Starting Up an Adult Family Home

The Department of Health Services (DHS) has within its administration, the Division of Quality Assurance (DQA), which is responsible for regulating facilities that serve the frail elderly, persons with developmental disabilities, mental health, physical disabilities, and persons with substance abuse problems. DQA is responsible for administering Wis. Admin. Code ch. DHS 88 as required by Wis. Stat. ch. 50, which governs licensure of adult family homes.

"Adult family home" means a place where three or four adults who are not related to the operator reside and receive care, treatment or services that are above the level of room and board and that may include up to seven hours per week of nursing care per resident, see Wis. Stat. § 50.01(1)(b).

DQA does not refer residents for placement in assisted living facilities nor does DQA provide funding to facilities to care for residents. Residents may be eligible to receive waiver funding through county departments of health and/or human services. For more information regarding funding for residents in assisted living, please visit the following websites:

In an effort to ensure the Bureau of Assisted Living (BAL) is using resources effectively, the Bureau conducted a systems analysis of the initial application process for community-based residential facilities (CBRFs), 3-4 bed adult family homes (AFHs), residential care apartment complexes (RCACs), and adult day care center providers.

Subsequent to the analysis, BAL determined that revision of the application materials and processes for the above provider types was needed to increase the efficiency of the licensing, certification, and registration process.

Effective July 17, 2017, assisted living applicants will utilize the revised application materials and processes for any initial license, certification, registration or change of ownership.

Review DQA Revised Licensing, Certification, and Registration Licensing Information, P-01854 (PDF) for additional information.

Licensing/Certification Terminology

Established Provider: A provider who currently operates the facility type for which an application for licensure or certification is being made.

New Provider: A provider who has never held a license or certification for the facility type for which an application for licensure or certification is currently being made.

Attestation Prior to Initial Licensing Survey: BAL will require every applicant to complete an applicant compliance statement prior to scheduling an initial licensing survey.

Fit and Qualified Application: Applicants will submit a completed fit and qualified application with the application.

Inactive Application: Applications not completed within six months of submission will be closed out.

Incomplete Application: If the application does not include the required documents, the application packet will be returned to the applicant without further processing. BAL will include a checklist identifying the missing item(s). The applicant may choose to resubmit the application with the required documentation. After a second unsuccessful submission, no further applications will be accepted from this applicant for the specified location for a period of one year.

Two Revisions: An application is not considered complete until all required documentation that meets regulations have been submitted. If the required documents do not meet the licensing/certification regulations, BAL will only send two revision letters per application. After a second unsuccessful revision, no further applications will be accepted from this applicant for the specified location for a period of one year.

Prior to Applying for a License

Effective December 18, 2019, viewing the "Starting an Adult Family Home" webcast is not currently required prior to licensure while the webcast information is being updated. In addition, the signed Verification of Completion for the webcast is not required to be submitted with your application for licensure.

Determining Ambulatory Status

The ambulatory status of the provider is to be identified in the program statement, service agreement, and floor plan.

Ambulatory AFH settings serve residents who are able to independently walk.

  • May not admit or retain a resident who is not able to walk or walk with assistance of a cane, crutches, or walker.
  • Not required to meet Wis. Admin. Code. § DHS 88.05(2)(a)1-3.
  • If an existing ambulatory AFH wants to retain a resident who temporarily walks only with difficulty, cannot walk at all, or can only walk with the assistance of crutches, cane or walker, the provider may submit a waiver request to the appropriate BAL assisted living regional director. The waiver request should indicate the temporary ambulation status of the resident and show the setting complies with the applicable codes in Wis. Admin. Code. § DHS 88.05(2)(a)-(d).

Ambulatory with conditions AFH settings serve residents who are able to walk only with difficulty, walk only with the assistance of crutches, a cane or walker or are unable to easily negotiate stairs without assistance. These settings may not serve residents who use wheelchairs or who are not able to walk at all.

