Last updated 2026-07-23
TL;DR
In Virginia, assisted living facilities are licensed by the Virginia Department of Social Services under 22VAC40-73 and Code of Virginia § 63.2-100, covering settings with four or more unrelated adults needing personal care or supervision. Group homes for intellectual disability, mental illness, or substance use disorders are licensed separately by DBHDS under 12VAC35-105. Medicare pays $0 toward room and board in either setting.
What is assisted living?
Assisted living is a residential option for adults who need help with daily tasks like bathing, dressing, medication management, or meals, but who don't need the round-the-clock skilled nursing care you'd find in a nursing home. Residents typically live in private or semi-private rooms or apartments, eat in a common dining room, and get staff support on a schedule that matches their needs. The Administration for Community Living's long-term care resource describes assisted living as a middle tier between independent living and nursing home care, built around personal care and supervision rather than medical treatment . That's a useful national framing, but every state writes its own rules about who can operate one, how big it can be, and what services it must provide. In Virginia specifically, the term has a precise legal meaning tied to state licensing law, which is where a lot of first-time operators get tripped up. If you've searched broadly for assisted living basics before landing here, this article walks through how Virginia's version of the model actually works, and how it's regulated day to day.
What is an assisted living facility (and what does Virginia's law say)?
An assisted living facility, or ALF, is a licensed residential setting that provides or arranges personal care, health monitoring, and supervision for adults who can't fully live on their own. In Virginia, this isn't just industry shorthand. It's a defined legal term. Code of Virginia § 63.2-100 defines an assisted living facility as "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" and who live in a primarily residential setting [1]. That four-or-more threshold matters a lot for small operators: cross it, and you need a license. Stay under it while caring only for relatives, and you generally don't. The operating rules that flow from that definition sit in the Virginia Administrative Code at 22VAC40-73, "Standards for Licensed Assisted Living Facilities," administered by the Virginia Department of Social Services (VDSS), Division of Licensing Programs [2][3]. This regulation is long and covers everything from admission agreements to fire safety, staffing ratios, and resident rights. If you're building a policy manual or comparing state rules for a facility assisted living project, 22VAC40-73 is the single document you'll reference more than any other.
What is a group home, and how is it different from a Virginia assisted living facility?
A group home is a licensed residential setting, usually serving a small number of unrelated adults or children, built around a specific population's needs rather than age-related decline alone. In Virginia, group homes for people with intellectual or developmental disabilities, serious mental illness, or substance use disorders are licensed by the Department of Behavioral Health and Developmental Services (DBHDS), not VDSS. The governing regulation is 12VAC35-105, "Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services" [4]. That's a real fork in the road for anyone planning a facility in Virginia. If your target residents are primarily aging adults needing help with daily living and supervision, you're almost certainly in VDSS's assisted living world under 22VAC40-73. If your target residents have a behavioral health diagnosis, developmental disability, or substance use disorder as the primary reason for placement, you're likely looking at a DBHDS-licensed group home instead, even if the day-to-day building and staffing look similar. Getting this wrong costs time. Applying to the wrong agency, or building a program design around the wrong regulation, means starting the paperwork over. If you're unsure which category your planned population falls under, call the licensing agency before you sign a lease or renovate a building. Confirm the pathway with VDSS or DBHDS directly, since a handful of populations (people aging in place with both a physical and behavioral health diagnosis, for example) can sit in a gray zone that the agency has to sort out case by case.
Assisted living vs. nursing home: what's the actual difference?
| Virginia licensing agency | VDSS, Division of Licensing Programs [2] | Virginia Department of Health | |
|---|---|---|---|
| Core regulation | 22VAC40-73 [3] | State/federal nursing facility rules | |
| Staffing | Direct care staff, medication aides, on-site supervision | Licensed nurses on duty, physician oversight | |
| Typical resident need | Help with ADLs, supervision, medication management | Skilled nursing, rehab, complex medical needs | |
| Medicare coverage | Room and board: $0 [5] | Short-term skilled stays can be covered under specific conditions | A good gut check: if a resident needs a nurse managing wound care, IV therapy, or ventilator support daily, that's nursing home territory. If a resident mainly needs supervision, help getting dressed, and someone making sure medications are taken on time, that's assisted living. Virginia treats these as genuinely separate license types, and a facility can't operate as both without meeting each set of standards. |
The core difference is medical intensity. Nursing homes (also called skilled nursing facilities) provide daily nursing care, rehabilitation, and medical oversight for people who need it around the clock. Assisted living provides personal care and supervision, with medical care coordinated but not delivered at the same clinical level. | Feature | Assisted Living Facility | Nursing Home (Skilled Nursing) |
What does assisted living provide?
