Utah · Assisted Living · Licensing
Type I vs. Type II Assisted Living in Utah (2026)
Two words on a state license decide how much help your parent may need, who has to be awake in the building at 3 a.m., and the day the facility is required to say it can no longer care for them. Here is what each type allows, in the rule's own words.
The bottom line
- Utah licenses assisted living under administrative rule R432-270 as either type I or type II, and the dividing line is evacuation: type I residents must be able to exit the building without the assistance of another person; type II residents may need the limited assistance of one person.
- A type I facility provides social care and may not retain a resident who needs total assistance in more than 3 activities of daily living. A type II facility may, and must keep at least one certified nurse aide on duty 24 hours a day.
- Neither type may provide skilled nursing care, and neither may retain anyone needing 24-hour continual nursing care expected to last longer than 15 days. That is the rule behind the phone call families never expect.
- A licensed health care professional must reassess every resident before admission and at least every 6 months. Ask for a copy each time; it is your early warning.
- Medicare pays $0 toward assisted living. Utah Medicaid's New Choices Waiver can pay for the services in a type 1 or type 2 facility — but the waiver contract says it does not cover room and board.
Most Utah families meet the words “type I” and “type II” twice. The first time is on a tour, where it sounds like a technicality. The second time is months or years later, in a meeting where someone explains that Mom's needs have outgrown the building. Those are the same conversation, and the rule that governs both is Utah Administrative Code R432-270, the state's assisted living facility rule, last amended effective November 9, 2023. It is short, it is public, and it answers the questions that matter most: how much help a resident may need and still live there, who has to be on site overnight, what the facility may never do, and what the contract you sign has to tell you. This article walks through it, with the Utah cost figures and the Medicaid rules that sit alongside it.
What does the license type actually decide?
One question: can the resident get out of the building in an emergency, and how much help does that take? R432-270-5 says a facility is licensed as a type I facility if the individuals under care “are capable of achieving enough mobility to exit the facility without the assistance of another person,” and as a type II facility if they can achieve “mobility enough to exit the facility only with the limited assistance of one person.” Every other difference — nurse staffing, how many daily tasks staff may do for a resident, what happens on hospice — follows from that single safety test.
The rule also defines what counts as a facility in the first place. If a person offers or provides care to two or more unrelated individuals in a residential setting, those individuals stay more than 24 hours, and the facility provides or arranges assistance with one or more activity of daily living, it must be licensed as an assisted living facility. Separately from type, each facility carries a capacity class:
| Capacity class | Licensed for | What it usually looks like in Utah |
|---|---|---|
| Large | 17 or more residents | Most purpose-built communities on the Wasatch Front and in St. George. |
| Small | 6 to 16 residents | Often a converted or purpose-built house; common in smaller Utah towns. |
| Limited capacity | 2 to 5 residents | The smallest licensed setting; sometimes called a residential-style home. |
Source: Utah Administrative Code R432-270-5(8) — R432-270-5, Licensing. A facility's capacity class is independent of its type: a limited-capacity home may be licensed type I or type II.
So a building carries two labels at once — a type and a size. “Large type II” describes a 60-apartment community with a nurse aide on every shift. “Limited capacity type I” describes a five-bedroom house where every resident still walks out on their own. Both are assisted living. They are not the same product, and the contract you sign is not the same contract.
Type I vs. type II, line by line
Here is the comparison in the rule's own terms, with the subsection for each row so you can check it yourself.
