Last updated 2026-07-25
TL;DR
Residential assisted living in Virginia means an Assisted Living Facility licensed by the Virginia Department of Social Services under 22VAC40-73. Operators need a license application, background checks, a fire inspection, health department approval, and a staffing plan before opening. It's separate from a nursing home license and from adult foster care, which Virginia handles through Adult Care Residences and separate DBHDS rules for behavioral health group homes.
What is assisted living in Virginia?
In Virginia, "assisted living" is a licensed category of care, more than a marketing phrase. The state calls the licensed entity an Assisted Living Facility (ALF), defined under Virginia law as any congregate residential setting that provides room, board, and personal or health care to four or more adults who need those services because of physical or mental impairment [1]. Virginia's rules come from the Board of Social Services regulations at 22VAC40-73, and the Virginia Department of Social Services (VDSS) Division of Licensing Programs administers them [2]. That four-person threshold matters a lot for small operators. If you're caring for three or fewer unrelated adults in your home, you may fall outside the ALF licensing requirement entirely, though local zoning and other state rules can still apply. Cross that line to four or more, and you're in licensed territory with all the paperwork, inspections, and staffing rules that come with it. Virginia licenses two tiers of assisted living care within the ALF category: Assisted Living Care and Residential Living Care. Residential Living Care is for residents who are capable of directing their own care with minimal staff assistance. Assisted Living Care is for residents who need at least moderate assistance with activities of daily living, including some who may need staff to respond to unpredictable or emergency situations [2]. A facility's license specifies which level or levels it's approved to serve, and that designation drives staffing ratios and admission criteria.
What is a group home?
"Group home" is a general term, and in Virginia it usually means something different from an assisted living facility. Group homes most often refer to licensed residential settings for people with intellectual or developmental disabilities (IDD) or mental illness, and those are licensed separately from ALFs. In Virginia, group homes for people with IDD or serious mental illness fall under the Department of Behavioral Health and Developmental Services (DBHDS), which licenses providers under 12VAC35-105 for behavioral health and developmental services [3]. If your population is primarily seniors needing help with daily living and health monitoring, you're likely looking at a VDSS-licensed ALF. If your population is adults with IDD or a behavioral health diagnosis needing residential support and habilitation, you're likely looking at a DBHDS-licensed group home instead. This distinction changes everything on your application: which agency you file with, what your staffing plan needs to show, what training your direct care staff need, and how Medicaid pays for the service (through a home and community-based services waiver rather than a personal care or auxiliary grant program, in many cases). Get the population definition right before you build anything else, because picking the wrong license category wastes months.
What is an assisted living facility, exactly?
An assisted living facility in Virginia is a licensed congregate setting providing room, board, and either or both assisted living care and residential living care to four or more adults unrelated to the provider, where those adults need the services due to physical or mental impairment [1]. It is not a hospital, not a nursing home, and not simply a rental property with a caregiver on call. The legal definition sits in the Code of Virginia at § 63.2-100, which VDSS regulations then flesh out operationally [1][2]. To operate one, you need a license from VDSS before you admit your first resident, not after. Operating an unlicensed ALF is a violation of state law and can trigger civil penalties and forced closure. Facilities range enormously in size, from small homes serving four to eight residents up to large campuses with 100-plus beds. Regardless of size, the same regulatory chapter, 22VAC40-73, applies, though some requirements scale with resident count (for example, staffing ratios and physical plant requirements differ for larger facilities under certain sections).
What is assisted living vs a nursing home?
Assisted living and nursing homes serve different acuity levels and answer to different regulators, and mixing them up is one of the most common mistakes new operators make. Assisted living facilities in Virginia are licensed by VDSS under 22VAC40-73 and are meant for residents who need help with daily activities and some health monitoring, but not the ongoing skilled nursing care a hospital-level condition requires [2]. Nursing homes, called "nursing facilities" in federal law, are licensed in Virginia by the Virginia Department of Health, not VDSS, and they operate under an entirely different set of state and federal rules, including the federal nursing home requirements at 42 CFR Part 483 [4]. Nursing facilities must have licensed nursing staff on duty around the clock and are built to handle residents with significant medical needs, including those who are bedbound or need frequent skilled interventions. Here's the practical dividing line: if a resident's needs exceed what your ALF license and staffing allow, Virginia's regulations require discharge or transfer planning, because keeping someone whose needs outstrip your license puts your license at risk during inspection. 22VAC40-73 spells out specific criteria for who an ALF may NOT retain, including certain conditions requiring continuous skilled nursing care [2]. Know those discharge criteria cold before you take your first resident, not after your first difficult case.
