The Major Difference Between RAL and ALF (And Why It Matters)

alf meaning assisted living acronyms assisted living business assisted living facility assisted living license types ral meaning ral vs alf residential assisted living senior living terms Dec 29, 2025

If you’re new to assisted living, the acronyms you come across can feel very overwhelming. I see this all the time, and honestly, it trips up a lot of people before they even get started. Let’s slow down and make this simple so you know what people really mean when they say RAL or ALF.

Want the full breakdown? Watch the video below👇

RAL Means Assisted Living in a Residential Setting

RAL stands for Residential Assisted Living. Sometimes you’ll hear RALF as well, but they’re usually talking about the same thing.

The keyword here is residential. A RAL is located in a normal neighborhood. It looks like a regular house. You might drive past it every day and never know it’s an assisted living home.

This is a great way for first-time owners to get started because it feels familiar. You’re operating in a house, often with fewer residents, and the environment feels more like a home than a facility.

In most states, RALs are smaller homes. Think somewhere around 6 to 16 residents, though the exact number of beds allowed in a RAL depends on your state's rules.

✅ Located in a normal residential neighborhood
✅ Smaller bed count in most states
✅ Same level of assisted living care

ALF Is a Broad Term for Assisted Living

ALF stands for Assisted Living Facility. This is the umbrella term for assisted living as a whole.

Here’s where people get confused. An ALF can be small or very large. It can be a residential-style home or a big building with 100 or more residents. The size does not define whether something is an ALF.

What defines an ALF is the type of care being provided. Assisted living means helping residents with activities of daily living, like dressing, bathing, toileting, eating, or medication reminders.

I run into this all the time. I tell someone I own assisted living, and they say, “Oh, so like a nursing home?” That’s not the same thing, and this distinction matters.

Assisted living:

✅ Focuses on helping with daily living activities
✅ Can range from small homes to large buildings
✅ Not defined by size, but by care level

Assisted Living Is Not the Same as a Nursing Home

This is an important part of the conversation.

In assisted living, residents need help, but not constant medical care. They may need reminders, hands-on help, or full assistance with certain tasks, but the setting is not clinical.

Nursing homes are different. They are staffed by nurses and provide ongoing clinical care that assisted living is not allowed to provide.

I like to think of assisted living as supportive and nursing homes as clinical. They serve different needs, even though people often mix them up.

💡 Assisted living helps with daily life
💡 Nursing homes provide medical-level care

The Real Difference Between RAL and ALF Is Often Licensing

Here’s the part most people don’t tell you. The difference between RAL and ALF is usually about licensing and bed count, not the level of care.

This is how I organize it in my own head. This is not a national rule, but I think it helps make sense of things.

🏠 Care homes are usually very small, often 4 to 6 residents
🏘️ Residential assisted living typically falls in the middle, maybe 6 to 16 or 20 residents
🏨 Assisted living facilities cover everything above that, including large buildings.

All of these still fall under assisted living care if the services are the same.

✅ Care homes are usually the smallest
✅ RALs sit in the middle range
✅ ALFs include the full size spectrum

Other Assisted Living Acronyms You May Hear

Depending on your state, you may never see the term RAL at all. That’s normal.

Some states use different names for the same type of care. You might see RCF for Residential Care Facility or RCFE in California, which stands for Residential Care Facility for the Elderly. Some states use ACF for Alternative Care Facility or ACH Adult Care Home.

This is where many people get stuck. They’re searching for the wrong term on their state website. Once you know what your state calls it, the process usually gets much clearer.

💡 The name matters less than the care and license
💡 States use different terms for similar homes

Wrap Up

The big takeaway is this. RAL and ALF are not opposites. They are part of the same world of assisted living, just described with different words and licenses. Once you understand that, everything starts to feel more manageable.

If you need help creating a business plan for your assisted living business, check out the Free Business Plan Checklist.

And if you’re ready to figure out your next step, join me for the next Roadmap Challenge, where I’ll walk you through how to get started.

