Last updated 2026-07-23
TL;DR
Virginia licenses assisted living facilities (ALFs) through the Department of Social Services under regulation 22VAC40-73, not the health department. Group homes for people with intellectual disabilities, mental illness, or substance use recovery are licensed separately by DBHDS. Medicare doesn't pay for room and board in either setting; Virginia's Auxiliary Grant and Medicaid waivers help some low-income residents cover the cost.
What is assisted living?
Assisted living is a housing and care model for adults who need help with daily tasks like bathing, dressing, medication reminders, or getting to meals, but who don't need the round-the-clock skilled nursing you'd find in a nursing home. Think of it as the middle tier between independent living and a nursing facility. The National Center for Assisted Living, the industry group under the American Health Care Association, describes assisted living as a long-term care option built around housing, personal care, and health-related services delivered in a residential setting rather than a hospital-like one. That's a useful frame because it explains why assisted living looks so different from state to state and even facility to facility. One community might feel like an apartment building with a dining hall; another might be a converted house with six residents and two caregivers on shift. In Virginia, this isn't just marketing language. It's a licensed category with its own statute and regulations, and the state draws a hard line between assisted living facilities (ALFs), which serve aged or disabled adults, and group homes, which mostly serve people with intellectual and developmental disabilities, serious mental illness, or substance use recovery needs. If you're planning to open either type of home, you need to know which regulator you actually answer to before you sign a lease or draft a policy manual. Related overview pages worth bookmarking: assisted living and assisted living facilities.
What is an assisted living facility?
An assisted living facility, or ALF, is a licensed residential setting where four or more unrelated adults receive some combination of housing, meals, personal care, and supervision because they can't safely live alone. Virginia's Code defines it in § 63.2-100, and the licensing agency is the Virginia Department of Social Services, not the health department [1]. Virginia actually splits ALFs into two levels of care under 22VAC40-73: residential living care, for residents who need only minimal help with daily activities, and assisted living care, for residents who need more hands-on assistance or who have some cognitive impairment [2]. A single building can be licensed for both levels, and a lot of Virginia operators run mixed-acuity homes for exactly that reason, it lets residents age in place instead of moving out when their needs increase. A facility that's just an apartment complex with an optional meal plan usually isn't an ALF. What tips a building into ALF territory is the combination of personal care services (someone helping with dressing, bathing, or medication) plus 24-hour oversight. If you're building out a policy manual, this distinction matters because your resident agreements, staffing ratios, and admission criteria all have to match the level of care you're actually licensed for. See also: assisted living facility and facility assisted living for how other states frame the same category.
What is a group home, and how is it different from assisted living in Virginia?
A group home is a small residential setting, usually somewhere between four and eight residents, where people with intellectual or developmental disabilities, serious mental illness, or substance use disorders live together with paid staff support. In Virginia, group homes serving these populations are licensed by the Department of Behavioral Health and Developmental Services (DBHDS), not the Department of Social Services. The main regulation covering licensed DBHDS providers, including group homes, is 12VAC35-105 [3]. This split trips up a lot of first-time operators. If your target resident is an older adult who needs help with activities of daily living because of age or a physical condition, you're almost certainly looking at a VDSS assisted living license under 22VAC40-73. If your target resident is a younger adult with an intellectual disability, autism, or a behavioral health diagnosis, you're looking at a DBHDS license instead, often tied to a specific Medicaid waiver slot. The paperwork, inspection cycle, staffing credentials, and even the physical plant requirements differ between the two agencies. Calling DBHDS when you actually need VDSS (or the reverse) wastes months. Confirm which agency has jurisdiction over your target population before you draft a business plan or sign a property lease.
What does assisted living provide day to day?
Assisted living covers a defined bundle: a private or semi-private room, meals, housekeeping, laundry, help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication management or reminders, social and recreational activities, and staff supervision around the clock. What it does not routinely provide is skilled nursing care like wound vac management, IV therapy, or ventilator support, though Virginia's assisted living care level does allow for residents with somewhat higher needs than the residential living care level [2]. Most Virginia ALFs contract with outside home health or hospice agencies when a resident's medical needs exceed what the facility staff can legally provide. That's normal and expected; it doesn't mean the facility is under-licensed. What matters is that the facility's admission and retention policies clearly state what level of care it can and can't handle, and that staff actually follow the discharge criteria when a resident's needs cross that line. A good policy manual spells out exactly which services are included in the base rate and which cost extra. Residents and families get frustrated fast when they assumed something was covered and it wasn't. This is one of the most common sources of complaints VDSS inspectors hear about during renewal surveys.
