Kentucky Assisted Living License Types: ALC, ALC-BH, and ALC-DC Under SB 11

What Senate Bill 11 Changed

Before Senate Bill 11 took effect, Kentucky's assisted living communities operated under a basic certification model — a lighter regulatory touch that did not give the Office of Inspector General (OIG) the same oversight authority it had over nursing homes. SB 11 converted assisted living from certification to formal health facility licensure under the Cabinet for Health and Family Services, bringing communities under the same inspection and enforcement framework as hospitals and skilled nursing facilities.

The law also created three distinct license tiers, each with specific care limits. This matters because a community's license type determines exactly what staff can and cannot do for your parent — and the differences are not cosmetic.

The Three License Types

ALC — Social Model (Standard Assisted Living)

The base license under KRS 194A.707 and 902 KAR 20:480. Social model ALCs provide help with activities of daily living — bathing, dressing, grooming, meal preparation — in a residential setting with private units of at least 200 square feet, each with a lockable door and private bathroom.

The critical limit: staff at a social model ALC can only assist with self-administration of medications. That means reminders, opening bottles, and helping a resident hold a pill. Staff cannot administer medication directly — no placing pills in a resident's mouth, no injections, no dosage adjustments, no clinical assessments. If your parent needs someone to physically give them their medications or monitor vitals, a social model ALC cannot legally provide that care.

Social model ALCs are entirely private-pay. Kentucky Medicaid does not cover room and board in any assisted living community.

ALC-BH — Basic Health Services

This license adds direct nursing oversight to the social model. ALC-BH communities can employ licensed nurses who administer medications under physician orders, monitor vital signs, and provide basic health services that social model staff are prohibited from touching.

The difference is meaningful for families whose parent is stable enough to live in a residential community but needs daily medication management — insulin injections, blood pressure monitoring, or multiple timed prescriptions that require hands-on administration rather than reminders.

ALC-BH communities still cannot provide the 24-hour skilled nursing care that a nursing facility delivers. They sit in the middle: more medical oversight than a social ALC, less than a nursing home.

ALC-DC — Secured Dementia Care Unit

The ALC-DC license authorizes a community to operate a secured (locked) dementia care unit. These units are designed for residents with Alzheimer's disease or other dementias who are at risk of wandering.

Kentucky has no standalone "memory care" facility license. If a community markets memory care, it must hold the ALC-DC designation under 902 KAR 20:480. Without it, the community cannot legally use locked exits, alarmed doors, or secured perimeters.

ALC-DC communities must meet additional staffing and physical design requirements: specialized dementia training for all direct-care staff, person-centered activity programming, and building layouts that reduce agitation and disorientation. When touring a memory care unit, ask to see their ALC-DC license — if they cannot produce it, the unit is not authorized to operate as a secured dementia environment.

How to Verify a Community's License

The OIG maintains a searchable Health Care Facility Directory through the CHFS website. You can look up any assisted living community by name or county and see its current license type (ALC, ALC-BH, or ALC-DC), inspection history, and any cited deficiencies.

When evaluating a community, check three things:

1. Does the license type match the care your parent needs? A social model ALC cannot handle medication administration, no matter what the marketing brochure says.
2. Is the license current? If the directory shows a provisional or expired status, confirm the community's current authorization and any corrective requirements with OIG before signing.
3. Are there recent deficiency citations? The directory shows survey findings and whether the community has submitted an acceptable plan of correction.

Why the License Type Matters for Your Decision

The gap between what a community advertises and what its license permits is where families get hurt. A social model ALC that takes in a resident with complex medication needs is operating outside its legal authority — and your parent's care suffers because the staff literally cannot provide what is needed.

If your parent's care needs fall between the tiers — they need medication management but not skilled nursing — then an ALC-BH is the appropriate setting. If dementia with wandering risk is the primary concern, only an ALC-DC provides the legal authority and physical security.

The Choosing Care in Kentucky guide includes a facility inspection worksheet built around these license categories, so you can audit any community against its actual regulatory authority before signing a residency agreement.

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