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Show full transcript 👇

Transcript

00:00:01 - 00:01:02
Hey friend, welcome to Assisted Living Investing. Super excited to be on here with you today. Today we are going to be talking about the difference between uh RAL and ALF. This is a comment that I got on on YouTube uh a few weeks ago and I thought, you know, let's let's just go ahead and and create, you know, create a video on this that's going to help you out as you're trying to figure these things out for your uh assisted living b business. as you're trying to get started. Seem to be having a few

00:00:32 - 00:01:27
technical difficulties here. I don't think we're live on LinkedIn or Facebook um today. So, sorry. Uh we we'll get those posted on links over there for you for sure. Um but I I think we're live on YouTube. So, [snorts] hopefully hopefully we are. If not, we'll just post it later. Um this is the the joys of going live on on these. It's hard for me to to know exactly what's happening. Anyways, hey friend, I'm Brandon Gustafson. I help first-time assisted living entrepreneurs launch

00:00:59 - 00:01:50
profitable, purpose-driven businesses, creating prosperity, purpose, and peace in their lives. I'm super excited to be here with you on the channel today and helping you uh along the path to to launching your assisted living business. Uh this is one of my favorite things to do uh throughout the week. Also, if you need help, I have a few different coaching programs. Would love to help you out. If you go to aliquiz.com, I've got a 30-cond quiz. You can take that. It will take you through my different

00:01:25 - 00:02:13
programs and and tell you which of those is going to be the best fit for you. So, go take that. Uh I also have an upcoming roadmap challenge. I would love to have you on the challenge. So, if you go to roadmapchallenge.com, you can learn more about that. And if you need some free resources, head over to assistedlivinginvesting.net. I've got a free underwriting calculator for you right there. Big blue box. You can't miss it. Go grab the free underwriting calculator or you can take the quiz there on that site as well.

00:01:49 - 00:02:53
Would love to have you there. All right, let's get into it. Um, today we are talking about the difference between RAL and ALF. Um, again, questions that people have as they're trying to to get in here and get things started um on on their path to launching their assisted living business. Um, today we're going to be talking about what is an RA, a RAW, what is an ALF, ALF? Um, what is the real difference between those two? And then I want to get into a few other acronyms. And I do want you to comment

00:02:20 - 00:03:26
down below if you've heard of an acronym or you're you're curious what an acronym is. Type in that acronym. So this could be RCF, RCFE, uh it could be ALF, could be ACF, could be there's so many throughout the throughout the nation and doing this and even in different countries. So type in your acronym and I will do my best to do the research for you to respond to you what that acronym means. So hopefully we can create this uh this video as a kind of a repository for where people can go to learn the

00:02:53 - 00:03:49
different acronyms of of assisted living and that will help you out as you're trying to just figure out how to get into this and what you're supposed to call it. Uh cuz that can be that can be something that's really really confusing as when you get into this world and people are using different acronyms all over the place. Uh I want to try to make this as simple as I can for you. All right. So, let's let's hop in. First, we're going to talk about what is RAL. So, a RAW, you may hear people call it a

00:03:21 - 00:04:23
Ralph uh RA that you may hear uh people even with this acronym, they call it different things, which is which is kind of funny. Um, a RAL stands for it's an acronym that stands for residentialass assisted living. And if you have the F at the end, it's residentialass assisted living facility. Okay? It's the one that um a lot of people use in this world. I think it was the first person I ever heard call it this was Jean Gino u before he passed away. Um and he was the founder of the the RAW Academy. So if

00:03:53 - 00:04:58
you haven't watched their stuff, they they do they do really good uh things on their website. Um go check them out. So, the the RAW Academy um I I believe Jean was the first person who kind of coined this phrase or at least made it popular enough that uh became more mainstream, but it stands for residentialass assisted living. The residential component of that is is the the key part of it. It is in a residential setting, meaning it is somewhere where um where where you know it's a normal

