Last updated 2026-07-25
TL;DR
An assisted living facility in Virginia is a residential setting licensed by the Virginia Department of Social Services under 22VAC40-73 to provide personal care, supervision, and health support to adults who can't live independently. It differs from a nursing home (skilled medical care) and from an unlicensed group home arrangement. Licensing involves an application, background checks, staffing plans, a fire inspection, and an on-site survey.
What is assisted living?
Assisted living is a category of residential care for adults, usually older adults or people with disabilities, who need help with daily activities like bathing, dressing, medication management, or meal preparation but don't need round-the-clock hospital-level nursing care. It sits between independent living and a nursing home on the care spectrum. In Virginia, the term has a specific legal meaning. The Virginia Department of Social Services (VDSS) defines and licenses "assisted living facilities" under Title 22VAC40-73 of the Virginia Administrative Code, and any place that markets itself that way while providing personal or health care to adults generally has to be licensed [1]. That's different from calling yourself "assisted living" informally. If you're taking in residents who need help with two or more activities of daily living, you're almost certainly in licensed territory, not a gray area. People often use "assisted living" loosely to describe anything from a small residential home with four beds to a 120-unit building with a dining hall and an activities director. Virginia's rules cover both ends of that range, but the staffing ratios, physical plant rules, and paperwork scale up as resident count and acuity go up.
What is a group home?
A group home is a residential setting, typically a house in a regular neighborhood, where a small number of unrelated people live together and receive support services. The term is used across several different licensing categories, and this causes a lot of confusion for new operators. In Virginia, homes serving people with intellectual or developmental disabilities are often licensed differently than homes serving seniors who need personal care. A group home for adults with IDD might fall under Department of Behavioral Health and Developmental Services (DBHDS) licensing, while a home providing personal care and supervision to seniors falls under VDSS's assisted living facility rules [1]. A group home is not automatically an assisted living facility, and an assisted living facility is not automatically a group home. The population served and the specific services provided determine which license applies. If you're planning to open a small residential home and you're not sure which category you fit, the first call should be to your state licensing agency, not a real estate agent or a franchise sales rep. Get that classification wrong and you'll redo your whole application.
What is an assisted living facility (and what is assisted living facility, legally, in Virginia)?
Under Virginia law, an assisted living facility (ALF) is "any public or private establishment... that is licensed by the Board of Social Services... for the maintenance or care of four or more adults... who need personal or health care services above the level of room and board" [2]. That's the operative definition, and it's the one VDSS uses to decide whether your building needs a license. Virginia sorts residents into two levels of care within that same license: assisted living care and residential living care. Residential living is for people who are more independent but still need some help and supervision. Assisted living care is for residents who need more help with activities of daily living or who have specific health monitoring needs [1]. Your license specifies which level(s) of care you're approved to provide, and admitting someone who needs a higher level than your license allows is a real compliance problem, not a paperwork technicality. A facility with three or fewer residents generally falls outside the ALF licensing requirement in Virginia, though local zoning and other rules can still apply [2]. That threshold matters a lot for small home-based operators deciding whether to structure a four-bed or five-bed home versus staying under the line.
What does assisted living provide?
An assisted living facility in Virginia is required to provide supervision, personal care assistance (bathing, dressing, toileting, mobility), medication management or administration, meals, housekeeping, laundry, and social or recreational activities appropriate to the resident population [1]. Facilities licensed for assisted living care (the higher level) must also be equipped to handle residents with greater physical or cognitive limitations. Specific requirements from 22VAC40-73 include a written individualized service plan for every resident, updated at least annually or whenever the resident's needs change [1]. Facilities must also maintain 24-hour staff awake and on duty if any resident is assessed as needing assisted living care rather than residential care [1]. That staffing requirement alone changes the labor cost model significantly compared to a home serving only independent, residential-care-level residents. Medication administration deserves its own mention because it trips up a lot of new operators. Virginia allows unlicensed direct care staff to administer medications only after completing a state-approved medication aide training program and passing competency evaluation [1]. If your staffing plan assumes any employee can hand out pills on day one, that assumption is wrong and will get flagged at inspection.