What does assisted living provide?
Assisted living in Virginia provides a defined bundle: a private or shared room, meals, help with activities of daily living (bathing, dressing, toileting, mobility, eating), medication management or administration, and some level of health monitoring, all inside a licensed 22VAC40-73 facility [2]. Beyond the basics, most ALFs offer housekeeping, laundry, transportation to appointments, and social or recreational programming. Higher-tier Assisted Living Care residents may also receive help with more complex needs, including staff response to unpredictable situations, though the regulation is specific that this still isn't the same as skilled nursing care [2]. What assisted living does NOT provide, by regulatory design, is ongoing skilled nursing, ventilator care, or continuous licensed-nurse supervision. If a resident's condition requires that level of care, Virginia's discharge criteria under 22VAC40-73 generally require the facility to transfer that resident to a higher level of care [2]. This is worth explaining clearly to families during intake, because it prevents painful conversations later when a resident's needs change and the facility can no longer legally keep them.
How to start a group home or assisted living facility in Virginia
Starting a licensed residential care operation in Virginia follows a rough sequence, though your specific agency and timeline will vary by population served and locality. Here's the general path for a VDSS-licensed ALF: 1. Confirm your population and license type. Decide whether you're serving seniors and adults needing personal care (VDSS/ALF) or adults with IDD/behavioral health needs (DBHDS group home). This determines your regulator and your regulation chapter. 2. Check local zoning first. Before you sign a lease or buy property, confirm with your local zoning or planning department that the property is zoned for a residential care use and how many residents the property can hold under your locality's code. Many Virginia localities treat small group homes as a permitted residential use under the Fair Housing Act framework, but confirm with your local zoning office because rules vary by jurisdiction. See our guide on assisted living at home for how home-based models intersect with zoning. 3. Complete pre-application steps with VDSS. VDSS requires prospective ALF operators to attend an orientation or pre-application conference before submitting a full application, and the license application itself requires detailed information on ownership, the administrator, floor plans, and policies [2]. 4. Pass the fire and health inspections. Your local fire marshal and health department must inspect and approve the physical plant before VDSS issues a license. Building and life-safety code compliance (often tied to the Virginia Uniform Statewide Building Code) is checked at this stage. 5. Submit background checks. Virginia requires criminal history record checks and a search of the Department of Social Services Child Protective Services Central Registry and the state's adult abuse/neglect registries for the administrator, staff, and certain household members, per 22VAC40-73 [2]. 6. Write your policy and procedure manual. VDSS reviews written policies covering admission and discharge criteria, medication management, emergency preparedness, resident rights, staff training, and abuse reporting before licensing. 7. Build your staffing plan. Staffing ratios in Virginia depend on resident count and care level (Residential Living vs. Assisted Living Care), and the regulation sets minimum direct care staff-to-resident ratios that must be on duty at all times [2]. 8. Submit the license application and fee. VDSS charges an application fee that varies with facility capacity; confirm the current fee schedule with the Division of Licensing Programs, since fees are set administratively and change periodically. 9. Pass the licensing inspection. A VDSS licensing inspector conducts an on-site survey before initial licensure and periodically after that (Virginia requires unannounced inspections, generally including at least one annual inspection) [2]. 10. Get your license, then plan for renewal and ongoing inspections. Initial licenses in Virginia are typically issued for a defined period, and renewal requires a similar (if lighter) review. This whole process commonly takes several months from initial application to opening day, and it can stretch longer if the physical plant needs renovation to meet fire and building code. Budget time, more than money, for this. For a full walk-through of a state licensing application built for a specific state, our assisted living facility guide breaks down the paperwork stage by stage.