| Standard | Type I | Type II | Rule |
|---|---|---|---|
| Who the license is for | Residents who can get themselves out of the building in an emergency without another person's help. | Residents who can get out only with the limited assistance of one person. | R432-270-5(2)-(3) |
| What the facility must provide | Social care. | Care in a home-like setting with an array of coordinated supportive personal and health care services available 24 hours a day. | R432-270-5(4)-(5) |
| Help with activities of daily living (ADLs) | No assistance or only limited assistance; may not need total assistance in more than 3 ADLs. | May need total assistance in more than 3 ADLs, if staffing and services meet the need. | R432-270-11(4)(a), (5)(a) |
| Health stability required at admission | Stable health. | Not stated as a separate condition; the test is the evacuation and ADL standard. | R432-270-11(4)(a)(ii) |
| Registered nurse | Must employ or contract with an RN to provide or delegate medication administration for any resident who cannot self-medicate or self-direct medications. | Must employ or contract with an RN to provide or supervise nursing services: a nursing assessment on each resident, general health monitoring, and routine nursing tasks. | R432-270-15(2)-(3) |
| Certified nurse aide on site | Not required by rule. | At least one CNA on duty 24 hours a day. | R432-270-15(6) |
| Skilled nursing care | May not provide it. Must help the resident obtain it elsewhere. | May not provide it. Must help the resident obtain it elsewhere. | R432-270-15(5) |
| Cognitive impairment | May accept and retain a cognitively impaired resident who can still evacuate without another person's help. | May accept and retain a cognitively impaired resident who can evacuate with the limited assistance of one person. | R432-270-11(4)(b)(i), (5)(c) |
| Hospice | May retain a hospice resident who cannot exit alone only with a dedicated, trained aide on site 24/7 for that resident, and such residents may be no more than 25% of the census. | May retain a hospice resident who cannot evacuate without significant assistance if an emergency evacuation plan is written into the service plan. | R432-270-11(9)-(10) |
| Living unit | A separate living unit per resident; two may share only if both ask in writing. | A separate living unit per resident; two may share only if both ask in writing. | R432-270-5(6) |
Sources: Utah Administrative Code R432-270-5 (Licensing), R432-270-11 (Admissions) and R432-270-15 (Nursing Services), as amended effective November 9, 2023. This is a plain-English summary of the rule text, not legal advice; read the sections themselves before you rely on them.
Two rows deserve a second look. The first is the 3-ADL line. Activities of daily living are the basics: bathing, dressing, toileting, transferring, eating, grooming. A type I facility may accept and retain residents who need “no assistance or only limited assistance” with them and who “do not require total assistance from staff or others with more than 3” of them. Cross that line and the license no longer fits, no matter how much everyone likes the place. A type II facility may keep such a resident, but only if “the staffing level and coordinated supportive health and social services meet the needs of the resident” and the resident can still evacuate with the limited assistance of one person.
The second is the overnight staffing row. In a type II facility the rule requires at least one certified nurse aide on duty 24 hours a day. In a type I facility it does not. That single sentence is the practical difference between a building that can meet a 3 a.m. fall with trained hands already inside and one that may not. Ask the question directly on a tour, and ask it about nights and weekends, not weekday afternoons.
What can neither type do?
Both license types stop at the same wall: R432-270-15(5) says type I and type II licensees “may not provide skilled nursing care, but shall assist the resident in obtaining required services.” The rule then defines skilled by two tests — the complexity or specialized nature of the prescribed services means they can be safely or effectively performed only by, or under the close supervision of, licensed health care professional personnel; or care is needed to prevent, to the extent possible, deterioration of a condition or to sustain a resident's current capacities. Assisted living in Utah is not a cheaper nursing home. It is a different license with a ceiling.
R432-270-11(6) sets out the three categories of resident that neither type may admit or retain:
| Neither type may admit or retain | What the rule says |
|---|---|
| Behavior that endangers | Behavior that is suicidal, sexually or socially inappropriate, assaultive, or that poses a danger to the resident or to others. |
| Certain communicable disease | Active tuberculosis or another chronic communicable disease that cannot be treated in the facility or on an outpatient basis, or that could spread to other residents or guests in the normal course of activities. |
| A hospital or nursing-home level of need | A need for inpatient hospital care, long-term nursing care, or 24-hour continual nursing care expected to last longer than 15 calendar days after the day the nursing care begins. |
Source: Utah Administrative Code R432-270-11(6) — R432-270-11, Admissions. Separately, neither type may deny someone admission for the sole reason that the individual or their legal representative asks to install or operate a monitoring device in the room.
