Tennessee assisted-care living facility rules: what you must document about each resident

Tennessee's assisted living rule puts the resident-level documentation in one place: the resident records section. It asks for a quick assessment, a plan of care, and, for locked units, an interdisciplinary review. It says little about personal history. This page covers what the rule text requires, checked against the Tennessee Secretary of State's published copy of Chapter 0720-26 (revised March 2026) on September 28, 2026.

Who these rules cover

Chapter 0720-26, Standards for Assisted-Care Living Facilities, applies to ACLFs licensed by the Tennessee Health Facilities Commission. The chapter moved from the Department of Health's Chapter 1200-08-25 to the Commission's Title 0720 in July 2022, so older materials may cite the 1200-08-25 numbers.

The rule's purpose section sets the tone: assisted-care living should meet "each individual's medical and other needs" and enhance the resident's ability to age in place "while promoting personal individuality, respect, independence, and privacy." An ACLF may also operate a secured unit, defined as a distinct part of the facility "where the residents are intentionally denied egress" except as life safety requires. Secured units add the requirements in 0720-26-.08(9).

The assessment: what it covers and by when

The deadline is short¹:

An ACLF shall complete a written assessment of the resident to be conducted by a direct care staff member within a time-period determined by the ACLF, but no later than seventy-two (72) hours after admission.Tenn. Comp. R. & Regs. 0720-26-.12(4)

The rule does not list what the assessment must contain. The definitions section describes its purpose: determining "the nature and extent of the problem(s) and needs of a resident," whether the ACLF can meet them, and gathering information "for the use in the development of the individual care plan"³. Because the plan of care must cover recreational and social activities, the assessment has to gather at least enough about the resident's interests to write that part of the plan.

Tennessee does not require a social history, life history, routine inventory or preference list by name in the assessment. The resident record rule does require a personal record (identifying details, next of kin, preferred physician and hospital, advance directives) and a medical record that includes medical history.

The plan of care

Within five days of admission, the ACLF develops a plan of care with input and participation from the resident or legal representative, the treating physician, or other licensed professionals delivering services. It is reviewed or revised as needs change and at least semi-annually. The plan must describe¹:

• The resident's needs, including ADLs and medical services: what assistance, how much, who provides it, how often and when.
• Arrangements for visits by or to physicians and other providers.
• Advance directives or healthcare power of attorney, as applicable.
• Recreational and social activities, as quoted below.
• Dietary needs.

Recreational and social activities which are suitable, desirable, and important to the well-being of the resident; andTenn. Comp. R. & Regs. 0720-26-.12(5)(b)4

This is the heart of Tennessee's preference requirement. "Desirable" and "important to the well-being of the resident" describe what this person wants and values, so a plan line that only says "activities as tolerated" leaves the requirement unaddressed.

Two other provisions point the same way. Food service must be "adapted to the habits, preferences and physical abilities of the residents"⁴, and residents have the right to participate, or to refuse to participate, in "cultural, educational, religious, community service, vocational and recreational activities"⁵.

Activities and social programming

Outside secured units, Chapter 0720-26 does not set a minimum activities schedule. It requires a "suitable and comfortable furnished area for activities and family visits," with a calendar, a working television, radio and clock⁴, and it relies on each resident's plan of care to say which recreational and social activities matter to them. In practice, the calendar should be traceable to what residents' plans say they enjoy.

Secured units

ACLFs with secured units must show surveyors twelve months of unit-specific performance information at the annual survey. The items tied to knowing the resident are²:

Documentation that an interdisciplinary team consisting of at least a physician, a registered nurse, and a family member (or patient care advocate) has evaluated each secured resident prior to admittance to the unit;Tenn. Comp. R. & Regs. 0720-26-.08(9)(a)

• Ongoing documentation that each resident's interdisciplinary team performs a quarterly review of whether secured placement is still appropriate.
• "A formulated calendar of daily group activities scheduled, including a resident attendance record for the previous three (3) months."
• Annual in-service training for all unit staff, including "communicating with families and other persons interested in the resident."

The unit must also keep a daily staffing record with at least one awake attendant on the unit at all times. Having a family member on the pre-admission team is a natural moment to gather the resident's history, even though the rule does not require it.

What surveyors tend to look for

Based on what the rule says to document:

• A written assessment dated within 72 hours of admission.
• A plan of care dated within 5 days, showing who gave input.
• Plan entries naming specific recreational and social activities that are desirable and important to the resident.
• Semi-annual reviews, and revisions after changes in need.
• For secured units: the interdisciplinary pre-admission evaluation, quarterly reviews, the daily group activities calendar and three months of attendance records.

Gathering interests and life history well

• Start inside the 72 hours, finish in two weeks. Get the essentials for the 5-day plan of care, then keep adding as the resident settles.
• Ask open questions. "Tell me about your work" or "What did a good weekend look like?" gets to what is desirable and important far better than a checklist.
• Involve family, especially the family member on a secured-unit team. Ask about routines, music, faith, pets and old friends.
• Record comfort and what to avoid. Both belong in what staff read before they walk into the room.
• Revisit at each semi-annual review, and after hospital stays or other changes.

How Porchlight can help

Porchlight helps you gather and keep the interests, routines and life-story material behind Tennessee's "suitable, desirable, and important" activities line, in the resident's own words. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and the answer is recorded and transcribed. The 800+ human-written questions are organized by life chapter; any question can be skipped and nothing is scored. Staff can note profile facts, including topics to avoid, and get a "Know Your Resident" briefing with conversation starters and a printable life-story biography. Families get a private page to listen and leave voice replies. The assessment, plan of care and compliance remain your facility's responsibility.

Frequently asked questions

What is assisted living called in Tennessee?

Tennessee licenses assisted living as assisted-care living facilities, or ACLFs, under Chapter 0720-26 of the rules of the Tennessee Health Facilities Commission. The chapter was previously numbered 1200-08-25 under the Department of Health.

How soon must a Tennessee ACLF assess a new resident?

A direct care staff member must complete a written assessment within a time period the ACLF sets, but no later than 72 hours after admission.

When is the plan of care due in Tennessee assisted living?

Within five days of admission. It is developed with input from the resident or legal representative and the treating physician or other licensed professionals, and reviewed as needs change and at least semi-annually.

Does Tennessee require a life history or preference assessment?

Not by name. The assessment's content is not listed in the rule. The plan of care must describe recreational and social activities that are suitable, desirable and important to the resident's well-being, and food must be adapted to residents' habits and preferences.

What extra documentation do Tennessee secured units need?

An interdisciplinary team of at least a physician, a registered nurse and a family member or patient care advocate must evaluate each resident before admission and review placement quarterly. The unit must keep a daily group activities calendar with three months of attendance records, daily staffing records, and annual staff training.