Knoxville Senior AdvisorIs memory care a separate license in Tennessee?
No. Tennessee issues no stand-alone memory care license; an ACLF that locks a distinct part of its building reports those beds to the Health Facilities Commission as secured beds, and nursing homes report secured and Alzheimer's beds the same way.
The rule defines a secured unit as a distinct part of an ACLF where residents are intentionally denied egress except as needed to meet life safety requirements (0720-26-.02(37)). A distinct part has to be physically identifiable and run separately: a wing, a floor, its own building, or a cluster of rooms at the end of a hall.
In the Health Facilities Commission's October 2026 bed report, 37 of the 57 licensed ACLFs in Knox, Blount, Anderson, Loudon, Sevier, Roane and Union counties report secured units, 1,133 secured beds in total, and 7 nursing homes report 195 secured or Alzheimer's beds. Use that count to separate a real locked unit from a sales phrase. Several Knoxville-area buildings, including stand-alone dementia residences in Farragut, Hardin Valley, Powell and Lenoir City, are secured from end to end.
What records must a secured unit keep for Tennessee surveyors?
An ACLF with a secured unit must be able to show surveyors pre-admission evaluations, quarterly placement reviews, logs of deaths, hospital transfers, incidents, pressure ulcers and infections, a daily staffing pattern, an activity calendar with three months of attendance, and proof of staff training (0720-26-.08(9)).
- An interdisciplinary team of at least a physician, a registered nurse and a family member or patient care advocate evaluates each resident before admission to the secured unit
- The team reviews the appropriateness of the placement every quarter
- The facility keeps current lists of deaths and hospitalizations with diagnoses, unusual incidents, and pressure ulcers or infections on the unit
- A daily staffing pattern and staff ratios for the unit are recorded
- A calendar of daily group activities with three months of attendance records
- 100% of unit staff receive annual in-service training on Alzheimer's disease and related disorders, dysfunctional behavior and catastrophic reactions, safety risks, help with daily activities, and communicating with families
Every item on that list is something a family can ask to see or take part in. Who was on the team that evaluated your mother before she moved in? When is her next quarterly review, and will you be invited? Can you see last week's staffing pattern for the unit?
How many staff must be on a Tennessee memory care unit overnight?
At least one attendant must be awake, on duty and physically on the secured unit 24 hours a day, seven days a week (0720-26-.08(9)(e)); the rule sets no resident-to-staff ratio beyond that minimum.
One person meets the letter of the rule for a 12-bed unit and a 60-bed building alike, so the minimum tells you very little. Ask how many people are on the unit at 2 a.m., whether they are employees or agency staff, and who watches the hall when the overnight aide is helping someone in a bathroom. The daily staffing record the rule already requires answers the question with paper, not a promise.
What dementia training does Tennessee require of memory care staff?
Every worker on a secured unit must receive in-service training each year on Alzheimer's disease and related dementias, managing difficult behavior and catastrophic reactions, spotting safety risks, helping with daily living, and communicating with families (0720-26-.08(9)(h)).
The rule requires that all unit staff be trained every year but does not fix a number of hours. Ask how many hours the community provides, who teaches them, and whether night and weekend staff attend the same sessions. Then ask how the unit handles exit-seeking, falls and late-afternoon agitation, because those behaviors, more than the diagnosis, decide whether someone can stay.
When must a Knoxville memory care resident move to a nursing home?
There is no fixed diagnosis that forces a move; Tennessee bars an ACLF from keeping someone who needs continuous nursing care, has stage III or IV pressure ulcers, shows aggressive behavior posing an imminent physical threat, needs restraints, or cannot be served safely, unless a specific exception applies.
The main exception lets an ACLF keep a resident who meets nursing-facility level of care when the treating physician certifies in writing that the person's needs can be met safely and the building can assure a timely evacuation (0720-26-.08(3)). Hospice can also be brought in. Ask any memory care community, before admission, which situations have led it to give a resident notice in the past year. See who an ACLF can serve.
Side by side
| A Tennessee secured unit must | A Tennessee secured unit does not have to | |
|---|---|---|
| Staffing | Keep an awake attendant on the unit at all hours | Meet a numeric staff-to-resident ratio |
| Admission | Evaluate each resident with a physician, an RN and family | Accept anyone with a dementia diagnosis |
| Reviews | Re-check every placement each quarter | Keep a resident whose needs exceed the rule |
| Training | Train 100% of unit staff every year | Provide a set number of training hours |
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.