That third row is the one that ends most stays. A parent goes into the hospital, comes back needing continual nursing care, and the fifteen-day clock decides whether assisted living can take them. It is not the facility being difficult; it is the license. Knowing the rule ahead of time turns a shock into a plan — and it is why so many Utah families look hard at a type II building, or at a licensed small health care (Type N) facility, before they need one. Our guide to choosing a nursing home in Utah covers the level above this one, and the nursing home discharge-rights guide covers the protections that attach once someone is in a nursing facility.
How does the facility decide — and how often?
By a written assessment, on a schedule. R432-270-12 requires a signed and dated resident assessment before admission and at least every 6 months after that. In both type I and type II facilities, the initial and six-month assessments must be completed and signed by a licensed health care professional. The assessment must accurately reflect the resident's status at the time it is done and must carry a signed statement from that professional that the resident meets the admission and level-of-assistance criteria for the facility. If there is a significant change in the resident's cognitive, medical, physical or social condition, the facility must revise the assessment and update the service plan to match.
Before accepting anyone, R432-270-11(2) requires the facility to gather enough information about the person's ability to function there through an interview with the resident and the resident's responsible person, plus that completed assessment. And if the department determines during an inspection or interview that a facility “knowingly and willfully admits or retains residents who do not meet license criteria,” it may require, for a specified period, that resident assessments be conducted by someone independent of the facility.
Sources: Utah Administrative Code R432-270-12 (Resident Assessment) and R432-270-11 (Admissions); U.S. Administration for Community Living — How Much Care Will You Need?
What the admission agreement has to say
R432-270-11(1) says the licensee must have written admission, retention and transfer policies “available to the public upon request.” Ask for them before you tour a second building. Then R432-270-11(8) requires a signed written admission agreement before admission, kept on file, specifying at least these seven things:
- Room and board charges, and the charges for basic and optional services
- A 30-day notice before any change in established charges
- Admission, retention, transfer, discharge, and eviction policies
- The conditions under which the agreement may be terminated
- The name of the responsible party
- Notice that the department may examine resident records to check licensing compliance
- Refund procedures covering 30-day transfer or discharge notices, emergency transfers, transfers without notice, and the death of a resident
Source: Utah Administrative Code R432-270-11(8) — R432-270-11, Admissions.
Read items three, four and seven together, because they decide what happens on the worst day. The discharge and eviction policy, the conditions under which the agreement may be terminated, and the refund rules for a 30-day notice, an emergency transfer, a transfer without notice and the death of a resident are the terms a family actually has to live under. They are also the terms nobody reads on a tour.
What does this cost in Utah, and who pays?
Assisted living is private-pay for most Utah families. In the CareScout (Genworth) Cost of Care Survey 2024, Utah's statewide median assisted living cost was about $4,685 a month, roughly $56,220 a year, ranging from about $3,863 in the Logan area to about $5,300 in the Salt Lake City area, against a national median near $5,900. A semi-private nursing home room in Utah ran about $100,375 a year, roughly $8,365 a month. That gap is why the license type matters financially as well as clinically: aging out of a type I building can mean moving up a whole price tier, not just down the hall.
Median monthly cost. The first four bars are assisted living — Utah statewide, the Utah metro low and high, and the U.S. median; the last is a Utah nursing home semi-private room, $100,375 per year restated monthly. Source: CareScout (Genworth) Cost of Care Survey 2024 — carescout.com/cost-of-care. These are medians, not quotes; what a given community charges depends on its rate structure and the level of care it assesses.
Medicare pays nothing toward it. Medicare does not cover room and board or the ongoing custodial help — bathing, dressing, meals, medication reminders — that is the entire point of assisted living. It covers short, skilled care instead, including up to about 100 days in a skilled nursing facility after a qualifying hospital stay. Our guide to what Medicare does and does not pay for long-term care walks through the narrow exceptions.
