New Hampshire assisted living rules: what you must document about each resident

New Hampshire's approach is structured: a single state form, fixed timelines, signatures from the resident, and a problem-and-goal care plan when the form shows a need. The rule text is mostly about needs, safety and function. It says less about who the resident is, and that gap is worth knowing before a survey rather than during one.

Who these rules cover

New Hampshire has two assisted living license types, both in the He-P 800 series of the Code of Administrative Rules:

• Assisted living residence–residential care (ALR-RC), He-P 804. The lower-acuity setting, with 24-hour oversight and personal care.
• Supported residential health care facility (SRHCF), He-P 805. Provides access to nursing, rehabilitation and behavioral health services. He-P 805 was readopted effective August 28, 2025.

Both require a residential service agreement under RSA 161-J before residency begins, and both use the same assessment form.

The assessment: the CARES Tool

Every resident is assessed on the department's "Care Assessment for Residential Services" form, called the CARES Tool. The rules require that staff who administer it be trained by the department or an approved entity. For an ALR-RC, the assessment must²

“(1) Be completed no more than 30 days prior to or within 24 hours following admission to the ALR-RC; (2) Be completed in consultation with the resident and guardian, agent, or personal representative, if any; (3) Be repeated every 6 months or after any significant change as defined in He-P 804.03(ch);”He-P 804.16(f)

For an SRHCF the timing is slightly different: the CARES Tool must be completed no more than 30 days prior to admission, with the same six-month and significant-change repeats.³ In both settings the tool is signed and dated by the person who completed it and signed by the resident or representative to acknowledge they took part. If the representative cannot sign, the facility needs documented evidence that they had the chance to help complete and review it.

If the CARES Tool flags the need for a nursing assessment, that assessment must be completed within 72 hours. The rules incorporate the form by reference but do not themselves list its questions, so check the current edition from DHHS for exactly what it asks.

The care plan

A care plan is not automatic in New Hampshire. It is required when the CARES Tool (or, in an SRHCF, the nursing assessment) identifies a need for one. It is then completed within 24 hours, made available to the staff who assist residents, and developed in consultation with the resident and any representative. Its content is problem-oriented:

“(1) The date the problem or need was identified; (2) A description of the problem or need; (3) The goal or objective of the plan; (4) The action or approach to be taken; (5) The responsible person(s) or position; and (6) The date of reevaluation, review, or resolution.”He-P 804.16(l)

Care plans are reviewed at least every six months to decide whether to continue, revise or discontinue them. Progress notes are also required: at least quarterly in an ALR-RC (covering changes in mobility, weight, memory, skin, continence, medications, behavior and personal care), and at least every 90 days in an SRHCF, where the list includes

“(3) Changes in behavior, such as eating habits, sleeping pattern, and relationships;”He-P 805.16(l)

Activities and interests

Activities are one of the core services each license must provide. The ALR-RC rule describes activities, with reasonable accommodation for residents with disabilities, including television, radio, internet, games, newspapers, visitors and music,²

“designed to sustain and promote physical, intellectual, social, and spiritual well-being of all residents in accordance with the admission agreement;”He-P 804.14(c)(6)

The SRHCF rule uses nearly the same words for "on-site activities." The one place the rules tie activities to an individual is community outings:

“The licensee shall assist with arranging transportation to community activities, as available, designed to meet the individual interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents.”He-P 804.14(e)

The SRHCF rule similarly calls for help arranging transportation to religious services and cultural, social, educational and recreational activities in the community. Preferences also appear in the rule on involuntary room changes, which require reasonable accommodation of individual needs and preferences, and the resident record includes religious preference if known.

Memory care and dementia

He-P 804 and 805 do not create a separate memory-care license. Instead, locked or secured residences or units are defined as a "mechanical restraint," and both parts expressly allow them (along with door-locking anklets or bracelets) as permitted by the state fire code. Both parts also require dementia training under RSA 151:47-49:³

“The licensee shall comply with all dementia training requirements pursuant to RSA 151:47-49.”He-P 805.14(r)

The training must include new information on best practices, with at least six hours of initial training for covered administrative and direct service staff and four hours each calendar year after that.

What surveyors tend to look for

Going only by what the rule text asks facilities to document:

• A current CARES Tool within the admission window, signed by the assessor and the resident or representative, and evidence the assessor was trained.
• Repeats every six months and after each significant change.
• Nursing assessments within 72 hours when flagged, and care plans within 24 hours when needed, with every required element.
• Six-month care plan reviews and progress notes on schedule.
• An activity program that addresses physical, intellectual, social and spiritual well-being, and help reaching community activities.
• Dementia training records for covered staff.

Gathering preferences and life history well

Because the rules lean on needs and function, many communities add their own preference work alongside the CARES Tool. A practical approach:

• Hold an open conversation in the first two weeks. "Tell me about where you grew up." "Tell me about a typical Saturday before you moved here." Answers point to activities and outings that fit.
• Include family. The rules already expect the representative to take part in the CARES Tool; ask them about routines and history too.
• Write down what brings comfort and what to avoid. Useful for staff, and for the behavior and relationship changes SRHCF progress notes track.
• Link interests to outings. The transportation rule speaks of individual interests; keep a note of each resident's so you can show it.
• Revisit every six months. Each CARES Tool repeat is a natural time to update what you know.

How Porchlight can help

Porchlight helps you gather and keep residents' interests, routines and life stories in their own words, alongside the CARES Tool rather than in place of it. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the spoken answer is recorded and transcribed. There are more than 800 human-written questions organized by life chapter; any can be skipped and nothing is scored. Staff can record profile facts, including topics to avoid, and receive a "Know Your Resident" briefing and a printable biography. Family get a private page to listen, reply by voice and add questions and photos. The assessment and compliance remain your community's responsibility.

Frequently asked questions

What assessment does New Hampshire require in assisted living?

Both assisted living residence-residential care (He-P 804) and supported residential health care facilities (He-P 805) must assess each resident with the state's Care Assessment for Residential Services (CARES) Tool, completed by trained staff in consultation with the resident and any guardian, agent or personal representative, and signed by both.

When is the CARES Tool due in New Hampshire?

In an ALR-RC, no more than 30 days before or within 24 hours after admission. In an SRHCF, no more than 30 days before admission. In both, it is repeated every 6 months or after a significant change.

Does New Hampshire require a life history or preference assessment in assisted living?

The He-P 804 and He-P 805 rule text does not name a life history, social history or preference assessment. It requires activities that sustain physical, intellectual, social and spiritual well-being, help arranging transportation to community activities that meet residents' individual interests, and reasonable accommodation of individual needs and preferences in some situations, such as room changes.

When is a care plan required in New Hampshire assisted living?

When the CARES Tool, or a nursing assessment it triggers, identifies the need for one. The care plan is completed within 24 hours, in consultation with the resident, lists each problem or need with a goal, approach and responsible person, and is reviewed at least every 6 months.

Does New Hampshire have memory care rules for assisted living?

There is no separate memory-care license in He-P 804 or 805. Locked or secured residences or units are defined as mechanical restraints, and the rules allow them as permitted by the state fire code. Staff must complete dementia training under RSA 151:47-49, with a minimum of 6 hours initially and 4 hours each year.