00:04:25 - 00:05:38
neighborhood. That's what it looks like is uh that it it's just in one of those settings where uh it's just kind of normal. Um and and and that's where we're just just in a normal house, HOA type of a setting. Uh that's that's the really defining point with an RA is it's in that residential setting. Okay. The next one is ALF or ALF. And we just talked about how a RAW can also be a Ralph when you add that on the end of it. And it really is just that R that's at the beginning that is is making the

00:05:01 - 00:06:08
change. So ALF stands for assisted living facility. This is the one that is it's very common in the industry uh to call something an ALF or call it an ALF because um that's that's a lot of what people are are talking about now. You may hear people call them old folks homes, old old folk homes, folks homes, however you would say that. Uh care homes or uh even something like uh a nursing home, which is is different. Nursing homes and assisted living are are different and the way that they

00:05:35 - 00:06:36
function uh the the amount of care that you that you provide to somebody, but somebody that is not in this industry will often interchange those. I I I mean, I live in this in this world, in this space. I tell people that I own assisted living facilities and that I have a coaching business where I coach people like you to start their own assisted living business. And the next question they ask, oh, how do you start a nursing home? And I'm like, did you not just hear what I said? Okay, so there is a difference between assisted

00:06:05 - 00:06:51
living and nursing home and it is based off of the amount of care that you are providing. in assisted living, you are providing uh an amount of care. And if you are interested in learning more about this, just type in senior industry down below and I'll do a video that is specific to the different types of homes and type of types of things that you have in the senior industry. So type that in down below if you want to learn a little bit more. But let me give you kind of an overview of what this looks

00:06:28 - 00:07:29
like. Assisted living, let's call it on the left hand side, is something that you are um that you're working with a person who needs um assistance, right? It's assisted living. They need assistance with activities of daily living. That is something like um dressing themselves or eating or remembering to take their medication or toileting or showering or those types of things. That's what you're doing. They can do it themselves sometimes. Sometimes they need a little bit of help. Sometimes they just need a

00:06:59 - 00:07:55
reminder. So there's just kind of this continuum of of areas uh that they need. And oftent times when we bring a resident in, we will do an assessment on them. So if you want to learn more about assessments, just type in assessment down below. But an assessment, we take them and let's say it's it's uh toileting is the thing that that they need to do. We will look at that from a on a continuum. Uh typically it's like a four-point scale. 0 1 2 3. Zero meaning they don't need help at all. Like

00:07:27 - 00:08:22
they're they're fine. Toileting not an issue with this person. Uh, a level one would be maybe they need reminders. Like, you know, you've got a toddler. You look like you need to go to the bathroom. Do you need to go to the bathroom? Like, that's that's the reminder. Um, number two would be, hey, we you know, I've got to help you get to the bathroom. Maybe I've got to wipe for you uh a little bit or uh you know, a couple times a day. Um, we're we're helping you out with toileting. And a

00:07:54 - 00:08:44
level three in that four-point scale is I'm doing everything. I I I have you on a schedule. Um I am taking you to the bathroom. I am taking your clothes off. I'm setting you on the toilet. I am waiting for you to finish so that I can then wipe you and then I'm putting the clothes back on. Okay, that's that's kind of like the four-point scale that we would go through. That's assisted living though. I'm helping you do that thing. Nursing. So, if we we've got this let's you know, my screen is split over

00:08:19 - 00:09:22
on the right side is uh is going to be uh nursing care. So, this is this is where it's a lot more clinical. Um, in an assisted living, you may have a nurse. You probably will have a nurse in your home, whether it's your employee or a contracted nurse, you you may have somebody over there. But in a nursing home that is staffed by nurses, um, CNAs, LPN's, RNs, LDNS, whatever. Uh, there there's a gamut of nurses, but it is a lot more clinical. They still will help out with the toileting, right?

