Last updated 2026-07-24
TL;DR
In Virginia, an assisted living community (formally called an assisted living facility, or ALF) is licensed by the Virginia Department of Social Services under 22VAC40-73. It provides room, board, supervision, and help with daily activities for adults who need support but not hospital-level nursing care. Medicare does not pay for the room and board.
What is an assisted living community in Virginia?
An assisted living community in Virginia is a licensed residential setting that provides housing, meals, supervision, and help with daily activities like bathing, dressing, and medication management to adults who can't fully live alone but don't need hospital-level nursing care. The state's legal term is "assisted living facility" or ALF, and that's the name you'll see on the actual license and in regulation text, even though most marketing brochures say "assisted living community" or "senior living community." They mean the same thing. Virginia regulates ALFs through the Department of Social Services (VDSS), Division of Licensing Programs, under regulation 22VAC40-73, "Standards for Licensed Assisted Living Facilities" [1]. The regulation defines an ALF as a facility that provides "maintenance or care for adults" who require assistance with activities of daily living, protection due to physical or mental impairment, or health support services, but who do not need continuous nursing care [1]. That definition matters because it draws a legal line between an ALF and a nursing facility. Nursing facilities in Virginia are licensed separately by the Virginia Department of Health, not VDSS. If a resident's needs cross into needing round-the-clock skilled nursing, the ALF is required to work with the family and physician on discharge or transfer, since ALFs aren't equipped or licensed to deliver that level of medical care [1]. Most Virginia ALFs also assign residents to one of two levels of assessed care under the Uniform Assessment Instrument (UAI): assisted living care or the higher-need "residential living care" designation is actually reversed in practice, residential living is the lower tier and assisted living care is the higher tier requiring more staff support. Facilities have to complete a UAI on every resident before admission and reassess periodically, and that assessment drives the care plan and staffing ratio [1].
What is assisted living, in plain terms?
Assisted living is a category of long-term care that sits between fully independent living and a nursing home. It combines a private or semi-private living space with help on daily tasks: bathing, dressing, toileting, medication reminders, meals, housekeeping, and social activities. It is not a hospital and not a medical treatment center. Nationally, the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies classify assisted living as a form of "home and community-based services" (HCBS) when Medicaid dollars are involved, distinct from institutional nursing facility care [2]. That distinction is why funding rules differ so much between assisted living and nursing homes, which we'll get into below. Every state licenses and defines assisted living a little differently. Virginia's version, the ALF under 22VAC40-73, has specific staffing, training, and physical plant rules that a facility in Maryland or North Carolina won't have in the same form. If you're comparing options across state lines, read our state licensing guides to see how the rules diverge.
What is a group home, and how is it different from assisted living?
A group home is a smaller residential setting, usually a single-family style house, that provides care and supervision for a small number of residents, often people with intellectual or developmental disabilities (IDD), mental illness, or substance use recovery needs, though some states also use the term loosely for small adult foster care homes. In Virginia, group homes serving people with developmental disabilities are typically licensed through the Department of Behavioral Health and Developmental Services (DBHDS) rather than VDSS, and they often operate under a Medicaid waiver (the Community Living or Family and Individual Supports waivers) rather than as a private-pay ALF. Adult foster care in Virginia, which is a smaller, more informal model of one to a handful of residents in a family home, is a separate licensing category from both ALFs and DBHDS group homes. The practical difference an operator feels day to day: group homes are usually smaller (often 4-8 beds), more likely to serve a single population (IDD, mental health, or recovery), and more likely to be funded through Medicaid waiver dollars. Assisted living communities are usually larger (from a handful of beds up to 100+ in some Virginia ALFs), serve primarily older adults, and are more often private-pay or funded through Auxiliary Grant or long-term care insurance. If you're deciding which model fits your goals, our assisted living facility guide and assisted living facilities comparison break down bed counts and staffing by model.
What is an assisted living facility (the legal definition)?