What's the difference between assisted living and nursing home licensing in Virginia?
| Licensing agency | Virginia Dept. of Social Services | Virginia Department of Health | |
|---|---|---|---|
| Governing regulation | 22VAC40-73 | 42 CFR Part 483 + state licensure rules | |
| Nursing staff required 24/7 | No (medication aides/staff, not necessarily RNs around the clock) | Yes, licensed nursing coverage required continuously | |
| Typical resident acuity | ADL help, medication management, some health monitoring | Skilled nursing, rehab, complex medical needs | |
| Minimum resident count to require license | 4 or more unrelated adults | Any licensed bed count | Operators sometimes assume a nursing home license lets them "scale down" into assisted living services, or vice versa. It doesn't. The two license types have separate applications, separate inspection standards, and separate staff credentialing requirements. If you want to serve both acuity levels eventually, most Virginia operators start with one license type, stabilize operations, and pursue the second license as a distinct project later, sometimes even in a physically separate building or wing. |
The core difference is the regulator, the acuity level allowed, and the staffing model. Assisted living facilities answer to VDSS under 22VAC40-73. Nursing homes answer to the Virginia Department of Health and to federal Medicare/Medicaid nursing facility rules under 42 CFR Part 483 [2][4]. | Feature | Assisted Living Facility (VDSS) | Nursing Home (VDH) |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board or personal care costs of assisted living, in Virginia or any other state. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care)" when that's the only type of care needed, and assisted living room and board falls into that non-covered custodial category [5]. Medicare Part A may cover short-term skilled nursing facility stays after a qualifying hospital stay, and Medicare Part B may cover doctor visits, some therapies, or durable medical equipment for a resident who happens to live in an ALF, but none of that pays for the facility's daily rate, room, or board [5]. Medicaid is a different story, and this is where most funding conversations in Virginia actually land. Virginia Medicaid can help cover some assisted living costs for eligible low-income residents through the state's Auxiliary Grant program combined with Medicaid state plan personal care services, and separately through home and community-based services waivers for people who qualify by disability or age criteria [6]. Medicaid.gov confirms that home and community-based services waivers let states cover services "in home and community-based settings" as an alternative to institutional care [6]. Eligibility, income limits, and available waiver slots vary and change, so anyone building a funding plan around Medicaid should confirm current criteria directly with the Virginia Department of Medical Assistance Services rather than relying on secondhand numbers.
How do I start a group home for people with IDD or behavioral health needs in Virginia?
The path looks similar in shape to ALF licensing but runs through a different agency and regulation. DBHDS licenses group homes and other residential services for people with developmental disabilities or mental illness under 12VAC35-105 [3]. Key differences from the ALF path: DBHDS licensing ties closely to Medicaid waiver enrollment, since most residents in these homes are funded through Virginia's IDD waivers (Community Living, Family and Individual Support, and Building Independence waivers, administered under the state's Medicaid HCBS authority) [3][6]. That means your application often needs to show more than a physical plant and staffing plan, and a provider enrollment agreement with the Department of Medical Assistance Services to bill Medicaid waiver services. Staff qualifications differ too. Direct support professionals in DBHDS-licensed homes need specific training curricula (often including Human Rights training, and depending on role, medication administration training approved by the Board of Nursing). Background check requirements mirror the ALF process (criminal history, central registry, sex offender registry checks) but are codified separately under 12VAC35-105. If you're unsure which category your target population falls into, that's the single most important question to resolve before you spend money on real estate or renovations. Our guide on assisted living facilities covers how other states draw this same line, which can help you see the pattern even though Virginia's specific agency names differ.
What does zoning mean for a Virginia group home or ALF?
Zoning is where a lot of otherwise well-prepared operators get stuck, because it's handled locally, not by the state. Virginia has no single statewide zoning override that guarantees a group home or ALF can locate anywhere; each city or county sets its own zoning ordinance, and those ordinances vary widely in how they treat residential care uses. For small group homes serving people with disabilities, the federal Fair Housing Act and Virginia's own fair housing law generally require localities to treat a home for a small number of unrelated people with disabilities the same as any other residential use of similar size, meaning a locality generally cannot single out a group home for special zoning restrictions solely because of the residents' disabilities. That said, larger ALFs (particularly those with 20, 50, or 100-plus beds) often fall under commercial or institutional zoning categories requiring conditional use permits, parking studies, and sometimes public hearings. Before you commit to a property, call your local zoning administrator and ask directly: is this parcel zoned for an assisted living facility or group home at my planned capacity, and what permit process applies? Get the answer in writing if you can. This single phone call, done early, avoids the worst-case scenario: a fully licensed facility that can't open because the property was never zoned correctly.