What is the difference between assisted living and a nursing home?
| Assisted living facility | $5,350 | Direct care aides, medication aides, no round-the-clock RN required in Virginia | |
|---|---|---|---|
| Nursing home, semi-private room | $8,669 | Licensed nurses on duty 24/7 | |
| Nursing home, private room | $9,733 | Licensed nurses on duty 24/7 | Source: Genworth Cost of Care Survey, 2023 [4]. Regulatory oversight differs too. Nursing homes are certified by CMS for Medicare and Medicaid participation and inspected under federal nursing home rules, while Virginia ALFs are licensed purely at the state level by VDSS under 22VAC40-73, with no federal certification layer [2]. |
Assisted living and nursing homes both provide housing and support for people who can't live entirely independently, but they differ in the intensity of medical care, staffing, and regulatory oversight. Nursing homes (also called skilled nursing facilities) are staffed with licensed nurses around the clock and are built for people who need daily medical monitoring or rehabilitation after a hospital stay. Assisted living is built for people who mainly need help with daily tasks, not ongoing skilled medical care. Cost tends to track that difference in intensity. Genworth's Cost of Care Survey, the most widely cited national benchmark for long-term care pricing, put the 2023 median cost of assisted living at $5,350 a month nationally, compared to $8,669 a month for a semi-private nursing home room and $9,733 for a private one [4]. Virginia's numbers move around by metro area, Northern Virginia runs well above the national median while more rural parts of the state often run below it, so treat these as national reference points rather than a Virginia-specific quote. | Setting | National median monthly cost (2023) | Staffing model |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board in an assisted living facility, and it doesn't cover custodial care, help with bathing, dressing, or supervision, when that's the only kind of care a person needs. Medicare.gov states plainly: "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need." [5] Medicare will still pay for medically necessary services a resident receives while living in assisted living, things like doctor visits, physical therapy after an injury, or a short-term home health episode, the same way it would for someone living at home. It just won't pay the facility's monthly room and care fee. That gap is exactly why Medicaid, not Medicare, is the program operators and families actually rely on to help cover assisted living costs for lower-income residents. Virginia handles that through its Auxiliary Grant program and certain Medicaid waivers, covered below.
Who licenses assisted living in Virginia, and what rules apply?
The Virginia Department of Social Services, through its Division of Licensing Programs, is the licensing authority for assisted living facilities statewide. The controlling regulation is 22VAC40-73, Standards for Licensed Assisted Living Facilities, which covers everything from admission and retention policies to staffing, physical plant requirements, medication management, emergency preparedness, and resident rights [2]. The statutory definition of an assisted living facility lives in Code of Virginia § 63.2-100, and it's worth reading closely before you assume your planned business fits the category, because the four-or-more-unrelated-residents threshold and the personal care component both matter for whether you need this specific license at all [1]. VDSS conducts licensing surveys before initial approval and then periodic renewal inspections after that, typically annual, though the exact interval and any risk-based adjustment should be confirmed with your local VDSS licensing specialist since inspection frequency can shift based on compliance history. Local building and fire codes, plus your locality's zoning ordinance, also apply on top of the state license; a facility that's fully compliant with 22VAC40-73 can still get shut down over an unresolved local zoning or fire marshal issue, so line those up early rather than treating them as an afterthought.
How do I get an assisted living license in Virginia?
The general path runs through VDSS's Division of Licensing Programs: submit a license application, pass a background check on the administrator and key staff, get your physical plant inspected for fire, health, and building code compliance, and submit required policies covering admission criteria, medication management, emergency preparedness, staffing plans, and resident rights, all built around the standards in 22VAC40-73 [2]. Expect these general stages, though exact forms, fee amounts, and timelines should be confirmed directly with VDSS since they change: - Confirm you actually need an ALF license (not a DBHDS group home license) by reviewing the § 63.2-100 definition [1].
- Contact your regional VDSS licensing office to request the current application packet and fee schedule.
- Secure a property that passes local zoning approval and fire marshal inspection for an assisted living use.
- Write your required policy manual: admission and discharge criteria, medication management, staffing plan by level of care, emergency and disaster planning, resident rights and grievance procedures.
- Hire and background-check your administrator, who in Virginia must meet specific qualification and, in many cases, continuing education requirements under 22VAC40-73; confirm current administrator qualification rules with VDSS since they've been revised more than once.
- Pass your initial licensing inspection before admitting residents. Building that policy manual from scratch is where a lot of first-time operators lose weeks, because VDSS wants specific, facility-tailored language, not a generic template copied from another state. This is genuinely where a purpose-built starting point helps: our $299 State Group Home Licensing Kit gives you a policy manual framework built around what state licensing agencies actually ask for, so you're editing to match your facility instead of writing every section from a blank page.
