The Basics

Differentiating assisted living in New Hampshire and Massachusetts

Senior woman getting a hand. Learn the basics about assisted living.

Learn more about the differences between assisted living regulations in the Bay State and the Granite State.

New Hampshire

There are two kinds of Assisted Living centers in NH; Residential Care Homes and Supported Residential Care Homes; the main difference being the level of care that can be provided by the staff of the center.

Residential Care Homes, as defined by the National Center for Assisted Living, are designed for adults who usually do not qualify for nursing home care but either can no longer manage independent living in their own homes or do not want to live alone. These residences provide a wide variety of support services based on the specific needs of residents. Services may include personal care, nutrition, homemaker services and medication management. Residents in this type of center who require ongoing nursing care cannot receive that care from a staff member and may have to bring in the outside services of a visiting nurse or home care provider. Residents in this type of center must also be able to self-evacuate from the building. Per the New Hampshire Department of Health & Human Services, this model is considered more of a social model than medical model.

By the same token, in a Supported Residential Care Home, the residents receive the same services as can be provided in a Residential Care Home with the addition of more attention to medical needs. Staff members of this type of center can care for those residents who have greater medical needs by offering nursing and/or rehabilitative care services. Provided that the medical needs of the resident can be met by the center staff or a licensed home health care agency, residents can remain in the center receiving skilled nursing services. Self-evacuation is not a determining factor in whether or not a resident can remain.

In New Hampshire, the Department of Health and Human Services, Office of Operations Support, Health Facilities Administration is responsible for surveying and regulating assisted living centers. The survey process includes an entrance visit; tour; interviews with residents and family members (if present), as well as staff; recorded reviews; and an exit interview. Surveyors use standard protocols for entrance interviews, tours of the physical environment, and reviews of medication orders. Residents who will be interviewed may be identified during the tour of the center based on observations about their activity, cleanliness and care needs.

Surveyors focus on quality of life and quality of care. Observations and discussions with residents are used to pursue quality of care issues. For example, if a resident is in bed at 11 am, the surveyor determines the reason. If a person is recovering from pneumonia, the surveyor checks to see that they are getting sufficient fluids and are comfortable. If they are in bed because no one has helped them get up, the surveyor looks for a staff member to explain why. Survey staff also completes various resident assessments and compare their findings with the resident’s record.

For more information, download the 2016 State AL Regulatory Review or visit the New Hampshire Association of Residential Care Homes website.

If you’re still not sure what level of assistance you or a loved one may require, download and fill out this brief questionnaire about Measuring Assistance Needs that will help get you started.


There is one classification for Assisted Living Residences (ALRs) in Massachusetts. These centers offer a combination of housing, meals and personal care services. Assisted living residences are not the same as licensed nursing centers; ALRs do not provide medical or nursing services. According to the Massachusetts Executive Office of Elder Affairs, Massachusetts Assisted Living Residences are not designed for people who need considerable medical care. Instead, assisted living is intended for adults who may need some help with activities such as housecleaning, meals, bathing, dressing and/or medication reminders and who would like the security of having assistance available on a 24 hour basis in a residential and non-institutional environment.

The Massachusetts Assisted Living Facilities Association (MASS ALFA) has published the following guide for consumer’s searching for Assisted Living in Massachusetts, which can be downloaded here.

Below is a recap of what services are provided by an assisted living residence in Massachusetts, per MASS ALFA:

Typically, “assistance” in these residences can be defined as help with the following:

  • Activities of daily living (or “ADLs”), such as bathing, dressing, grooming, transferring (help with moving about), toileting, and meal reminders;
  • Self-Administered Medication Management (“SAMM”), which provides the resident with reminders and assistance in taking medication. Some assisted living residences also offer Limited Medication Administration (“LMA”), often for an additional fee, whereby certain medications may be administered by a nurse;
  • Up to three meals a day served in a common dining room, and in some cases, additional snacks;
  • Emergency call/response systems or other ways for staff to provide emergency help; Activities and programs tailored to seniors’ needs and interests, targeting health, exercise, socialization, recreation, and wellness;
  • Housekeeping services, which usually include housecleaning, laundry, and other needs, such as help with accessing dry cleaning;
  • Transportation services, which may include taking residents on group trips, shopping or to doctor’s appointments.

Because assisted living staff is not permitted, per state regulations, to provide 24-hour skilled nursing care services, a resident may bring in any services privately, such as hospice or a visiting nurse to provide assistance with skilled care. These private services would be at an extra cost to the resident. Nursing homes provide 24-hour skilled nursing, rehabilitative services and extensive nursing assistance or intensive therapies for those who have on-going complex or unstable medical conditions.

For more information, visit the Assisted Living page of the MA Office of Elder Affairs or download the 2016 State AL Regulatory Review.

If you’re still not sure what level of assistance you or a loved one may require, download and fill out this brief questionnaire about Measuring Assistance Needs that will help get you started.