Virginia's regulation recognizes two levels of care inside the assisted living license: residential living care, for people who can direct their own care with some support, and assisted living care, for people who need more supervision and can't fully direct their own care [3]. A facility can be licensed for one level or both, and the level a resident is assigned changes what staffing and services the facility must provide for them. At a baseline, Virginia ALFs typically provide meals, housekeeping, laundry, help with activities of daily living (bathing, dressing, toileting, mobility), medication administration or oversight, 24-hour supervision, and coordination with outside medical providers. Before or at admission, Virginia requires use of the Uniform Assessment Instrument (UAI) to determine a resident's level of care and functional needs, which also ties into Medicaid Auxiliary Grant eligibility for residents who qualify [3]. Some facilities also seek certification to serve residents with dementia in a secure, dedicated unit, which comes with additional staffing and physical plant requirements under 22VAC40-73. If your program plans to specialize in memory care, budget extra time in your policy manual and staff training plan specifically for that certification track.
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 long-term custodial care generally. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need" [5]. Medicare Part A and Part B can still cover medically necessary services a resident receives, like doctor visits, certain therapies, or durable medical equipment, but the facility's daily rate itself is the resident's or family's responsibility, or covered through other means. Medicaid is a different story, with limits. Virginia Medicaid does not pay assisted living room and board either, but through home and community-based services waivers such as Commonwealth Coordinated Care Plus (CCC Plus), Medicaid can sometimes pay for personal care and support services delivered inside a licensed assisted living facility . Separately, Virginia's Auxiliary Grant program, a state supplement to Supplemental Security Income, helps eligible low-income aged, blind, or disabled residents cover the cost of room and board in a licensed assisted living facility. Eligibility and payment rates run through VDSS and local departments of social services, and they vary by locality, so confirm current rates with your state licensing agency rather than assuming a flat number.
How do you start a group home or assisted living facility in Virginia?
Starting either license type in Virginia follows a similar backbone, even though the agency and regulation differ by population. Here's the general order of operations most operators follow. 1. Decide your population and confirm your regulatory pathway (VDSS for aging/physical disability assisted living, DBHDS for ID/DD, mental illness, or substance use group homes). 2. Form your business entity and get your tax IDs in order before you touch a lease. 3. Secure a site that meets local zoning for the intended use, and check building and fire code requirements early, since retrofitting a house for accessibility and life-safety compliance after the fact gets expensive fast. 4. Write your policy and procedure manual: admission criteria, medication management, emergency plans, staff training, resident rights, and grievance procedures. This document is what inspectors actually read line by line during licensing review. 5. Build your staffing plan, including a licensed administrator if the regulation requires one, direct care staff coverage for every shift, and background check documentation for anyone with resident contact. 6. Submit your license application, required fees, and disclosure statements to VDSS or DBHDS, along with your policy manual and floor plans. 7. Pass your pre-license inspection. The agency won't issue an initial license until the physical building and paperwork both check out. 8. Get your license, then prepare for your first renewal inspection, typically at least annually going forward [6]. A lot of first-time applicants underestimate step 4. Writing a policy manual from scratch that satisfies 22VAC40-73 or 12VAC35-105 line by line takes real time, and generic templates pulled off the internet rarely match Virginia's specific citation requirements. That's the gap our $299 State Group Home Licensing Kit is built to close: state-specific policy and procedure starting documents so you're not drafting an emergency plan or a medication policy from a blank page. It doesn't replace talking to your licensing specialist, and it won't get your application approved faster on its own, but it saves you from reinventing the paperwork every operator before you has already had to write.
