Last updated 2026-07-24
TL;DR
Assisted living in VA means state-licensed residential care regulated by the Virginia Department of Social Services under 22VAC40-73. Facilities are classified by resident acuity (assisted living or auxiliary grade levels), must pass fire and health inspections, and Medicare does not pay for the room-and-board portion of care. Virginia Medicaid can help through the Auxiliary Grants and Commonwealth Coordinated Care Plus waiver.
What is assisted living?
Assisted living is a category of licensed residential care for adults who need help with daily activities like bathing, dressing, medication management, or meal prep, but who don't need the round-the-clock skilled nursing you'd get in a hospital-level setting. It sits between independent living and a nursing home on the care spectrum. In Virginia, the state doesn't use the word loosely. "Assisted living facility" is a defined legal term under Virginia's licensing regulations, and any place operating under that name has to hold a license issued by the Virginia Department of Social Services (VDSS) [1]. That's different from an unlicensed "personal care home" or a private arrangement where a family hires an aide directly. The regulation that governs almost everything about how these facilities run in Virginia is 22VAC40-73, the Standards for Licensed Assisted Living Facilities [2]. If you're planning to open one, that's the document you'll live in for the next year of your life.
What is a group home?
A group home is a smaller residential setting, usually serving people with intellectual or developmental disabilities (IDD), mental illness, or substance use recovery needs, in a home-like environment rather than an institutional one. Group homes and assisted living facilities overlap in concept but not always in licensing category. In Virginia, group homes for individuals with IDD are often licensed or certified separately, sometimes through the Department of Behavioral Health and Developmental Services (DBHDS) rather than VDSS, depending on the population and funding source. A group home serving seniors who need help with activities of daily living, on the other hand, usually falls under the assisted living facility license from VDSS if it meets the resident count and service definitions in 22VAC40-73 [2]. The practical difference for an operator: which state agency reviews your application, which staffing ratios apply, and which population you're allowed to serve under your license. Mixing up the categories at the application stage is one of the most common (and costly) mistakes new operators make. If you're weighing a senior-focused facility against an IDD or behavioral health group home, it's worth reading a general overview of assisted living facilities before you pick a lane.
What is an assisted living facility?
Virginia's own definition is specific. Under the Code of Virginia, an assisted living facility is "any congregate residential setting that provides or coordinates personal and health care services, 24-hour supervision, and assistance (scheduled and unscheduled) for the maintenance or care of four or more adults who are aged, infirm or disabled" [3]. That four-or-more threshold matters a lot: three or fewer residents in a private home arrangement may fall outside licensure entirely, depending on the specifics. Facilities are also classified by the level of care they're approved to provide. Virginia's regulations describe "assisted living care" residents versus lower-acuity "residential living" residents, and a facility's license specifies which level(s) it can serve [2]. A facility licensed only for residential living can't legally keep a resident whose care needs have escalated past that level without either getting a waiver or transitioning that resident elsewhere. This classification system exists because acuity drives everything else: staffing ratios, physical plant requirements (like the number of accessible bathing facilities), medication administration rules, and fire safety code applicability all shift based on which level of resident you're licensed to serve.
What is assisted living vs nursing home?
| Assisted living facility | Direct care aides, medication aide, contracted/visiting nurse | ~$5,250 [4] | |
|---|---|---|---|
| Nursing home (semi-private) | RN on site 24/7, licensed nursing staff | ~$9,733 [4] | The practical line for families: if a person can direct their own care and just needs supervision plus help with a few ADLs, assisted living usually fits. If they need daily wound care, IV therapy, or post-acute rehab, that's a nursing home conversation. |
The short version: assisted living is for people who need help with daily activities but not continuous skilled nursing care, and a nursing home (skilled nursing facility) is for people who need ongoing medical and nursing supervision, often after a hospital stay or due to a chronic condition requiring clinical management. Nursing homes in Virginia are licensed separately under a different regulatory structure through the Virginia Department of Health, and they must have a registered nurse on site and licensed nursing staff providing hands-on clinical care. Assisted living facilities are not required to have nursing staff on site around the clock, though many employ or contract nurses for medication oversight and health monitoring [2]. Cost reflects that gap. Genworth's 2023 Cost of Care Survey put the median monthly cost of assisted living in Virginia at roughly $5,250, compared to roughly $9,733 a month for a semi-private room in a nursing home in the state [4]. Costs vary a lot by region (Northern Virginia runs well above the state median; rural areas run below it), so treat any statewide figure as a starting point, not a quote. | Setting | Typical staffing | Median monthly cost (VA, 2023) |
What does assisted living provide?
