Tennessee Assisted Living 2026, Costs, Rules, and Funding

Choosing an assisted living facility in Tennessee starts with understanding two things that have changed 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 sit below the national average, but by less than most guides claim. The CareScout 2025 Cost of Care Survey (released March 2026) puts the national assisted living median at $6,200/month ($74,400/year). CareScout's Tennessee release of the same survey puts the state median at $67,140/year, about $5,595/month, roughly 90 percent of the national figure rather than the 70 to 85 percent older guides quote.

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 statewide, the five practical sources of funding (private pay, long-term-care insurance, VA Aid and Attendance, TennCare CHOICES Groups 2 and 3, and family contribution), and how to evaluate a facility before signing a contract.

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

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 below that, but only modestly.2

TN statewide median (2025 survey, released March 2026)

Two bounds on that number. It comes from CareScout's Tennessee release of the 2025 survey, collected from providers between July and November 2025 at the metropolitan-statistical-area level, and it is a provider-reported median, not a rate anyone is entitled to. And it is statewide only: no metro-level Tennessee assisted living figure is currently supported by a retrievable source. Nashville, Knoxville, Chattanooga and Memphis dollar figures circulating online, along with per-floorplan medians for studios and one-bedrooms, trace back to a cost page that no longer exists, so this guide does not publish them. Ask each community for its own rate sheet instead.2

For families currently in higher-cost AL markets, California, the Northeast, the Pacific Northwest, relocating a parent to TN can still lower the monthly bill, particularly when paired with TN's lack of state income tax. The gap is smaller than it is often sold as, though: at about 90 percent of the national median, Tennessee is a discount, not a different price bracket. We cover this trade-off in detail in the Tennessee Medicaid programs guide.

What's included in the base monthly fee

Tenn. Comp. R. & Regs. 0720-26-.07 (Services Provided) sets the floor: every ACLF must furnish protective care, safety, daily awareness of where each resident is, readiness to intervene in a crisis, room and board, and non-medical help with activities of daily living, plus laundry service and organized dietary service with at least three meals a day. That is a regulatory minimum on the facility, not a definition of what any given community's base monthly rate covers, which is a matter of the private admission contract. In practice, an ACLF base rate usually includes:

• 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:2

• 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 base2
• Community fee / move-in fee, typically $1,000–$5,000 one-time at admission, may be partially refundable2
• 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 pattern2

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:1

• 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

Communities commonly quote a memory-care premium of roughly $858 to $1,128/month above their own assisted-living rate for the secured unit, the dementia-trained staffing, and the structured programming. Read that as directional only: it is an industry figure, not a surveyed Tennessee number, and no authoritative survey publishes a Tennessee memory-care median. Price it against the individual community's own base rate rather than against the $5,595 statewide assisted-living median.2

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.2

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 widely cited at roughly 22 months nationally, though that figure is not currently traceable to a retrievable source and no Tennessee-specific version is published. Treat it as a rough planning anchor, not a forecast.

At the current Tennessee median a year of assisted living runs about $67,000, so plan against roughly $60,000 to $70,000 a year. On those numbers a $200,000 home sale funds about three years of standalone AL on its own, and meaningfully longer once Social Security and a pension carry part of the monthly bill.2

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.2

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 and Attendance as part of the VA pension program. The benefit can be used for assisted living. The Maximum Annual Pension Rates below took effect with the December 1, 2025 cost-of-living increase and run through November 30, 2026; check the VA Veterans Pension rate tables after the next December COLA:2

Add $2,984 to the annual rate for each additional dependent child. 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), so almost nobody receives the full figure. The net worth limit for the same December 1, 2025 through November 30, 2026 period is $163,699.2

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

This is the most misunderstood AL funding source. On the CHOICES Member Benefit Table, the covered benefit is called Assisted Care Living Facility, it is available to Group 2 and Group 3 members (not Group 1), it is limited to 1 unit per day and 12 months per year, and the table says in plain words that you must pay for your room and board.2

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 Supplemental Security Income (SSI) Federal Benefit Rate of $994/month in 2026 per SSA October 24, 2025 COLA when paired with SSI/optional state supplement)2

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, assisted living included, is capped against what nursing-facility care would otherwise cost: $294.87 per day, or $107,627.55 per year, effective January 1, 2026 per TennCare's cost-neutrality memo. If a member's care can reasonably be expected to exceed that cap, they do not qualify to enroll in or stay in Group 2 and are generally redirected to nursing facility care under Group 1.4
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.

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.1

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:1

• 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.5

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.1

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:1

• 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

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 $67,140 a year, about $5,595 a month, modestly below the national $6,200 a month and roughly 90 percent of it.1,2

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, whose Assisted Care Living Facility benefit is open to Group 2 and Group 3 members and pays for 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.

Learn More

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

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.