What is assisted living vs nursing home?
| Licensing agency (VA) | Virginia DSS | Virginia Dept. of Health |
|---|---|---|
| Staffing | Direct care staff, med aides | Licensed nurses 24/7 |
| Care level | Personal care, supervision | Skilled medical/nursing care |
| Typical resident | Needs ADL help, stable health | Needs ongoing medical treatment |
| National median monthly cost | ~$5,350 [4] | ~$9,733 (private room) [4] |
Assisted living and nursing homes are licensed under completely different frameworks and serve different acuity levels. Assisted living provides personal care and supervision in a residential, home-like setting; a nursing home (also called a skilled nursing facility) provides 24-hour skilled nursing care ordered by a physician, for people who need ongoing medical treatment, wound care, IV therapy, or rehabilitation after hospitalization. In Virginia, nursing homes are licensed by the Virginia Department of Health, not VDSS, and they must have licensed nurses on-site around the clock [3]. Assisted living facilities are not required to have a registered nurse on staff at all times; some smaller homes have no nurse on staff and instead contract with outside agencies for skilled needs, or transfer residents to a nursing home when their needs exceed what the ALF license allows. Cost also differs sharply. National median costs from Genworth's 2023 Cost of Care data put assisted living around $5,350 a month nationally, compared to roughly $9,733 a month for a private room in a nursing home [4]. Virginia-specific figures vary by region, but the same relative gap holds: assisted living costs meaningfully less than skilled nursing because it delivers a lower level of medical care. | Feature | Assisted living facility | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room and board or personal care costs of assisted living. CMS is explicit about this: Medicare does not pay for long-term custodial care, including assisted living [1]. Medicare Part A may cover a short skilled nursing facility stay after a qualifying hospitalization, and Medicare can cover medically necessary services delivered to a resident (like a doctor's visit or physical therapy), but it does not pay the facility's monthly rate for housing, meals, or personal care. Medicaid is different and more relevant for many operators. Virginia's Medicaid program, through its Commonwealth Coordinated Care Plus (CCC Plus) waiver, can help cover some assisted living services for eligible low-income residents, but coverage rules, provider enrollment, and reimbursement rates are specific and change over time . If your business model depends on Medicaid waiver residents, confirm current waiver enrollment requirements and reimbursement rates directly with the Virginia Department of Medical Assistance Services before you build a pro forma around it. Don't tell prospective families that "Medicare covers assisted living." It doesn't, and repeating that misinformation, even innocently, creates real liability and erodes trust fast.
How to start a group home (or assisted living facility) in Virginia
Starting a licensed residential care operation in Virginia follows a sequence, and skipping steps to save time almost always costs more time later. Here's the realistic order of operations. 1. Confirm which license category fits your population. Seniors needing personal care point toward VDSS's assisted living facility license under 22VAC40-73 [1]. Adults with intellectual or developmental disabilities may point toward DBHDS licensing instead. Call the agency and describe your resident population before you sign a lease. 2. Choose and secure a property that fits zoning. Residential care homes often qualify for reasonable-accommodation protections under the Fair Housing Act, but local zoning, fire code, and building code still apply and vary by county. Confirm zoning classification with your local planning department before signing a lease or purchase agreement. 3. Build your staffing plan and policy manual. Virginia requires specific staff-to-resident ratios, a designated administrator who meets licensure or registration requirements, and required training hours for direct care staff [1] [1]. Your policy and procedure manual needs to cover admission and discharge criteria, medication management, emergency preparedness, infection control, and resident rights, among other required topics. 4. Submit the license application to VDSS, including required fees, floor plans, fire marshal approval, and background check documentation for all staff and any household members on-site [1]. Background checks in Virginia include a sworn disclosure statement, a criminal history record check, and a search of the state's sex offender registry and the DSS central registry for child abuse and neglect (relevant for staff who also work with minors) . 5. Pass your pre-licensure inspection. VDSS conducts an on-site inspection to confirm the physical plant, staffing, and policies actually match what's in your application before issuing the license. 6. Maintain compliance after opening. Virginia conducts ongoing inspections, and violations get published; this is public record and prospective families do check it. Building all of this from scratch, the application, the policy manual, the staffing plan, the forms, takes most first-time operators several months of research just to figure out what's required in their state before they write a single policy. That's the gap the $299 State Group Home Licensing Kit is built to close: a state-specific packet of application checklists, policy manual templates, and staffing plan frameworks, so you're customizing documents instead of drafting them cold. It doesn't replace your state's application or guarantee approval; only your state licensing agency approves a license.