Under Virginia's regulations, a licensed assisted living facility has to provide at minimum: 24-hour supervision, assistance with activities of daily living (bathing, dressing, toileting, mobility, eating), medication management or administration (depending on staff licensure), three meals a day plus snacks, housekeeping and laundry, and a written individualized service plan for each resident that's reviewed at least annually or whenever the resident's needs change [2]. Facilities must also maintain emergency preparedness plans, provide activities programming, and meet minimum staffing ratios that scale with the number and acuity of residents. The specific staff-to-resident ratio during waking and sleeping hours is spelled out in 22VAC40-73 and depends on whether residents are classified as needing assisted living care or residential living care [2]. What assisted living does not typically provide: ongoing skilled nursing care, rehabilitation therapy as a core service, or the kind of intensive medical monitoring you'd get post-surgery. If a resident's needs exceed what the facility is licensed to provide, Virginia regulations require the facility to either arrange for additional services or help transition that resident to a more appropriate setting [2].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room-and-board or personal care costs of assisted living, and this is one of the most persistent points of confusion for families and new operators alike. CMS is explicit about this: Medicare covers medical care, not custodial or residential care, and "Medicare doesn't cover long-term care (also called custodial care)" for daily living assistance in a residential setting [5]. Medicare Part A may pay for short-term skilled nursing care after a qualifying hospital stay, and Medicare Part B can cover doctor visits, some therapies, or durable medical equipment for a resident who happens to live in an assisted living facility. But the facility's monthly rate itself, room, meals, and personal care, is not a Medicare-covered expense [5]. This matters for operators because it shapes your entire payer mix conversation. If you're building a pro forma or a family information packet, don't imply Medicare will offset resident fees. It won't, and stating otherwise is the kind of claim that gets facilities in trouble with state licensing boards and, potentially, the FTC.
How does Virginia Medicaid help pay for assisted living?
Virginia Medicaid doesn't pay assisted living facilities directly the way it pays nursing homes, but two programs help residents afford care. The Auxiliary Grant (AG) program is a state-supplemented income payment for low-income aged, blind, or disabled individuals living in licensed assisted living facilities that have chosen to accept AG residents, and it's administered jointly by the Virginia Department of Social Services and Department for Aging and Rehabilitative Services [6]. Separately, Virginia's Commonwealth Coordinated Care Plus (CCC Plus) Medicaid managed care program can cover home and community-based waiver services, including personal care, for individuals who meet nursing-facility level of care criteria and choose to receive services in a residential setting rather than a nursing home. This isn't a straight facility payment either; it funds specific services, and eligibility runs through Virginia Medicaid's standard financial and functional criteria. Operators considering AG participation need to apply separately with VDSS and meet specific per-resident rate and reporting requirements. It's a real payer source, but it comes with its own paperwork stack on top of your licensing file, and rates are set by the state, not negotiated facility by facility. Confirm current AG rates and application steps with your regional VDSS licensing office.