How do you start a group home in Virginia?
Starting a group home in Virginia (serving people with intellectual or developmental disabilities, mental illness, or substance use recovery needs) runs through DBHDS rather than VDSS. The core regulation is 12VAC35-105 [3], and DBHDS licensing is often tied to a specific Medicaid waiver, most commonly the Developmental Disabilities (DD) Waiver system in Virginia, so your provider enrollment and your DBHDS license typically move on parallel tracks. The practical steps look similar in shape to ALF licensing but run through a different agency: confirm your target population and required regulation with DBHDS directly, secure a property that clears local zoning for a residential group care use, write policies covering behavior support, medication administration, staff training and supervision ratios, incident reporting, and human rights protections, hire staff who meet DBHDS training requirements (including required Human Rights Training in many programs), and pass your DBHDS licensing survey before admitting residents. Zoning deserves a specific mention here. Group homes for people with disabilities are generally protected under the federal Fair Housing Act from being treated differently than any other single-family residential use, but that protection doesn't erase every local requirement, like occupancy limits, spacing rules between group homes, or a registration step, so confirm your specific locality's zoning posture with your county or city planning office before committing to a lease.
What staffing does Virginia require in assisted living facilities?
Virginia's 22VAC40-73 sets staffing expectations that scale with resident count and level of care rather than a single flat ratio for every building [2]. At minimum, you need direct care staff awake and on duty 24 hours a day, an administrator who meets state qualification standards, and enough staff on each shift to meet residents' scheduled and unscheduled care needs, a standard that VDSS surveyors evaluate against your actual resident acuity mix during inspections. Medication aides need specific state-approved training and registration before they can administer medications in an ALF, and administrators typically need continuing education hours to keep their qualification current. Because these specific hour counts, ratios, and certification requirements get updated periodically, confirm the current numbers directly with VDSS or in the current published text of 22VAC40-73 rather than relying on a number you saw somewhere else, including this article, once time has passed. One planning note: staffing is usually the single biggest ongoing line item in a licensed residential operation, bigger than rent in most markets. Build your staffing plan around your actual resident acuity, not the bare regulatory minimum, because an inspector citing you for insufficient coverage during a bad shift is a lot more expensive than staffing one extra shift a week.
What happens during a Virginia assisted living inspection?
VDSS licensing specialists conduct an initial inspection before your ALF opens, then periodic renewal inspections after that, plus complaint-driven and unannounced visits when a concern gets reported. Inspectors check your physical plant, resident records, medication administration practices, staffing levels against your posted schedule, staff training files, emergency preparedness plans, and whether your actual practices match your written policies [2]. The most common finding across state ALF programs generally, and Virginia is no exception, tends to cluster around medication documentation gaps, staffing shortfalls versus the posted schedule, and outdated or incomplete resident care plans. None of those are exotic; they're just the boring administrative details that get skipped when a facility is short-staffed or growing fast. If you fail an inspection item, VDSS typically issues a plan of correction with a deadline rather than an immediate license action, reserving suspension or revocation for serious or repeated violations. The exact escalation process, timelines, and appeal rights should be confirmed with VDSS since enforcement procedure details can change and vary by the severity of the finding.
How much does assisted living cost in Virginia, and does Medicaid help?
National median assisted living costs ran about $5,350 a month in Genworth's 2023 Cost of Care Survey, and Virginia facilities in higher-cost metro areas like Northern Virginia typically run above that figure while rural facilities often run below it [4]. Virginia doesn't publish a single statewide average, so confirm current pricing directly with facilities or with VDSS's public facility search rather than relying on a single statewide number. Medicare does not cover this cost, as covered above [5]. What Virginia actually uses is the Auxiliary Grant (AG) program, a state supplement to Supplemental Security Income that helps eligible aged, blind, or disabled residents cover room and board costs in licensed ALFs and certain licensed group homes, administered through VDSS's benefits programs. Separately, some Virginia Medicaid home and community-based services waivers can fund personal care and support services for residents in community residential settings, though they generally don't pay the room-and-board portion the way Auxiliary Grant does. If you're building a business plan around resident affordability, don't assume Medicaid or the Auxiliary Grant will cover a specific dollar amount for your facility; grant amounts, eligibility rules, and provider participation requirements change and vary by circumstance, so verify current figures directly with VDSS and with Virginia's Medicaid agency before you build pricing assumptions into a pro forma. For a broader look at how funding sources differ across states, see senior assisted living facilities near me and assisted living at home for in-home alternatives some families consider instead.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential option for adults who need help with daily activities like bathing, dressing, or medication management, but don't require the round-the-clock skilled nursing of a nursing home. It combines housing, meals, personal care, and supervision in a home-like setting rather than a medical facility.