What is the difference between assisted living and nursing home care, in practice?
The regulatory difference is clean on paper (personal care versus skilled nursing) but the practical difference shows up in daily staffing and what happens when a resident's health declines. An assisted living facility in Virginia can lose its ability to keep a resident if that resident's needs exceed the facility's licensed level of care; 22VAC40-73 requires facilities to have a discharge plan and to transfer residents whose needs surpass what the license allows [1]. A nursing home, by contrast, is built and staffed to absorb that decline. It has licensed nurses on every shift, physician oversight, and equipment for higher-acuity medical needs. That's also why nursing home care costs more: you're paying for medical infrastructure, more than personal care support. For operators, this distinction shapes your admission and retention policies. A clear, written policy about what triggers discharge or transfer (a cognitive decline threshold, a specific medical need your staff can't safely manage) protects both residents and your license. Vague admission criteria are one of the most common findings in state inspection reports.
How do I start a group home? Costs and startup budget realities
Startup costs vary enormously depending on whether you're renovating an existing home, building new, or leasing a commercial space, and depending on how many beds and what level of care you're licensed for. There's no single honest number here, and anyone quoting you a flat national figure is guessing. What's true across states: expect meaningful costs in property (purchase, lease, or renovation to meet fire and ADA-adjacent accessibility requirements), staffing before you have full occupancy, licensing and background check fees, liability insurance, and a reserve for the gap between your license approval date and your first paying resident. Confirm current application and licensing fee amounts directly with VDSS, since these figures are set by regulation and change periodically [1]. A realistic financial plan assumes it takes months, not weeks, to go from lease signing to a full census. Underestimating that runway is the single most common reason new operators run out of cash in year one, and no licensing kit or consultant can fix a budget that assumed instant full occupancy.
What should a policy and procedures manual cover for a Virginia ALF?
Virginia's regulations (22VAC40-73) specify required written policies covering admission and retention criteria, resident rights, medication management, emergency preparedness and evacuation, infection control, staff training, abuse/neglect reporting, and grievance procedures [1]. Your manual isn't a formality; inspectors compare what you claim to do against what's written and against what staff can actually describe when asked. A few sections inspectors focus on repeatedly: your emergency preparedness plan (Virginia requires specific evacuation and continuity procedures, tested periodically), your medication management procedures (who can administer what, and under what training), and your resident assessment and service planning process (the individualized service plan required for every resident) [1]. If you're drafting this from scratch, review the actual regulation text section by section rather than adapting a generic template found online; Virginia's specific citation numbers, timelines (like annual service plan updates), and required disclosures don't match every other state's rules, and a mismatched manual is an easy inspection finding.
Where to go from here
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Frequently asked questions
What is assisted living?
Assisted living is residential care for adults who need help with daily activities like bathing, dressing, or medication management but don't need full-time skilled nursing care. It provides housing, supervision, meals, and personal care support in a home-like setting, licensed at the state level under specific regulations like Virginia's 22VAC40-73.
What is a group home?
A group home is a residential setting where a small number of unrelated people live together and receive support services, often for seniors, people with disabilities, or people in behavioral health recovery. Licensing category depends on the population served; in Virginia, this might mean VDSS assisted living licensing or DBHDS licensing depending on residents' needs.