Utah Medicaid can pay for the services, not the rent. The New Choices Waiver reimburses Adult Residential Services under HCPCS code T2031 for waiver clients who live in a licensed and waiver-approved assisted living facility — type 1 or type 2 — or in a licensed small health care (Type N) facility licensed under R432-300. The service package covers personal care and ADL assistance, three meals a day, housekeeping and laundry, general monitoring and emergency response 24 hours a day, social and recreational activities, chore services, medication assistance and oversight, and nursing or skilled therapy that is incidental rather than integral. The waiver's own provider contract is blunt about the limits: the service “does not cover 24-hour skilled care or supervision, room and board, items of comfort or convenience, or the costs of facility maintenance, upkeep and improvement.” It also requires the provider to accept the Medicaid rate as payment in full and bars billing the client or their family an additional fee for services rendered.
Two eligibility facts trip families up. Every New Choices Waiver participant must meet a nursing facility level of care at application and throughout enrollment, and in 2026 an applicant's monthly income limit is $2,982. And the program is a transition program: Utah DHHS says people who are not currently living in a nursing facility, a licensed assisted living facility, a Type N facility or another Utah licensed medical institution are not eligible to apply, with a minimum length-of-stay requirement in each setting. The program office is at (800) 662-9651, option 6. Our Utah Medicaid waiver guide compares New Choices with the Aging Waiver.
Eight things to ask before you sign
- Which license does this building hold — type I or type II? Ask to see it. If a community has more than one wing or license, ask which one the apartment you are being shown sits under.
- Is a certified nurse aide on duty overnight? Required in type II, not in type I. Ask about 2 a.m. on a Sunday, not 2 p.m. on a Tuesday.
- What is the registered nurse's role here? In type I the RN's required job is medication administration or delegation for residents who cannot manage their own. In type II the RN must also assess each resident, monitor general health, and provide or supervise routine nursing tasks.
- May I see your written admission, retention and transfer policies? R432-270-11(1) says they must be available to the public upon request. A facility that hesitates has told you something.
- Walk me through the discharge triggers for my parent specifically. Total assistance in more than 3 ADLs, inability to evacuate, 15-plus days of continual nursing care — which is most likely to arrive first, given their diagnosis?
- Who signs the six-month assessment, and will I get a copy? It must be a licensed health care professional. The copy is your early warning system.
- What is in the base rate, and what is a level-of-care add-on? The agreement must list room and board charges and the charges for basic and optional services, and give 30 days' notice before any change in established charges. Ask what triggered the last increase.
- Are you enrolled as a New Choices Waiver provider? If private funds may run out, being in a waiver-approved building already can spare a second move at the worst possible moment.
Bring the assessment, the rate sheet and the family's real numbers, and we will map the cost curve from a type I apartment through type II to a nursing facility, and which of your resources — savings, long-term care or hybrid coverage, annuity income, veterans benefits, Medicaid as the backstop — is meant to carry which stretch. Plain English, no pressure. Education, not financial, tax or legal advice.
Talk to a planner →If something is wrong, who do you call?
Utah has two doors. The Long-Term Care Ombudsman advocates for residents of nursing homes and assisted living facilities; anyone — a resident, a relative, a friend, even facility staff — may raise a complaint on a resident's behalf, and the program's published practice is to begin an investigation within 5 business days. The county you live in determines which regional ombudsman serves you; Utah DHHS Aging & Adult Services lists them and hosts a resident-rights complaint form. Licensing concerns go to the other door: the Utah DHHS Division of Licensing and Background Checks, Office of Licensing, which licenses and inspects these facilities under R432-270. If the concern involves abuse, neglect or exploitation of an older adult or an adult with a disability, Utah's Adult Protective Services hotline is 1-800-371-7897.
Frequently asked questions
What is the difference between Type I and Type II assisted living in Utah?