What inspections happen before and after a Virginia ALF opens?
Three separate inspections typically have to clear before VDSS issues an initial license: a fire safety inspection (usually from the local fire marshal or the state Office of the State Fire Marshal, depending on jurisdiction), a health department inspection (covering food service, water supply, and sanitation), and the VDSS licensing survey itself covering the physical plant and paperwork required under 22VAC40-73 [2]. After licensing, Virginia requires ongoing inspections. VDSS conducts announced and unannounced monitoring visits, and the regulation requires at minimum an annual renewal inspection, with additional visits triggered by complaints [2]. Inspectors review resident records, medication administration records, staff training files, incident reports, and the physical condition of the building during each visit. Common citation areas in ALF inspections nationally, and in Virginia specifically, tend to cluster around medication management errors, incomplete staff training documentation, and inadequate individualized service plans. Building your policy manual and staff training calendar around these known trouble spots before your first inspection, rather than after a deficiency citation, saves real time and stress.
How much does it cost to license residential assisted living in Virginia?
Costs break into three buckets: state licensing fees, physical plant costs, and operational start-up costs, and only the first one is set by a government fee schedule. VDSS charges an application fee tied to facility capacity, and this fee schedule is published and updated periodically by the Division of Licensing Programs; confirm the current fee amount directly with VDSS before budgeting, since fee schedules are set administratively and can change [2]. Local fire and health inspection fees are set by the locality and also vary. Physical plant costs are the biggest wildcard. A home that already meets the Uniform Statewide Building Code requirements for an ALF (fire sprinklers where required, exit routes, ADA-accessible bathrooms) costs far less to bring online than a property needing structural renovation. Get a fire marshal walkthrough before you buy or lease anything; it's the cheapest insurance policy against a surprise six-figure renovation bill. Building your own policy manual, staffing plan, and application package from scratch typically means either hiring a consultant, hiring an attorney familiar with 22VAC40-73, or using a structured template product. GroupHomePath's $299 one-time State Group Home Licensing Kit gives Virginia-focused operators a starting framework for the policy manual and application checklist, which is worth comparing against attorney hourly rates before you decide how much of this to build yourself. You can start building your state-specific packet at /licensing-kit-builder.
What should the staffing plan cover for a Virginia ALF?
Your staffing plan needs to show, in writing, exactly how many direct care staff will be on duty during each shift relative to your resident count and their assessed care level, because 22VAC40-73 ties minimum staffing to both facility census and the mix of Residential Living versus Assisted Living Care residents [2]. At minimum, plan for an administrator (who must meet Virginia's specific administrator qualification and training requirements), direct care staff sufficient to meet the regulation's ratio requirements around the clock, and a medication aide or licensed nurse if residents need medication administration beyond self-administration. Virginia also requires ongoing staff training hours annually, covering topics like resident rights, infection control, emergency preparedness, and abuse/neglect reporting. Build in coverage for call-outs and turnover from day one. Inspectors check staffing logs against resident census on the day of the visit, and a facility caught understaffed relative to its licensed ratio is one of the more serious citation categories because it goes directly to resident safety.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care model providing housing, meals, and help with daily activities (bathing, dressing, medication) to adults who need support but not full-time skilled nursing. In Virginia, it's licensed as an Assisted Living Facility by VDSS under 22VAC40-73, distinct from nursing homes and from DBHDS-licensed group homes.
What is a group home?
A group home is a licensed residential setting, usually for people with intellectual/developmental disabilities or mental illness, that provides housing and support services. In Virginia, these are typically licensed by DBHDS under 12VAC35-105, separately from assisted living facilities, which VDSS licenses for seniors and adults needing personal care.
What is an assisted living facility?