  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2) – "Residents shall be able to easily enter and exit the home, to easily get to their sleeping rooms, a bathroom, the kitchen and all common living areas in the home, and to easily move about in the home."
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(a)1 – exits ramped to grade with a hard surfaced pathway with handrails.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(b) – grab bars.
  • The setting must assess for Wis. Admin. Code. § DHS 88.05(2)(c) – levered handles.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(d) – "Any resident who is unable to easily negotiate stairs without assistance shall have his or her bedroom, toilet and bathing facilities and all common living areas on the first floor." If the resident has a change in ambulation status, the licensee must comply with the following:
    • If the resident is no longer able to easily negotiate stairs without assistance, the resident will be moved to the first floor. If a first floor room is not available, the AFH may not retain the resident.
    • If the resident is no longer able to walk at all and if the AFH meets all requirements for a non-ambulatory designation:
      • The licensee may submit a waiver request to the appropriate BAL assisted living regional director if the resident’s non-ambulatory status is temporary
      • The licensee may submit a request to the appropriate BAL regional office to change the ambulation designation on the AFH license if the resident’s nonambulatory status is permanent.
  • The program statement and admission agreement must include information regarding the potential for discharge if a resident experiences a change in ambulation status and the setting is unable to obtain a waiver or change the licensure status.
Nonambulatory with conditions AFH settings serve residents in a single story or multi-story home who are not able to walk at all and/or are able to walk only with difficulty or only with the assistance of crutches, a cane or walker and/or who independently walk. These settings meet the regulatory structural requirements to admit at least one or more nonambulatory resident but not all bedrooms meet the regulatory requirements for a non-ambulatory license.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2) – "Residents shall be able to easily enter and exit the home, to easily get to their sleeping rooms, a bathroom, the kitchen and all common living areas in the home, and to easily move about in the home."
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(a)1-3:
    • Exits ramped to grade with a hard surfaced pathway with handrails.
    • All exit and common use doors and non-ambulatory resident bedroom doors have a 32-inch clear opening.
    • Sufficient turn radius in bathroom(s) used by non-ambulatory resident(s).
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(b) – grab bars.
  • The setting must assess for Wis. Admin. Code. § DHS 88.05(2)(c) – levered handles.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(2)(d) – "Any resident who is unable to easily negotiate stairs without assistance shall have his or her bedroom, toilet and bathing facilities and all common living areas on the first floor." If the resident has a change in ambulation status, the licensee must comply with the following:
    • If the resident is no longer able to easily negotiate stairs without assistance, the resident will be moved to the first floor. If a first floor room is not available, the AFH may not retain the resident. If the resident is not able to walk at all, the resident will be moved to a first floor room that meets the requirements for a nonambulatory resident. If a nonambulatory first floor room is not available, the AFH may not retain the resident.
  • The program statement and admission agreement must include information regarding the potential for discharge if a resident experiences a change in ambulation status and an appropriate first floor room is unavailable. The program statement must also clearly state how many bedrooms are designated for nonambulatory residents.
  • The setting must comply with Wis. Admin. Code. § DHS 88.05(3)(h)5:
    • 80 square feet per ambulatory resident in single occupancy bedroom.
    • 60 square feet per ambulatory resident in double occupancy bedroom.
    • 100 square feet per resident requiring the use of a wheelchair.

Nonambulatory AFH settings serve residents in a single-story home who are not able to walk at all and/or are able to walk only with difficulty or only with the assistance of crutches, a cane or walker and/or who independently walk.

  • The setting must comply with Wis. Admin. Code. §§ DHS 88.05(2)(a)-(c) and 88.05(3)(h)5.

License Application

When DHS determines that the application is complete, an initial licensing visit will be scheduled. DHS has 70 days to approve or deny a license. This 70 days for processing begins after a complete license application packet is received and DHS completes the initial licensing survey.

The following license application information should be submitted:

Applications not completed within six months of submission will be closed out.

If the application does not include the required documents, the application packet will be returned to the applicant without further processing. BAL will include a checklist identifying what item(s) are missing. The applicant may choose to resubmit the application with the required documentation. After a second unsuccessful submission, no further applications will be accepted from this applicant for a period of one year from the date the application was received.

Once the application is deemed complete, the BAL central licensing unit will send an Adult Family Home (AFH) Applicant Compliance Statement, F-02108 (Word) to the applicant. When the applicant is ready for an onsite inspection initial licensing survey, the applicant will return the completed compliance statement to central licensing and an assisted living surveyor will be assigned.