What are Virginia's staffing and administrator requirements?
Every licensed Virginia assisted living facility needs an administrator, and that role generally requires licensure through the Virginia Board of Long-Term Care Administrators, part of the Department of Health Professions . That's a separate professional licensing process from the facility license itself, and it has its own education, exam, and continuing education requirements, so build the timeline for getting an administrator licensed into your overall launch schedule. Direct care staff have their own training requirements under 22VAC40-73, generally centered on a state-approved orientation and direct care curriculum for staff who aren't already certified nurse aides or don't hold an equivalent credential. Hour requirements and content details get updated periodically by the State Board of Social Services, so confirm the current curriculum and hour count directly with VDSS rather than relying on an old number you find online. Staffing ratios and awake-staff requirements scale with resident count and the level of care residents are assessed at (residential living vs. assisted living care), and a facility certified for dementia care carries additional staffing rules on top of the base requirement. Build your staffing plan around your actual expected census and acuity mix, not the regulatory minimum alone. Inspectors and, more importantly, residents' families notice the difference between a facility staffed to the letter of the law and one staffed to actually keep people safe overnight.
What happens during a Virginia assisted living inspection?
Virginia law requires the Commissioner of Social Services to inspect licensed assisted living facilities on a regular schedule, generally at least once a year, and inspections can also happen unannounced in response to complaints [6]. Inspectors review resident records, staff files, medication logs, the physical building, fire drills, and your policy manual against the specific standards in 22VAC40-73. If an inspector finds a violation, the facility typically gets a statement of deficiency and has to submit a plan of correction with a timeline for fixing it. Repeated or serious violations can lead to enforcement action up to license revocation, so a facility's compliance history matters both for regulators and for families comparing options. Prepping for inspection isn't a one-time event. The facilities that pass cleanly year after year are the ones that treat their policy manual as a living document, updating it whenever a regulation changes or an incident reveals a gap, rather than pulling it out once a year right before the inspector's visit.
What does it cost to get licensed, and what should I budget?
Virginia's licensing fees for assisted living facilities are set through the State Board of Social Services and vary based on facility capacity, so there's no single flat number that applies to every applicant. Confirm the current fee schedule directly with VDSS's Division of Licensing Programs before you budget your application costs [2]. Beyond the state fee itself, plan for costs around administrator licensure exam and application fees through the Board of Long-Term Care Administrators , background check processing for every staff member with resident contact, building modifications to meet fire and accessibility codes, and staff training time before your doors open. None of these are one-time-only either; renewal fees, continuing education for your administrator, and periodic building inspections continue for as long as you operate. Don't treat the state license fee as your real startup number. For most small operators, staffing costs, building retrofit costs, and insurance dwarf the licensing fee itself. If you're comparing markets, our guides on assisted living facilities across other states can help you see how Virginia's requirements stack up against neighboring states before you commit to a location.
Where do zoning rules fit into a Virginia assisted living project?
Local zoning is a separate hurdle from state licensing, and it trips up more first-time operators than the state paperwork does. A property zoned for single-family residential use may or may not allow a licensed group care use, depending on how your locality's zoning ordinance treats residential care facilities. The federal Fair Housing Act limits how far localities can go in blocking small group homes for people with disabilities, and HUD's Fair Housing Act guidance addresses how zoning restrictions interact with housing for people with disabilities . That said, Fair Housing Act protections don't override every local requirement, like occupancy limits, parking, or fire code compliance, so a straightforward call to your locality's zoning or planning office before you sign a lease saves real money. If you're evaluating a specific property, ask the locality directly whether your planned resident count and population type is a permitted use, a conditional use requiring a hearing, or not allowed at all in that zoning district. Get the answer in writing if you can. Verbal assurances from a leasing agent are not the same as a zoning determination.
Frequently asked questions
What is assisted living?
Assisted living is a residential care option for adults who need help with daily tasks like bathing, dressing, or medication management, but who don't need full-time skilled nursing care. Residents live in a residential setting with staff support on a scheduled and as-needed basis, distinct from independent living or nursing home care.
What is a group home?