The license turns on one question: how much help does the resident need to get out of the building in an emergency? Utah Administrative Code R432-270-5 licenses a facility as type I if the individuals under care are capable of achieving enough mobility to exit without the assistance of another person, and as type II if they can exit only with the limited assistance of one person. Everything else follows from that. A type I facility provides social care and may not keep a resident who needs total assistance in more than three activities of daily living. A type II facility provides an array of coordinated supportive personal and health care services available 24 hours a day, must have a registered nurse assess and monitor every resident, must keep at least one certified nurse aide on duty around the clock, and may keep a resident who needs total assistance in more than three activities of daily living as long as staffing and services meet the need.
Can a Utah assisted living facility make my parent leave?
Yes, and the rule says when. R432-270-11(6) bars both type I and type II facilities from admitting or retaining anyone who manifests behavior that is suicidal, sexually or socially inappropriate, assaultive or a danger to self or others; who has active tuberculosis or another chronic communicable disease that cannot be treated in the facility or on an outpatient basis; or who requires inpatient hospital care, long-term nursing care, or 24-hour continual nursing care that will last longer than 15 calendar days after the day the nursing care begins. Separately, a type I facility may not retain a resident who has come to need total assistance in more than three activities of daily living, or who can no longer exit the building without another person's help. The facility's written admission, retention and transfer policies must be available to the public on request, and the admission agreement has to spell out discharge and eviction policies, the conditions for terminating the agreement, and the refund rules that apply to a 30-day notice, an emergency transfer, a transfer without notice, and death.
Is a Type II assisted living facility the same as a nursing home?
No. R432-270-15(5) says neither type I nor type II assisted living may provide skilled nursing care; the facility must instead assist the resident in obtaining those services. A nursing service counts as skilled when its complexity or specialized nature means it can be performed safely or effectively only by, or under the close supervision of, licensed health care professionals, or when the care is needed to prevent deterioration of a condition or to sustain a resident's current capacities. A type II facility is the higher-acuity assisted living license, not a lower-priced nursing home. In Utah the cost gap is wide: a semi-private nursing home room ran about $100,375 a year, roughly $8,365 a month, against a statewide assisted living median of about $4,685 a month in the CareScout (Genworth) Cost of Care Survey 2024.
How often does the facility have to reassess my parent?
R432-270-12 requires a signed, dated resident assessment before admission and at least every six months after that, completed and signed in both type I and type II facilities by a licensed health care professional. The assessment must accurately reflect the resident's status at the time it is done and must include a signed statement that the resident meets the admission and level-of-assistance criteria for that facility. The facility also has to revise the assessment, and update the service plan, whenever there is a significant change in the resident's cognitive, medical, physical or social condition. Ask for a copy each time. That document is the paper trail that tells you, months before a crisis, whether a type I facility is getting close to the line it cannot cross.
Does Medicare or Medicaid pay for assisted living in Utah?
Medicare pays nothing toward assisted living room and board or the ongoing custodial help that is the point of assisted living; it covers short, skilled care instead, including up to about 100 days in a skilled nursing facility after a qualifying hospital stay. Utah Medicaid can help through the New Choices Waiver, which reimburses Adult Residential Services under HCPCS code T2031 in a licensed and waiver-approved assisted living facility of either type 1 or type 2, or in a licensed small health care (Type N) facility. The waiver's own provider contract is explicit that the service does not cover 24-hour skilled care or supervision, room and board, items of comfort or convenience, or facility upkeep, and that the provider must accept the Medicaid rate as payment in full and may not bill the client or their family an additional fee for services rendered. Every participant must meet a nursing facility level of care, and in 2026 an applicant's monthly income limit is $2,982.
What should I ask before signing an assisted living agreement in Utah?
Ask which license the building holds, type I or type II, and ask to see it. Ask for the written admission, retention and transfer policies, which R432-270-11(1) says must be available to the public upon request. Then read the admission agreement against the seven items the rule requires it to contain: room and board charges and the charges for basic and optional services; a 30-day notice before any change in established charges; the admission, retention, transfer, discharge and eviction policies; the conditions when the agreement may be terminated; the name of the responsible party; notice that the department has authority to examine resident records; and the refund procedures for transfers, discharges and the death of a resident. Finally, ask whether the facility is enrolled as a New Choices Waiver provider, because a family that pays privately today and needs Medicaid in three years will not want to move a parent twice.