00:08:51 - 00:09:45
they're they're still going to provide that level of of care, but a lot of what they are doing, the reason a person is at a nursing home instead of an assisted living facility is because they need more clinical care that you just can't provide. You're not allowed to provide it in an assisted living facility. Okay? So, that's that's the big difference. Uh again, if you want to learn a little bit more about the the different areas in assisted or in the senior living space,

00:09:18 - 00:10:26
uh just comment that down below and I'll I'll I'll create a video on that. But ALF stands for assisted living facility and it is kind of broad for the entire industry in uh the the amount of in that type of care. Okay, so that's that's what ALF stands for. Assisted living because it is broad can run the gamut of the types of homes that you have. You could have big box facilities over here that have, you know, 100 beds, 50, 20, 50, 60, 200 beds. Like large facilities, big box all the way down to small

00:09:52 - 00:11:01
residential care home assisted living that have four to six to 10, 12, 16, 20 beds. um is is typically where where they excuse me where they land on that continuum there. So assisted living does not it's not specific to the size of the facility. Now some states will have different acronyms or different terms for it or there different licenses but at at a at a at its core assisted living alf is an assisted living facility just fits in this entire group. Like I'm I'm trying to let's see there we go. I got

00:10:26 - 00:11:31
hands that that are aligned there. um going from like four beds all the way up to 250 plus beds. Um anything in there is what would be considered an assisted living facility as long as the type of care aligns with what you would do in an assisted living um home assisted living facility. That's and that brings me to something. Well, I'll talk about other acronyms here, but you may see uh ALF, ALH, which would be assisted living home. Uh we'll talk about a few more acronyms here um in just a second, but I

00:10:58 - 00:12:08
do want to really specifically call out here that um there's the difference between RA and ALF really is they're just acronyms like this. Welcome to healthcare. This is the world of healthcare where everything has an acronym. It just does. And and that is something that uh having so I've been I've worked in the healthcare industry since 2013. Uh so it's been a long time and when I first got into the world of healthcare I came from the world from the world of sports. Um so I I I have an

00:11:34 - 00:12:41
undergrad in sports management. I worked for uh an Olympic federation. Um and I worked for uh I I worked for professional sports teams um and I did some in collegiate athletics as well. I I worked in that area for for a little bit of time before I got into the world of healthcare. And even just working at a at a a small level uh in the world of healthcare where I was doing like medical billing, I was introduced to just a world of acronyms and that is the world that you live in when you are in healthcare. There are acronyms all over

00:12:07 - 00:13:08
the place and often times they're the same acronyms and so they're specific to different organizations or different uh sectors of the industry. So you just kind of have to get used to it and figure out what those are. Again, if you are interested in a specific acronym, type that down in the comments below. I'll do my best to answer that question for you. Now, the other thing that I do want to tell you, often times the difference between an RAL and an ALF is the license type. So, this is going to

00:12:37 - 00:13:31
be based off of bedcount largely. And I like to the way that I do this in my brain, uh, because it works the best, but it is not a national standard. This is just my way of of organizing it in my brain is I say there are typically three different types of licenses for assisted living in most states and it is based off of bedcount. You have a care home. Uh and oftent times this can be an unlicensed home but this is typically like four to six. So when we were talking about our our big uh let's see

00:13:05 - 00:14:09
there are my hands. Uh when I'm talking about this big long thing right here, a care home is right here. It's four to six small. Then we have residential assisted living uh which is typically going to be somewhere between like um 6 to 20 beds depending on the state 6 to 16 just kind of depends. And then we have the rest of this gamut which is 16 or 20 plus. Um and that's going to be assisted living. It just kind of goes off the chart. There's there's in my in my mind the the best way for me to to uh

00:13:37 - 00:14:27
to describe that is to say there's typically three license types and it's based off of bedcount. care home, residential assisted living, assisted living. Um, that that's how I typically will do that, but it's not the case in every single state. Um, but it's it's probably the best way for you to to understand the different types of facilities. And when you hear people use an acronym, when they say care home, they're probably talking about something that's small, you know, four to six

