New Hampshire Assisted Living Licensing: He-P 804 vs He-P 805 Explained

New Hampshire divides assisted living into two distinct licensing tiers — and the difference determines whether a facility can legally keep your parent as their health declines. Most families discover this distinction only after a forced discharge disrupts their parent's care. Understanding it upfront prevents that crisis.

He-P 804: Residential Care

He-P 804 facilities are licensed as Assisted Living Residences — Residential Care under DHHS administrative rule He-P 804 and the enabling statute RSA 151:9. They provide a homelike environment with personal care support: help with bathing, dressing, medication reminders, meal service, and social activities.

The defining constraint is the self-evacuation requirement. He-P 804 facilities are built to IBC I-1 Condition 2 and NFPA 101 Chapter 32/33 standards — structural codes designed for occupants who can get themselves out during an emergency with minimal staff assistance. Residents must be capable of self-preservation, meaning they can physically respond to fire alarms and evacuate the building.

This is not a minor technicality. If your parent loses the ability to walk independently, begins using a wheelchair full-time, or develops cognitive decline severe enough to prevent them from responding to evacuation prompts, the facility is legally required to discharge them. Quarterly fire drill reviews evaluate each resident's evacuation capability. A failure triggers the discharge process.

For families, this means He-P 804 works for parents who are medically stable, cognitively intact enough to follow directions, and physically mobile.

He-P 805: Supported Residential Health Care

He-P 805 facilities are licensed as Supported Residential Health Care Facilities — a higher-acuity tier designed for residents who cannot self-evacuate. These facilities meet IBC I-2 Condition 1 and NFPA 101 Chapter 18/19 standards, featuring advanced fire suppression systems, smoke barriers, and wider corridors that allow staff to evacuate non-ambulatory residents.

The clinical capabilities are significantly broader:

• 24-hour licensed nursing oversight on site
• Mechanical transfer assistance (Hoyer lifts, standing aids)
• Complex medication administration beyond basic reminders
• Short-term intensive nursing care (up to 21 days)
• Hospice support within the facility

He-P 805 facilities must maintain minimum room sizes: 80 square feet for single occupancy and 140 square feet for double occupancy, excluding closets and bathrooms. They are required to establish quality improvement plans, conduct emergency preparedness training, and maintain comprehensive background checks for staff and volunteers with direct resident access.

For families, He-P 805 means a parent can age in place through progressive decline — from independent mobility to wheelchair dependence to end-of-life care — without being forced into a second disruptive move.

The Home Care Licensing Layer: He-P 809

Families choosing in-home care encounter a third regulatory framework. Licensed home health agencies operate under He-P 809, which governs the delivery of skilled clinical services in a patient's home — physical therapy, wound care, IV administration, and other interventions delivered by licensed professionals.

Non-medical home care (homemaker and companion services) operates through a lighter regulatory framework focused on agency registration. The distinction matters because Medicare and insurance typically cover He-P 809 skilled services on a short-term restorative basis, while non-medical homemaker services are almost always private-pay or Medicaid waiver-funded.

How to Verify a Facility's License

Use the DHHS Health Facilities License Search to confirm any facility's current licensing status. The search shows:

• Whether the facility holds an He-P 804 or He-P 805 license
• The licensed bed capacity
• Complaint history and past inspection results
• Current license validity

Ask the facility directly during your tour: "Are you licensed under He-P 804 or He-P 805?" Any hesitation or vague answer — "we're licensed for all levels of care" — is a warning sign. The license type defines legal boundaries the facility cannot exceed.

Why This Matters for Placement Decisions

Placing a parent in the wrong tier creates predictable problems:

• A declining parent in an He-P 804 facility will eventually face involuntary discharge, forcing a stressful mid-crisis move
• An He-P 805 facility costs more than He-P 804, but eliminates the risk of forced relocation as needs increase
• County nursing homes (He-P 803) are often the primary option for Medicaid-eligible seniors because they maintain larger Medicaid bed capacity than private facilities

The New Hampshire Care Decision Guide maps your parent's functional abilities to the appropriate licensing tier and walks you through the facility evaluation process, including the specific regulatory questions to ask during tours.

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