accredited attorneys/agents. Avoid anyone offering to charge a fee for filing the application, VA-accredited representatives are legally required to handle initial applications without charge.

4. TennCare CHOICES Group 2

This is the most misunderstood AL funding source. CHOICES Group 2 covers Assisted Living Services, but NOT room and board.

What CHOICES will pay:

• Personal care services
• Attendant care
• Homemaker services
• Companion care
• Adult day care
• Personal Emergency Response System (PERS)
• Other community-based services bundled into the AL package

What CHOICES will NOT pay:

• Room and board (the resident is responsible, typically capped at the SSI Federal Benefit Rate of $994/month in 2026 per SSA October 24, 2025 COLA when paired with SSI/optional state supplement)

Three additional limitations:

1. Most TN ALFs do not accept CHOICES. Participation is limited to facilities that have negotiated rates with the three CHOICES MCOs (BlueCare, UnitedHealthcare Community Plan, Wellpoint Tennessee). Ask any facility you're considering whether they're a CHOICES-contracted provider, most aren't.
2. Cost-neutrality cap. The Group 2 services bundle (including AL) cannot exceed $107,627.55/year ($294.87/day) per the TennCare January 1, 2026 cost-neutrality memo. If services exceed this cap, the member is generally redirected to nursing facility care under Group 1.
3. Group 2 is not entitlement. It operates under an enrollment cap (approximately 12,500 historical slots) with a waitlist. Access can be slow, and approval is not guaranteed even if the member is otherwise eligible.

For a deep-dive on CHOICES eligibility and the Group 1/2/3 framework, see our TennCare CHOICES guide.

5. Family contribution and pooled resources

In practice, many TN families fund AL through pooled resources: the parent's Social Security and pension cover part, savings cover part, the home sale covers part, and adult children contribute to bridge the gap. If multiple siblings are contributing, it's worth putting the arrangement in writing, informal sibling contributions become a source of conflict surprisingly often.

Need help comparing TN assisted living costs or applying for CHOICES?

Brevy can help your family compare facility costs across TN metros, evaluate whether CHOICES Group 2 is realistic for your situation, and walk through the Aid & Attendance application if your loved one is a veteran or surviving spouse. We don't take referral fees from facilities, so our recommendations aren't influenced by who pays us.

Talk to a Brevy advisor

The Tennessee Health Facilities Commission: Your Most Important Tool

The single most useful resource for any family evaluating a TN assisted living facility is the HFC Health Care Facilities Search at internet.health.tn.gov/facilitylistings.

What you can look up:

• License number
• License type (ACLF vs. RHA vs. ACH vs. CACH)
• Total bed count
• Date of most recent state survey
• Facility owner / parent corporation

What you should request directly from the facility (these are public records and the facility cannot legally refuse):

• Most recent state survey reports (statements of deficiency and plans of correction)
• Plans of correction for any cited deficiencies
• The facility's most recent annual Alzheimer's-unit report (if it has a memory care unit)

If you encounter resistance, file a complaint with HFC at 877-287-0010 or 615-741-7221. You should also call the regional Long-Term Care Ombudsman for the county to ask about complaint history at the facility.

Resident Rights and the LTC Ombudsman

TN ACLF resident rights are codified at Tenn. Comp. R. & Regs. 0720-26-.14, with statutory umbrella at Tenn. Code §68-11-901 et seq. Rights include:

• Dignity and privacy
• Freedom from abuse, neglect, and physical/chemical restraints
• Participation in care planning
• Access to a documented grievance process
• Access to the Long-Term Care Ombudsman

Critical clarification: the Long-Term Care Ombudsman covers TN ALFs. The Ombudsman program at the Tennessee Department of Disability and Aging (DDA) has jurisdiction over ACLFs, RHAs/Homes for the Aged, and Adult Care Homes in addition to nursing homes. Statewide line: 877-236-0013. State Ombudsman: Teresa Teeple. There are nine regional ombudsman programs covering all 95 TN counties.

If a family member is being mistreated, ignored, financially exploited, or otherwise wronged at a TN ALF, the Ombudsman is the right first call, in addition to (or before) calling Adult Protective Services or law enforcement.

Discharge Protections (Where TN AL Falls Short of Nursing Home Standards)

Discharge and transfer rules for TN ALFs are codified at 0720-26-.08. The general standard is 30-day notice for involuntary transfer or discharge, applied by 0720-26-.08 and by ombudsman practice.