00:14:02 - 00:15:07
beds. When they say residential assisted living, they're probably saying something that's it's pretty small, 16 to between 12 and 20. um depends on what the high end of that of that residential style facility is uh what the limits are in a state, but that's going to fit there. And then the rest of it, ALF assisted living facility is more of a big box. Typically, though, some people um don't don't always adhere to to that guidance, but that's how when I hear somebody say stuff, that's how I usually

00:14:34 - 00:15:31
interpret it in my brain. Okay? But what you do need to understand it all fits into this this continuum of assisted living. And so you are providing the same level of care whether you're on this end or this end. You're providing the same level of care to your residents in in that uh in in that type of a setting. When when you're assisted living, there are things that are further to the left of that that would be like independent living or there's things over to the right that are more

00:15:03 - 00:16:03
senior living or sorry that are more nursing homes. Um and then somewhere in in between here is actually memory care, which is a subset of assisted living. You're just dealing with individuals who have memory care issues like dementia and Alzheimer's. Okay, that is a lot of information. So, if you got questions, comment it down below. Uh, so I can help you answer those questions because there's a lot that goes into this, right? Um, I do want to talk here briefly about other names, other

00:15:32 - 00:16:31
acronyms that you may hear as you are getting into this world of assisted living and you you're like, well, my state doesn't call it an RA. Um, like I can't find that anywhere on my state's website. And that very well could be the case. This is often times the issue with finding how to get your license is you just don't know what it's called in your state. Um, so it can be really confusing because you're looking for residential assisted living license type and there is no license type called that in your

00:16:02 - 00:17:01
state. And so you've got to hone in on what it is called in your state and that's going to allow you to find the correct license type. And once you figure that out, um, you you you talk to the right department, the right agency at a state. And then the actual application process is not as difficult as you would think. Uh, it's just finding the right person to talk to is is the hard part. And a lot of that comes back to what is it actually called in your state. And so that's one something you want to pay attention to.

00:16:32 - 00:17:30
So I'm going to run through a few of them here with you. If you have others that you have heard, type that in the comments down below. I will do my best to define those for you um and and help you out and if it's one that I just I don't know I don't know what it is or if it's not assisted living and it's something else I'll clarify that for you as well. So comment those things down below. Let's get into a few of them though that that I was that I'm aware of that are pretty common. Okay. ACF. ACF

00:17:01 - 00:18:05
stands for alternative care facility. oftent times uh an alternative care facility. I I worked uh one of the facilities that I owned previously, we sold this in June of 2025, was uh an alternative care facility and we dealt with a mental health population, but our our facility license type was ACF and this was in the state of Colorado. Um oftentimes an alternative care facility is going to be for a specific type of resident. So in in my case it was um mental health uh is is who we're dealing

00:17:33 - 00:18:38
with and that was that's different from memory care. Um mental health was like people with schizophrenia uh bipolar disorder. That's the type of resident that we were dealing with. Okay. RCF this stands for residential care facility. It's very similar to a RAL a residential assisted living. Um it's just a residential care facility. The C stands for care. Okay. RCFE, you know, you would think it's the exact same, and it is pretty close. Um, this one's very common in in Cal, excuse me,

00:18:05 - 00:19:20
in California. RCFE, though, stands for residential care facility for the elderly. Okay. Care home. This one's not an acronym. Some people just call it a care home. Um, or they'll call it like an a residential care home. Sometimes they will use an acronym, RCH or CH. Sometimes you'll see that as well. Um there's an adult care home which is AC. You may hear that. And a this is this is different from the the AC that is like the the broad um healthcare legislation. This is this is not that AC. This is

00:18:42 - 00:20:05
also not AC that you would use to um to do bank transfers. This is specific to care homes. AC adult care home. Okay. So you may see that one a board and care home. So B and uh like an amperand CH, you may see that or BCH, boarding care home. Um you may see uh long-term care home, LTC or an LTCH. You do have to be careful with an LTC because that that has a different uh connotation in the healthcare industry uh for long-term care facilities, which are more typically going to be a nursing home. But sometimes in some states they will