How to start a group home or assisted living facility in Virginia
Starting a licensed assisted living facility (or a residential group home under the applicable state agency) in Virginia follows a sequence, and skipping steps almost always costs you time later, not less of it. 1. Decide your population and license category. Seniors needing ADL help point you toward VDSS assisted living licensure under 22VAC40-73 [2]. IDD, mental health, or substance recovery populations may point toward DBHDS licensure instead, depending on services offered. Confirm the correct agency with Virginia's licensing offices before you sign a lease. 2. Check zoning and property requirements. Local zoning ordinances, fire marshal review, and building code compliance (often the Uniform Statewide Building Code) all apply before VDSS will even schedule a licensing inspection. A property that looks perfect on Zillow can fail zoning for a group care use in an R-1 residential district. Confirm with your local zoning office early, not after you've signed a lease. 3. Write your policy and procedure manual. Virginia requires written policies covering admission and discharge criteria, medication management, emergency preparedness, resident rights, staffing plans, and infection control, among others, all cross-referenced to specific sections of 22VAC40-73 [2]. 4. Build your staffing plan. You'll need to show VDSS a staffing schedule that meets minimum ratios for your intended resident acuity mix, plus documentation of required training (including the mandated administrator and direct care staff training hours specified in the regulation) [2]. 5. Submit your license application. VDSS requires a formal application, disclosure of ownership, background checks for staff and administrators, and a facility inspection covering both life safety code and the 22VAC40-73 standards before a license is issued [1] [2]. 6. Pass your initial inspection and open. Expect VDSS to conduct an on-site survey; deficiencies get cited and must be corrected on a timeline set by the inspector. A lot of first-time operators underestimate step 3. The policy manual isn't paperwork theater, inspectors check it against what's actually happening on the floor, and a mismatch between your written policy and observed practice is a fast way to rack up citations. If you want a structured starting point instead of building every policy from a blank page, the $299 State Group Home Licensing Kit gives you a framework built around the questions state inspectors actually ask, though you'll still need to customize it to Virginia's specific regulation numbers and your local zoning requirements.
What does it cost and how long does licensing take?
Virginia doesn't publish one flat statewide fee that applies to every applicant; fees and processing timelines depend on facility size, region, and current VDSS caseload. Confirm current application fees, renewal fees, and expected processing time directly with VDSS's licensing programs office, since these figures change and vary by facility capacity [1]. What you can budget around with more confidence: staffing costs (Virginia's minimum wage as of 2024 was $12.00 per hour under state law, and direct care staff pay typically runs above minimum wage in most markets) , facility buildout or retrofit costs to meet life safety code, liability insurance, and the ongoing cost of required staff training and background checks. Timelines for licensing approval vary widely based on how complete your application is on first submission and whether your building passes fire and health inspections the first time through. Applications with policy manuals that don't match the regulation, or buildings that need real construction work to meet code, take a lot longer than applications where those pieces are already lined up.
What inspections should I expect after opening?
Once licensed, Virginia assisted living facilities are subject to periodic unannounced inspections by VDSS to confirm ongoing compliance with 22VAC40-73, and facilities are also subject to complaint-based investigations if a resident, family member, or staff member files a concern [2]. Common citation areas nationally, and Virginia is no exception, include medication management errors, incomplete or outdated individualized service plans, staffing ratio shortfalls (especially on night shifts), and fire drill documentation gaps. Keeping your policy manual, your staffing schedule, and your actual daily logs in sync is the single best thing an administrator can do to reduce citation risk. VDSS publishes inspection reports for licensed facilities, and prospective operators or families can review a facility's compliance history before choosing to work with, invest in, or apply to work at a given location. If you're researching a market before applying, checking existing facilities' inspection histories in that region gives you a real sense of what local inspectors focus on.
Frequently asked questions
What is assisted living?
Assisted living is licensed residential care for adults who need help with daily activities like bathing, dressing, or medication management, but not full-time skilled nursing care. In Virginia it's a defined legal category regulated by the Department of Social Services under 22VAC40-73, distinct from independent living and from nursing home care.
What is a group home?
A group home is a smaller residential setting, often serving people with intellectual/developmental disabilities, mental illness, or recovery needs, in a home-like environment. Depending on the population served, Virginia group homes may be licensed through VDSS (as assisted living) or through DBHDS (for IDD or behavioral health populations).