An assisted living facility (ALF) is a licensed congregate setting providing room, board, and assisted living or residential living care to four or more unrelated adults who need it due to physical or mental impairment. Virginia defines this at Code of Virginia § 63.2-100 and regulates it under 22VAC40-73 through VDSS.
What is the difference between assisted living and a nursing home?
Assisted living (licensed by VDSS in Virginia) serves residents needing help with daily activities and some health monitoring. Nursing homes (licensed by the Virginia Department of Health under federal rules at 42 CFR Part 483) provide 24/7 skilled nursing care for higher-acuity residents. Different regulators, different staffing requirements, different resident needs.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the room, board, or custodial care costs of assisted living. Medicare.gov states Medicare doesn't cover long-term custodial care. Medicare may cover short-term skilled nursing after a hospital stay or medical services a resident receives while living in an ALF, but not the facility's daily rate.
How do I start a group home in Virginia?
Confirm which population you'll serve (seniors/personal care vs. IDD/behavioral health), since that determines whether VDSS or DBHDS licenses you. Then check local zoning, complete pre-application steps, pass fire and health inspections, submit background checks and a policy manual, build a compliant staffing plan, and pass the licensing survey before admitting residents.
How much does it cost to start an assisted living facility in Virginia?
Costs include a VDSS application fee tied to capacity (confirm current amounts with VDSS), local fire and health inspection fees, and physical plant costs that vary enormously depending on whether the property already meets building and fire code for the population size you plan to serve. Renovation costs are usually the largest variable.
What does assisted living provide that a nursing home doesn't, and vice versa?
Assisted living provides help with daily activities, meals, medication management, and some health monitoring in a home-like setting, but not 24/7 skilled nursing. Nursing homes provide continuous licensed nursing care, rehabilitation, and management of complex medical conditions that exceed what an ALF's staffing and license allow.
Can I run a small group home in Virginia without a state license?
Virginia's ALF licensing requirement applies to settings serving four or more unrelated adults needing care due to impairment. Homes serving three or fewer may fall outside that specific threshold, but local zoning rules and other state requirements can still apply, so confirm your exact situation with VDSS and your local zoning office before assuming you're exempt.
Who inspects assisted living facilities in Virginia?
VDSS conducts the licensing survey and ongoing monitoring inspections, including at least an annual renewal inspection plus complaint-driven visits. Local fire marshals and health departments conduct separate fire safety and sanitation inspections before initial licensing and periodically after that.
Does Virginia Medicaid pay for assisted living?
Virginia Medicaid can help cover some assisted living costs for eligible low-income residents through the Auxiliary Grant program paired with Medicaid personal care services, and through home and community-based services waivers for qualifying individuals. Eligibility and available waiver slots vary, so confirm current rules with the Virginia Department of Medical Assistance Services.
What's the difference between Residential Living Care and Assisted Living Care in Virginia?
Residential Living Care under 22VAC40-73 is for residents capable of directing their own care with minimal staff help. Assisted Living Care is for residents needing at least moderate assistance with daily activities, including some who need staff able to respond to unpredictable situations. A facility's license specifies which level(s) it's approved for.
How long does it take to get an assisted living license in Virginia?
There's no fixed statewide timeline, but the process, from initial pre-application conference through background checks, fire and health inspections, and the final VDSS licensing survey, commonly takes several months. Renovation needs to meet fire and building code can extend that timeline significantly.
Sources
- Code of Virginia, § 63.2-100: Legal definition of an assisted living facility in Virginia
- Virginia Administrative Code, 22VAC40-73 (Standards for Licensed Assisted Living Facilities): Licensing standards, staffing ratios, inspections, discharge criteria, and background check requirements for Virginia ALFs
- Virginia Administrative Code, 12VAC35-105 (DBHDS licensing regulations): Licensing requirements for group homes serving people with developmental disabilities or mental illness in Virginia
- Code of Federal Regulations, 42 CFR Part 483: Federal requirements for nursing facilities, distinct from assisted living regulation
- Medicare.gov, Long-Term Care: Medicare does not cover long-term custodial care, including assisted living room and board
- Medicaid.gov, Home & Community Based Services: Medicaid HCBS waivers allow states to cover services in home and community-based settings as an alternative to institutional care