00:19:24 - 00:20:29
call assisted living a long-term care home. And usually they'll they'll define that by home versus facility where home is more of the the residential style of assisted living and facility is more of a nursing home. So it can be really confusing like this. I I apologize. I didn't make the rules here. Okay. And then memory care. You may see may see MC for memory care. So there's there's a few out there a few different acronyms. It's really confusing. Uh they like they they it would be really nice if we could

00:19:56 - 00:21:02
standardize this across the industry, but because assisted living is not done at a federal level and it does go out to all of the different states, the chances of us ever at this point, I I think it's it's too far gone. The chances of everything being standardized um I I don't think is going to happen. there would be a chance that if if assisted living ever became a uh a benefit for Medicare beneficiaries that there would be some standardization. I I will say that I just don't know if it ever will

00:20:29 - 00:21:34
because the type of care that you receive in assisted living is different from the type of care you can uh be provided through Medicare. This is why uh residents on that have assisted living that need assisted living services uh while they could have Medicare, there's no Medicare benefit, but they can have Medicaid and there is a Medicaid benefit. Um so it's it's kind of for those reasons. It's because it's more of a what's the word? Lifestyle uh type of a benefit than a uh a clinical type of a

00:21:02 - 00:21:59
benefit if that makes sense. Um, so that that's what you're looking at and that is uh why it is it's it's in the realm of Medicaid rather than Medicare. That that's uh I could I could probably talk deeper on that. But if you're interested in learning more about the difference between Medicaid and Medicare, type in Medicaid down below. I'll do a video uh I have a few videos already on that topic. Um but type Medicaid in down below and I will uh either point you to that or I will uh I I'll help you. I

00:21:31 - 00:22:30
I'll do a separate video for you. So, we went through this uh quite a bit today um in talking about RAL versus ALF, what the difference really is and how how you can define those things. Um and then talked about some of the other names that exist. And I went a little bit deep here into assisted living versus nursing home. Um because I think there's a lot of just mis uh a misunderstanding of the difference between those two things. So, hope that was helpful for you. If it was, make sure you like the video,

00:22:00 - 00:22:50
subscribe, and ring the bell as well so you get notified every time we put out content like this. Would love to help you and guide you through the process of launching your own assisted living business. And one of the best ways for me to do that is to have you join my next roadmap challenge. So, if you go to roadmapchallenge.com, you can learn more about that. But this is a live challenge. It's it's it's me teaching you in a live setting. This is not a webinar. This isn't like a a sales pitch

00:22:25 - 00:23:23
or anything like that. This is me coming in working with you directly to help you launch your assisted living business. Um, and we go through a ton of things from building your vision to understanding underwriting to figuring out how which type of property is going to be best for you and the different options that are out there to understanding how funding works and the licensing process. So, we cover a lot in the road map challenge and it's it's a ton of fun. Um, and you can get VIP access where you get access to me for an

00:22:54 - 00:23:41
extra hour to ask me questions, whatever questions you have, and I'll help you get unstuck and help you make some progress. So, go check it out, roadmapchallenge.com. I have a few other coaching options out there if you want to see which one is best for you. Take the 30 secondond quiz at aliquiz.com and head over to assistedlivinginvesting.net as well to get you a free underwriting calculator to help you out as you're trying to launch your assisted living business. Are you curious about assisted

00:23:18 - 00:24:05
living, but you're not sure how to get started? At Assisted Living Investing, I'm here to help first-time assisted living entrepreneurs launch profitable, purpose-driven businesses, creating prosperity, purpose, and peace in their lives so that they can reach their goals of time and financial freedom. I love doing this. It's so much fun for me and I would love to help you along your path. Go take the quiz, aliquiz.com. And remember, it doesn't take a lot, just a little bit. Just keep going step by step

00:23:41 - 00:23:59
by step. And I promise you, if you do and you are consistent and persistent, you're going to be successful. Thanks for watching and have a great day.

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