Little Rock Senior AdvisorBy Little Rock Senior Advisor Care Team · November 6, 2026
Arkansas licenses assisted living as Level I or Level II. Level II buildings employ or contract with an RN, can give medications and can keep residents who reach nursing home level of care, including Living Choices Medicaid residents. Around Little Rock, 2,166 of 2,442 licensed assisted living beds (89%) are Level II.
Why does the level matter so much in Arkansas?
Most states describe assisted living by size or by the services a building chooses to offer. Arkansas draws one bright line instead: whether a resident meets the medical test for nursing home level of care. A Level I building may not house anyone who meets that test. A Level II building must employ or contract with a registered nurse and may keep those residents, including people whose care is paid by the Living Choices waiver.
For a family, that line decides how long a parent can stay as health declines and whether Medicaid can ever help with the care bill. Those are the two questions that cause the most painful surprises a year or two after move-in, which is why the level belongs at the top of every tour checklist rather than at the bottom.
How many Level I and Level II buildings are there around Little Rock?
The Arkansas Health Services Permit Agency's July 2026 Bed Need Book lists 31 assisted living facilities with licensed beds in Pulaski, Faulkner, Saline, Lonoke, Grant and Perry counties. Only 4 hold Level I beds: Brookdale Conway (100 beds, Faulkner County), Vitality Living Pleasant Hills (70 beds, Pulaski County), Willow Grove of Sherwood (60 beds, Pulaski County), Lake Forest Senior Living at Hot Springs Village (46 beds, Saline County). The other 27 are Level II.
| Level | Buildings | Licensed beds | Share of beds |
|---|---|---|---|
| Level I | 4 | 276 | 11% |
| Level II | 27 | 2,166 | 89% |
| All assisted living | 31 | 2,442 | 100% |
That makes central Arkansas a Level II market. A family touring west Little Rock, Maumelle, Bryant or Conway will mostly see Level II buildings, and should treat a Level I building as a deliberate choice rather than a default.
Who is a Level I building right for?
A Level I building suits a parent who is still fairly independent: someone who manages medications with a reminder, gets around with a cane or walker, and mainly wants meals, housekeeping, company and someone nearby at night. Staff at Level I help residents take their own medications but may not administer them, and when a resident has a short-term nursing need, the building brings in a licensed home health agency.
The trade-off is the ceiling. If a parent's memory or mobility declines to nursing home level of care, the Level I rules do not allow the building to keep them, and the family faces a second move. Ask any Level I administrator how many residents moved out last year because their needs grew, and where they went.
What does Level II add, and what does it not?
Level II adds a registered nurse on staff or under contract, licensed practical nurses and certified nursing assistants, medication administration by licensed nurses, and the ability to serve residents at nursing home level of care. It also makes the building eligible to participate in the Living Choices waiver, Arkansas Medicaid's program for care services in assisted living.
What it does not add is round-the-clock nursing. The RN does not have to be on site at all hours, and no Arkansas assisted living building may keep a resident who needs 24-hour nursing, is bedridden, or needs more help to evacuate than the staff can give. Families often hear 'Level II' and imagine a small nursing home. It is not one.
How should a family decide?
Think about the likely course of a parent's health over the next two to three years, not just this month. A parent with a progressive condition such as Parkinson's disease or early dementia is usually better served by a Level II building from the start, because it avoids the disruption of a second move. A parent whose main need is company and meals may be happier and pay less in a Level I building.
Then think about money. If savings could run out within a few years, Level II matters twice over, because Living Choices only works in Level II buildings that choose to participate. Ask each Level II building whether it keeps Living Choices apartments and whether a private-pay resident can convert later without moving.
What should we ask on the tour?
At either level, ask for the staffing schedule by shift, not just the legal minimum, and ask what conditions would trigger a 30-day discharge notice. At Level II, ask who the RN is, how many hours a week the RN is physically in the building, and who gives medications overnight. At Level I, ask how the building handles the point at which a resident needs medications administered.
Bring the state's record with you. Our facility pages show each building's level, licensed beds and history from the Bed Need Book, including former names, which can be a clue to a recent change of owner.
Frequently asked questions
Can a Level I resident move to Level II in the same building?
Only if the building also holds Level II beds; a resident who meets Level II criteria may not live in a Level I unit.
Does Level II mean a nurse is always present?
No. A Level II building must employ or contract with an RN, but the RN may be reachable by phone rather than on site at all hours.
Does Medicaid pay at Level I?
No. The Living Choices waiver works only in participating Level II buildings.
Is Level II more expensive?
Often, but Arkansas publishes no price split by level. Compare written price sheets, including the next care level up.
Where can I see each building's level?
Our assisted living roster lists every licensed building in the six counties with its level and beds from the state's Bed Need Book.
