Glossary

Assisted Living (AL)

Also known as: AL, personal care (in some states' terminology), AL

A licensed senior housing category providing help with activities of daily living (bathing, dressing, medication management) along with housing and meals, positioned between independent living and skilled nursing on the acuity spectrum.

Assisted living is licensed at the state level under regulations that vary considerably from state to state -- unlike skilled nursing, there is no uniform federal certification framework, so staffing ratios, permissible acuity levels, and physical plant requirements differ meaningfully by jurisdiction, which underwriters must diligence market-by-market rather than assuming a national standard. Revenue is overwhelmingly private-pay (Medicaid covers only a minority of AL residents nationally, and typically only the service component through home- and community-based services waivers rather than room and board), which is the central reason AL has historically carried different investment risk characteristics than skilled nursing, which is heavily Medicaid- and Medicare-dependent.