But there's an important caveat: AL residents have weaker formal appeal rights than nursing facility residents. The TennCare Bureau hearing right that protects nursing facility residents from involuntary discharge generally applies to Medicaid (NF) discharges, not to private-pay AL discharges. If a TN ALF wants to discharge a private-pay resident, the resident's legal recourse is more limited than at a nursing home.

In practical terms: read the discharge provisions of the AL contract carefully before signing. Watch for vague language around needs that exceed facility capabilities, which is commonly invoked to discharge residents whose acuity has risen, whose behavioral symptoms have worsened, or whose family is in payment dispute.

If you're facing an involuntary discharge from a TN ALF, call the regional Long-Term Care Ombudsman immediately and consider consulting an elder-law attorney.

What a TN AL Contract Must Disclose

Per 0720-26-.08 and Tenn. Code §68-11-910, an ACLF contract must disclose, at minimum:

• Whether the facility carries liability insurance and the identity of the carrier (or self-insured status with the responsible corporate entity)
• Services included in the base rate vs. add-ons and level-of-care surcharges
• Admission and continued-stay criteria, TN statute prohibits ACLF admission or retention of residents requiring stage III/IV decubitus treatment, exfoliative dermatitis, contact-isolation infectious disease, residents who exhibit physically aggressive behavior posing imminent threat, residents requiring physical or chemical restraints, or residents whose needs cannot be safely met by the facility
• Discharge and transfer policies and notice procedures
• Resident rights and grievance procedures (per 0720-26-.14)
• Refund and move-out financial policies

If a contract you're being asked to sign omits any of these required disclosures, that's a regulatory violation and a meaningful red flag about facility management.

How to Choose an Assisted Living Facility in Tennessee

A practical nine-step framework:

1. Pull the state license and inspection history at internet.health.tn.gov/facilitylistings. Verify license type (ACLF if you need medication management; RHA only if your loved one is more independent), bed count, and date of most recent survey.

2. Request the most recent state survey reports directly from the facility, statements of deficiency and plans of correction. These are public records. A facility that resists is showing you something.

3. Check ombudsman complaint history. Call the regional Ombudsman for the county and ask whether the facility has had recent complaints and how they were resolved.

4. Tour at least twice, including unannounced during peak care hours. Mornings 7–10 AM and dinner 5–7 PM are when staffing levels and resident engagement are most visible. Watch how staff interact with residents who aren't part of your tour.

5. Ask for staff turnover (annual) and resident-to-direct-care-staff ratios by shift. TN does not mandate a fixed ratio for ACLFs, so this varies widely. High turnover and thin night staffing are major quality-of-care signals.

6. Review the contract carefully for required disclosures, level-of-care assessment process, rate-increase policy (typical 5–10%/year in TN), and discharge triggers. Have an elder-law attorney review for $300–$500 if the facility is large or expensive, the cost is trivial relative to the contract value.

7. Confirm CHOICES participation if Medicaid is anticipated within ~24 months. Most TN ALFs do not participate. If your loved one is likely to spend down assets and need Medicaid, choosing a non-participating facility means moving later.

8. Verify memory care credentials (if applicable). Ask for the secured unit's annual report submitted to HFC, staff dementia in-service training documentation, and interdisciplinary team membership.

9. Cross-check VA eligibility if your loved one is a wartime veteran or surviving spouse. Aid & Attendance can substantially reduce out-of-pocket cost. Contact your county Veterans Service Officer at the Tennessee Department of Veterans Services.

Bottom Line

Tennessee assisted living in 2026 is regulated by the new Tennessee Health Facilities Commission under Chapter 0720-26, the regulator and rule chapter most third-party content still has wrong. TN's mainstream license type is the Assisted-Care Living Facility (ACLF), which allows medication management and limited medical services. Statewide median cost is $4,200–$5,300 per month, well below the national $6,200 figure.

Most TN families will fund AL through some combination of private pay, long-term care insurance, VA Aid & Attendance, family contribution, and (for the minority who can access it) TennCare CHOICES Group 2, which pays for AL services but never room and board. Most TN ALFs do not accept CHOICES.

The most important practical step before choosing a facility is to pull the inspection history from HFC and the discharge contract terms. The most important practical safeguard once a loved one is in residence is the regional Long-Term Care Ombudsman, they cover ALFs in TN, and they are the right first call when something goes wrong.

Find personalized help comparing Tennessee assisted living options at brevy.com.