What is a group home?
A group home is a small residential setting, usually four to eight residents, where people with intellectual or developmental disabilities, serious mental illness, or substance use disorders live with paid staff support. In Virginia, group homes serving these populations are licensed by DBHDS under 12VAC35-105, separately from assisted living facilities [5].
What is an assisted living facility?
An assisted living facility (ALF) is a licensed residential setting serving four or more unrelated adults who need housing, meals, and help with daily living activities plus supervision. Virginia defines it in Code of Virginia § 63.2-100 and licenses it through VDSS under regulation 22VAC40-73 [2][3].
What is the difference between assisted living and a nursing home?
Assisted living serves people who mostly need help with daily tasks; nursing homes serve people who need ongoing skilled medical care with licensed nurses on duty 24/7. Genworth's 2023 survey put median monthly costs at $5,350 for assisted living versus $8,669 to $9,733 for a nursing home room [9].
Does Medicare cover assisted living facilities?
No. Medicare.gov states that Medicare doesn't cover long-term custodial care if that's the only care a person needs, which includes assisted living room and board [8]. Medicare can still pay for medically necessary services, like doctor visits or short-term rehab, that a resident receives while living there.
How do I start a group home in Virginia?
Confirm your target population and licensing agency with DBHDS, secure a property that clears local zoning for residential group care, write required policies (behavior support, medication administration, staffing, incident reporting), hire staff who meet DBHDS training standards, and pass a DBHDS licensing survey before admitting residents [4][5].
How do I get an assisted living license in Virginia?
Apply through VDSS's Division of Licensing Programs, secure a property that passes local zoning and fire code review, submit required policies covering admission, medication management, and staffing built around 22VAC40-73, hire a qualified administrator, and pass VDSS's initial licensing inspection before admitting residents [1][3].
How much does assisted living cost in Virginia?
Virginia doesn't publish one statewide average. Genworth's 2023 national survey found a median of $5,350 a month for assisted living, with Northern Virginia typically running higher and rural areas often lower [9]. Confirm current local pricing directly with facilities or through VDSS's public licensing database.
Does Virginia Medicaid pay for assisted living?
Virginia's Auxiliary Grant program, a state supplement to SSI, helps eligible low-income aged, blind, or disabled residents cover room and board in licensed assisted living facilities [6]. Some Medicaid home and community-based waivers can also fund personal care services in these settings, though usually not the room-and-board portion [7].
Who licenses assisted living facilities in Virginia?
The Virginia Department of Social Services (VDSS), through its Division of Licensing Programs, licenses assisted living facilities statewide under regulation 22VAC40-73 [1][3]. Group homes serving people with intellectual disabilities, mental illness, or substance use needs are licensed separately by the Department of Behavioral Health and Developmental Services (DBHDS) [4].
What does assisted living provide?
Assisted living typically provides a private or semi-private room, meals, housekeeping, laundry, help with bathing and dressing, medication reminders, social activities, and 24-hour staff supervision. It generally does not include skilled nursing services like wound care or IV therapy, which fall under nursing home or home health care instead.
What's the difference between an assisted living facility and a group home in Virginia?
Assisted living facilities in Virginia primarily serve aged or physically disabled adults and are licensed by VDSS under 22VAC40-73. Group homes primarily serve people with intellectual or developmental disabilities, mental illness, or substance use recovery needs and are licensed by DBHDS under 12VAC35-105 [3][5]. The regulator you need depends entirely on your target population.
How many staff does Virginia require in an assisted living facility?
Virginia's 22VAC40-73 requires enough direct care staff on duty around the clock to meet residents' scheduled and unscheduled needs, scaled to resident count and level of care, plus a qualified administrator [3]. Exact ratios and medication aide training requirements change periodically, so confirm current numbers directly with VDSS.
Sources
- Code of Virginia § 63.2-100: Statutory definition of an assisted living facility in Virginia
- Virginia Administrative Code, 22VAC40-73, Standards for Licensed Assisted Living Facilities: Regulatory standards governing ALF levels of care, staffing, and inspections
- Virginia Administrative Code, 12VAC35-105: DBHDS licensing regulation covering providers including group homes
- Medicare.gov, Long-term care coverage: Medicare doesn't cover long-term custodial care if that's the only care needed
- Genworth Cost of Care Survey, 2023: National median monthly costs for assisted living and nursing home care