What is an assisted living facility?
Under Virginia law, an assisted living facility is any establishment licensed by the state to provide maintenance and care to four or more adults who need personal or health care services above basic room and board. It's a specific legal category, more than a marketing term, defined in the Code of Virginia [2].
What is assisted living vs nursing home?
Assisted living provides personal care and supervision in a residential setting; a nursing home provides 24-hour skilled nursing care under physician orders for medically complex residents. They're licensed by different state agencies in Virginia (VDSS versus the Virginia Department of Health) and cost different amounts, with nursing homes typically costing far more.
What does assisted living provide?
Virginia-licensed assisted living facilities provide supervision, help with daily activities, medication management, meals, housekeeping, laundry, and social activities, plus an individualized written service plan for each resident updated at least annually. Higher-acuity facilities must also provide 24-hour awake staff, per 22VAC40-73 [3].
How do I start a group home?
Confirm which license category fits your intended resident population, secure a property that meets zoning and fire code, build a compliant staffing plan and policy manual, submit your application with required background checks, and pass a pre-licensure inspection. The exact steps and fees are set by your state licensing agency and vary by state.
What is the difference between assisted living and nursing home care?
Assisted living covers personal care and supervision for relatively stable residents; nursing home care covers ongoing skilled medical treatment for residents with more complex health needs. The staffing, licensing agency, and cost differ substantially, with nursing homes requiring licensed nurses around the clock.
Does Medicare cover assisted living facilities?
No. CMS states that Medicare does not cover long-term custodial care, including room, board, and personal care at assisted living facilities [7]. Medicare can cover specific medical services a resident receives, like doctor visits or short-term rehab after hospitalization, but not the facility's monthly rate.
Does Medicaid pay for assisted living in Virginia?
Virginia Medicaid can help cover some assisted living services for eligible low-income residents through its CCC Plus waiver program, but eligibility rules and provider enrollment requirements are specific and change. Confirm current details directly with the Virginia Department of Medical Assistance Services before building any financial plan around it.
How many residents can a home have before it needs an assisted living license in Virginia?
Virginia generally requires licensing for establishments caring for four or more adults who need personal or health care services above room and board. Homes with three or fewer residents typically fall outside that specific licensing threshold, though other local and safety rules can still apply [2].
Can unlicensed staff give medications in a Virginia assisted living facility?
Yes, but only after completing Virginia's state-approved medication aide training program and passing a competency evaluation. Untrained staff administering medication is a common and serious inspection finding, so staffing plans need to account for this training requirement before opening [4].
What's the difference between residential living care and assisted living care in Virginia?
These are the two levels of care under a single Virginia ALF license. Residential living care is for more independent residents needing minimal help; assisted living care is for residents needing more support with daily activities or closer health monitoring, and requires 24-hour awake staff [3].
Sources
- Virginia DSS, Assisted Living Facilities regulation 22VAC40-73: Virginia licenses assisted living facilities under 22VAC40-73
- Code of Virginia § 63.2-100, definitions: Legal definition of an assisted living facility as caring for four or more adults needing services above room and board
- Genworth Cost of Care Survey 2023: National median monthly costs for assisted living versus nursing home private room
- Medicare.gov, long-term care coverage: Medicare does not cover long-term custodial care including assisted living
- Code of Virginia: Assisted living facilities in Virginia must be licensed by the Virginia Department of Social Services under this code section governing licensure requirements.
- Virginia Department of Social Services: The Virginia Department of Social Services regulates and licenses assisted living facilities in the state.
- Virginia Administrative Code: Standards for licensed assisted living facilities in Virginia, including staffing and resident care requirements, are set out in this administrative code chapter.
- Medicaid.gov: Medicaid, unlike Medicare, may cover certain long-term services and supports including some assisted living costs under specific state waiver programs.
- Code of Virginia: Virginia law establishes background check and criminal history record requirements for assisted living facility staff and operators.
- PubMed Central: Research on differences in resident outcomes between assisted living and nursing home care settings.