A group home is a licensed residential setting, usually small, that serves people with a specific need, such as intellectual or developmental disability, serious mental illness, or substance use disorder. In Virginia, group homes for these populations are licensed by DBHDS under 12VAC35-105, separately from VDSS-licensed assisted living facilities.
What is an assisted living facility?
An assisted living facility is a licensed residential setting providing personal care, supervision, and coordinated health services for adults who can't fully live independently. Virginia defines it in Code of Virginia § 63.2-100 as a congregate setting serving four or more aged, infirm, or disabled adults, licensed and inspected by VDSS under 22VAC40-73.
What is the difference between assisted living and a nursing home?
Assisted living provides personal care and supervision for people who need help with daily activities. Nursing homes provide daily skilled nursing care and medical oversight for people with more intensive medical needs. Virginia licenses these under entirely different agencies and regulations, and a facility can't operate as both without separate licenses.
What does assisted living provide?
Virginia assisted living facilities typically provide meals, housekeeping, help with bathing and dressing, medication administration or oversight, 24-hour supervision, and coordination with outside medical providers. Virginia recognizes two levels of care, residential living care and assisted living care, based on a resident's assessed needs under the Uniform Assessment Instrument.
How do I start a group home in Virginia?
Confirm which agency licenses your planned population (VDSS for assisted living, DBHDS for ID/DD, mental illness, or substance use group homes), secure a zoning-compliant property, write a policy and procedure manual matching the specific regulation, build a staffing plan with a licensed administrator if required, and submit your application with required fees and background checks.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board in an assisted living facility and generally excludes long-term custodial care. Medicare can still cover medically necessary services a resident receives, like doctor visits or therapy, but the facility's daily rate is not a covered Medicare benefit.
Does Medicaid pay for assisted living in Virginia?
Virginia Medicaid does not directly pay assisted living room and board, but through home and community-based waivers like Commonwealth Coordinated Care Plus, it can sometimes cover personal care services delivered inside a licensed facility. Virginia's Auxiliary Grant program separately helps eligible low-income residents cover room and board costs.
What agency licenses assisted living facilities in Virginia?
The Virginia Department of Social Services (VDSS), through its Division of Licensing Programs, licenses assisted living facilities under Code of Virginia § 63.2-1701 and regulates them under 22VAC40-73, "Standards for Licensed Assisted Living Facilities."
How many residents trigger the need for an assisted living license in Virginia?
Virginia's legal definition applies to congregate settings caring for four or more aged, infirm, or disabled adults who aren't related to the operator by blood or marriage. Caring for fewer unrelated adults, or only relatives, generally falls outside the ALF licensing requirement, but confirm edge cases with VDSS directly.
How often are Virginia assisted living facilities inspected?
State law requires at least one inspection per year for licensed assisted living facilities, and VDSS can also conduct unannounced inspections in response to complaints. Facilities found with violations must submit a plan of correction with a timeline for fixing the issue.
Is a special administrator license required to run a Virginia assisted living facility?
Yes. Virginia requires assisted living facility administrators to hold a license through the Virginia Board of Long-Term Care Administrators, part of the Department of Health Professions. This is a separate professional licensing process with its own education, exam, and continuing education requirements.
Can a Virginia assisted living facility care for residents with dementia?
Yes, but facilities that want a dedicated, secure memory care unit need additional certification under 22VAC40-73, with extra staffing, training, and physical plant requirements beyond the base assisted living license. Confirm current certification standards with VDSS before marketing a facility as memory care capable.
Sources
- Code of Virginia § 63.2-100: Legal definition of an assisted living facility, including the four-or-more resident threshold
- Virginia Administrative Code 22VAC40-73: Standards for Licensed Assisted Living Facilities, including levels of care and staff training
- Code of Virginia § 63.2-1706: Requirement for at least annual inspection of licensed assisted living facilities
- Virginia Administrative Code 12VAC35-105: DBHDS licensing regulation for group homes serving ID/DD, mental illness, and substance use populations
- Medicare.gov, Long-Term Care Coverage: Medicare does not cover long-term custodial care, including assisted living room and board
- Medicaid.gov, Home & Community Based Services: Medicaid HCBS waivers can cover personal care services delivered inside assisted living settings