Knoxville Senior AdvisorWhat is the main difference between an ACLF and a home for the aged?
An assisted-care living facility may administer medications and arrange nursing, therapy and hospice in the building, while a home for the aged gives room, board and personal services to ambulatory residents and transfers them to a hospital, nursing home or ACLF when health care becomes necessary.
Both licenses come from the Tennessee Health Facilities Commission, and both require that most residents be older adults. Around Knoxville, HFC licenses 5 homes for the aged, from 21 to 148 beds, compared with 57 ACLFs.
Who is a good fit for a home for the aged near Knoxville?
Someone who is mostly independent and walks on their own but should not live alone: an older adult who needs meals, housekeeping, reminders and a watchful household rather than medication administration or nursing visits.
The home-like setting can suit a person overwhelmed by a big building. The trade-off is that a hospital stay or a new medical need may mean another move, so ask any home how it handled the last resident whose health declined.
Who needs an ACLF instead?
Anyone who needs staff to give medications, help with bathing and dressing every day, regular visits from home health or hospice, or a secured memory care unit should look at licensed ACLFs.
ACLFs can also keep residents who meet nursing-facility level of care when a physician certifies that their needs can be met safely. The October 2026 bed report lists 57 licensed ACLFs in Knox, Blount, Anderson, Loudon, Sevier, Roane and Union counties with 4,032 licensed beds, 1,133 of them secured; 33 are in Knox County.
How do the two licenses compare on cost?
Neither license sets prices, but homes for the aged generally charge less because they offer fewer services; ACLF pricing usually adds care levels on top of base rent, while homes for the aged more often quote one monthly rate.
TennCare CHOICES Assisted Care Living Facility services are tied to ACLFs, so a resident who may need Medicaid help later should ask early whether the setting accepts CHOICES members.
Can someone move from a home for the aged to an ACLF on the same campus?
Sometimes. A few operators in Knox, Loudon and Roane counties hold both licenses at related addresses, which can make a later transfer simpler.
Our roster lists every licensed home for the aged next to the ACLFs, with license numbers and survey dates, so you can see which operators hold both.
Side by side
| Assisted-care living facility | Home for the aged | |
|---|---|---|
| Rule | 0720-26 | 0720-21 |
| Medications | May administer typically self-administered drugs | Residents manage or receive outside help |
| Health care | Can arrange nursing, therapy, hospice | Transfers the resident when health care is needed |
| Memory care | May run a secured unit | No secured unit |
Sources: Tenn. Comp. R. & Regs. chapters 0720-26, 0720-21 and 0720-18; Health Facilities Commission, TennCare and Department of Disability and Aging pages; CareScout and VA rate tables, as cited above. See our editorial standards.