The assisted living surveyor will review the items listed on the Adult Family Home (AFH) Initial Survey Checklist, F-02634A (Word) during the initial licensing survey and tour of the facility.

Caregiver Background Checks

Caregiver background checks must be completed at a minimum of every four years.

  • The Caregiver Background Check Process website includes information on Wis. Admin. Code ch. DHS 12 Caregiver Background Checks; ch. DHS 13 Reporting and Investigation of Caregiver Misconduct; copies of forms and answers to frequently asked questions.

DHS will complete caregiver background checks on the following persons prior to initial licensure and every four years thereafter:

1) Non-government entities

  • The owner of the entity, whether or not the person has regular, direct contact with clients. If the owner is a corporation or other type of business that does not have a single owner, then the organization may designate one principal officer to legally represent the organization for the purposes of fulfilling the background check requirement. For new applicants, the individual who signs the application fulfills this requirement.
  • Principal officers, corporation or board members of the business organization, who have regular, direct contact with clients.
  • Nonclient residents (over age 10) of the entity who have regular, direct contact with clients.

2) Government and tribal entities

  • An individual, for example, the entity administrator designated by the government agency or tribe who operates the entity, whether or not the person has regular, direct contact with clients.
  • Nonclient residents (over age 10) of the entity who have regular, direct contact with clients.

New applicants for licensure must submit a Background Information Disclosure (BID) form and a BID Appendix form, for each individual as described above, following the Caregiver Background Check Process.

The entity must complete a caregiver background check on all caregivers. A caregiver is a person who is all of the following:

  • Employed by or under contract with an entity;
  • Has regular, direct contact with the entity's clients or the personal property of the clients; and is under the entity's control.

"Direct contact" is defined as face-to-face physical proximity to a client that affords the opportunity to commit abuse or neglect or misappropriation of a client's property.

A completed caregiver background check consists of:

  • A completed Background Information Disclosure (BID).
  • Response from the entity's inquiry to the Department of Justice.
  • Letter from DHS containing information regarding any government findings of misconduct or credential limitations.

Copies of background checks for anyone covered under this rule must be available for review upon DHS request.

Licensing Fee

A licensing fee of $171 is charged every two years. The fee is submitted with the application and made payable to "DQA."

Initial application fees and/or license/certification continuation fees are NON-REFUNDABLE.

Return the application, other materials and fee to:

Division of Quality Assurance
Attn: Licensing Associates
200 North Jefferson Street, Suite 501
Green Bay, WI 54301

Address any questions to the licensing associates at DHSDQABALLicensing@dhs.wisconsin.gov or 608-266-8482.

Licensing Training Resources

Supporting Older People With Intellectual Disabilities: A Course for Promoting Health

Initial Licensing Live Webinars

The Bureau of Assisted Living (BAL) is pleased to announce informational webinars to provide information about what prospective providers must know when starting a community-based residential facility (CBRF) or adult family home (AFH).

Webinar participants will learn:

  • How to submit a licensure application.
  • Considerations in choosing a building.
  • Policies and procedures – why they are important and how to use them.
  • Key elements of AFH/CBRF operations, including program statement and more.

If you plan to start an AFH or CBRF, you may find our informational live webinar helpful; however, attending the live webinar is not required to obtain licensure.

How to Participate in Live Webinars

These interactive webinars will be conducted utilizing Zoom online meeting technology. Zoom is a web conferencing product that allow users to conduct live meetings and presentations over the Internet. There is no registration or cost to attend the webinar.

Join the live webinar by selecting this link near the start time of the webinar:
Or dial: +1-646-558-8656, webinar ID: 842 0408 8507
Webinar Date Time Provider Type
September 29, 2021
10 a.m. - 11 a.m.
11:15 a.m. – 12 p.m.
CBRF
AFH
November 16, 2021
10 a.m. - 10:30 a.m.
10:30 a.m. – 11 a.m.
CBRF
AFH

Additional Information

Refer to DHS Adult Family Home information

Wisconsin Economic Development Corporation (WEDC): Starting a Business in Wisconsin

Contact Us

Questions about the licensing process may be directed to BAL licensing associates at DHSDQABALLicensing@dhs.wisconsin.gov or 608-266-8482.

Last Revised: September 21, 2021