What is an assisted living facility?
Under Virginia law, an assisted living facility is a congregate residential setting providing 24-hour supervision and personal/health care coordination for four or more aged, infirm, or disabled adults. It requires a VDSS license and must operate under the standards set in 22VAC40-73.
What is the difference between assisted living and nursing home?
Assisted living serves people who need help with daily activities but not continuous skilled nursing care; nursing homes serve people needing ongoing clinical/medical supervision, often with an RN on site 24/7. In Virginia, Genworth's 2023 survey put median monthly assisted living cost near $5,250 versus about $9,733 for a nursing home semi-private room.
Does Medicare cover assisted living facilities?
No. Medicare doesn't cover custodial or long-term residential care costs like room, board, and personal care in assisted living. CMS states Medicare covers medical care, not long-term custodial care. Medicare Part A/B may still pay for doctor visits or short-term skilled care a resident receives while living there.
How do I start a group home in Virginia?
Decide your population and correct licensing agency (VDSS for assisted living, DBHDS for many IDD/behavioral health group homes), confirm local zoning allows the use, write policies matching 22VAC40-73 or the applicable regulation, build a compliant staffing plan, and submit your license application with required background checks and inspections.
What does assisted living provide that a nursing home doesn't have to?
Assisted living emphasizes a home-like, less clinical environment: private or semi-private rooms, dining and social programming, and help with daily activities, without requiring 24/7 licensed nursing staff. Nursing homes are built around continuous skilled nursing and medical monitoring, which assisted living facilities are not licensed to provide.
How much does assisted living cost in Virginia?
Genworth's 2023 Cost of Care Survey estimated median monthly assisted living costs in Virginia at roughly $5,250, though costs vary significantly by region, with Northern Virginia typically running well above that figure and rural areas below it. Get current local quotes before budgeting.
Will Virginia Medicaid pay for assisted living?
Virginia Medicaid doesn't pay assisted living facilities directly like it pays nursing homes, but the Auxiliary Grant program supplements income for eligible low-income residents in participating facilities, and the CCC Plus waiver can cover certain personal care services for those who qualify by functional and financial criteria.
What's the minimum number of residents that makes a home an assisted living facility in Virginia?
Virginia law defines an assisted living facility as serving four or more aged, infirm, or disabled adults in a congregate residential setting. Homes serving three or fewer residents may fall outside this specific licensure category, though other rules can still apply depending on the arrangement.
Do assisted living facilities in Virginia need a nurse on staff?
Not necessarily around the clock. Virginia's regulations require medication management and health monitoring appropriate to resident acuity, but facilities aren't required to have an RN on site 24/7 the way nursing homes are. Many facilities contract with or employ nurses for oversight rather than continuous bedside care.
What happens if a resident's needs exceed what the facility is licensed for?
Virginia regulation requires the facility to either arrange additional services to meet the resident's needs or help transition the resident to a more appropriate care setting, such as a nursing home. Facilities can't simply keep residents whose acuity has moved past their licensed care level.
Sources
- Virginia Department of Social Services, Assisted Living Facilities Licensing: VDSS is the agency that licenses assisted living facilities in Virginia
- Virginia Administrative Code, 22VAC40-73, Standards for Licensed Assisted Living Facilities: Core regulation governing staffing, service plans, care levels, and inspections for Virginia ALFs
- Code of Virginia, § 63.2-100, Definitions: Legal definition of an assisted living facility as serving four or more aged, infirm, or disabled adults
- Genworth, Cost of Care Survey 2023: Median monthly costs for assisted living versus nursing home care in Virginia
- Medicare.gov, Long-Term Care: Medicare does not cover custodial/long-term residential care costs
- Virginia Department of Social Services, Auxiliary Grant Program: Auxiliary Grant supplements income for eligible residents in licensed assisted living facilities