Sources
- Utah Administrative Code R432-270-5, Licensing (type I and type II definitions; social care vs. coordinated supportive personal and health care services 24 hours a day; separate living unit; large, small and limited-capacity classes), amended effective November 9, 2023: R432-270-5
- Utah Administrative Code R432-270-11, Admissions (public admission, retention and transfer policies; type I 3-ADL and evacuation criteria; type II retention criteria; the three categories neither type may admit or retain, including 24-hour continual nursing care lasting more than 15 days; monitoring-device protection; the seven required admission-agreement terms; hospice conditions and the 25% type I cap): R432-270-11
- Utah Administrative Code R432-270-12, Resident Assessment (assessment before admission and at least every 6 months, signed by a licensed health care professional; update on significant change): R432-270-12
- Utah Administrative Code R432-270-15, Nursing Services (RN duties in type I and type II; at least one certified nurse aide on duty 24 hours a day in type II; prohibition on skilled nursing care and the two-part definition of skilled): R432-270-15
- Utah Administrative Code R432-270, Assisted Living Facilities (full rule): R432-270
- Utah DHHS Medicaid — New Choices Waiver program page (nursing facility level of care; transition-program eligibility and minimum length of stay; program contact (800) 662-9651, option 6): medicaid.utah.gov — New Choices Waiver
- Utah DHHS Medicaid — New Choices Waiver Attachment B, Adult Residential Services (ALF Type 1 & 2 and Type N), HCPCS T2031 (service package; exclusion of room and board, 24-hour skilled care and items of comfort; provider must accept the Medicaid rate as payment in full; R432-270 and R432-300 licensure requirement): Utah Medicaid — New Choices Waiver documents
- Utah DHHS Division of Licensing and Background Checks — health facility licensing information: dlbc.utah.gov — health facilities
- Utah DHHS Aging & Adult Services — Long-Term Care Ombudsman and the resident-rights complaint form: daas.utah.gov — ombudsman · resident rights
- CareScout (Genworth) Cost of Care Survey 2024 — Utah assisted living and nursing home medians: carescout.com/cost-of-care
- U.S. Administration for Community Living — How Much Care Will You Need? (about 70% of people turning 65 will need some long-term care; about 20% will need it more than five years): acl.gov/ltc
- Medicare.gov — what Medicare covers and does not cover in long-term care: medicare.gov — long-term care
About this article. Written by the Utah Retirement Income Data Desk and reviewed by Brian Penner, Retirement income & long-term care planner. Educational only — not medical, financial, tax, or legal advice. The licensing, admission, assessment, staffing and discharge standards described here are a plain-English summary of Utah Administrative Code R432-270 as published as of September 14, 2026, and administrative rules can be amended; read the current sections at the links above, or contact the Utah DHHS Office of Licensing, before you rely on them. Cost figures are medians from the CareScout (Genworth) Cost of Care Survey 2024 and are not quotes for any community. Medicaid eligibility, waiver services and income limits are set by Utah DHHS and change; verify current rules with Utah Medicaid. Insurance and annuity guarantees, where discussed elsewhere on this site, are subject to the claims-paying ability of the issuing company, and no investment or savings result is guaranteed. Utah Retirement Income is a licensed independent insurance agency (NPN 16493717) and is not a government agency; we are not connected with or endorsed by Medicare, Medicaid, the Centers for Medicare & Medicaid Services, the Utah Department of Health and Human Services, the Social Security Administration, or any other government program, and nothing here should be read as an endorsement by them. No facility, named or unnamed, is recommended, rated or endorsed by us. If you call or text us, you consent to be contacted at the number you provide about your options; message and data rates may apply, and you can opt out at any time by replying STOP.