An assisted living facility is the formal, regulatory term for what most people call assisted living. It's the term you'll see on the actual state license, the regulation citation, and any legal document. Virginia's regulation defines an ALF as "any public or private facility, or portion thereof, that maintains or operates residential living units and provides personal care services" for four or more aged, infirm, or disabled adults who are not related to the operator [1]. That "four or more" threshold is important: a smaller private arrangement with fewer than four unrelated residents may fall outside ALF licensing entirely and into a different category, so if you're planning a smaller home, confirm the exact resident count threshold and any exemptions with the Virginia Department of Social Services before you assume you're exempt. The regulation also separates facilities by the number of beds and the level of care offered, which affects staffing ratios, physical plant requirements (like sprinkler systems), and required administrator qualifications. A 12-bed ALF and a 90-bed ALF are both licensed under the same regulation, but the staffing math and life-safety code requirements scale up substantially with size [1].
What is assisted living facility care actually like day to day?
Assisted living facility care combines housing, meals, and personal care support in one setting, with staff on-site to help with daily tasks and respond to emergencies, but without the round-the-clock skilled nursing staff you'd find in a hospital or nursing home. Under 22VAC40-73, Virginia ALFs must provide (at minimum): three meals a day plus snacks, housekeeping and laundry, help with activities of daily living based on the resident's assessed need, medication management or administration (depending on staff licensure), some level of social and recreational activity programming, and 24-hour awake staff supervision appropriate to the resident population [1]. Staffing requirements scale with resident count and assessed acuity. Facilities must have a licensed administrator, and direct care staff must complete state-required training (Virginia requires specific pre-service and ongoing training hours for direct care staff under the regulation) before working unsupervised with residents [1]. If a resident needs skilled nursing tasks like wound care or IV medication, Virginia law generally requires those tasks be performed by, or under close supervision of, a licensed nurse, and an ALF that can't meet that need is required to help the resident and family arrange a transfer.
What is assisted living vs nursing home? How are they different?
| Virginia licensing agency | Virginia Department of Social Services [1] | Virginia Department of Health | |
|---|---|---|---|
| Level of medical care | Personal care, medication management, no continuous skilled nursing [1] | 24/7 skilled nursing, rehab, complex medical care | |
| Typical staffing | Direct care aides, awake staff, licensed administrator [1] | Licensed nurses (RN/LPN) on every shift, certified nursing assistants | |
| Medicare coverage | Not covered for room/board [2][3] | Short-term rehab stays can be covered under specific conditions [3] | |
| Medicaid coverage | Possible via HCBS waiver or Auxiliary Grant, varies by state [2] | Covered as an institutional benefit in every state Medicaid program | |
| Typical setting | Apartment-style rooms, communal dining, home-like | Hospital-like wings, medical equipment visible | The biggest practical difference for families: nursing homes are built and staffed for medical recovery and chronic illness management, while assisted living is built for daily living support with a lighter medical footprint. Choosing wrong in either direction (placing someone with heavy medical needs in an ALF, or placing someone who's mostly independent in a nursing home) usually shows up fast in cost and in quality of life. |
Assisted living is for people who need daily help and supervision but can still direct much of their own care. A nursing home (formally a "nursing facility" or "skilled nursing facility") is for people who need continuous, hands-on medical and nursing care, often after a hospital stay or due to advanced chronic illness. | Feature | Assisted Living (ALF) | Nursing Home (SNF) |
What does assisted living provide, specifically?
Assisted living provides a bundled package of housing, meals, personal care assistance, medication support, housekeeping, transportation coordination, and social activity programming, with the specific mix defined by state regulation and by the individual resident's care plan. In Virginia, the required minimum package under 22VAC40-73 includes: a private or shared living unit, three meals daily plus snacks accommodating special diets, housekeeping and personal laundry, assistance with activities of daily living (bathing, dressing, toileting, transferring, eating) based on the resident's UAI assessment, medication management or administration, and an activities program appropriate to the resident population [1]. Facilities licensed for a higher level of care (assisted living care versus residential living care) are required to have additional staff coverage and often additional nursing oversight. What assisted living does not typically provide: continuous skilled nursing, hospital-level medical monitoring, ventilator or complex wound care (in most facilities), or secure memory care unless the facility holds a specific dementia-care or "safe, secure environment" designation under Virginia regulation, which comes with its own additional staffing and training rules [1].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room and board costs of assisted living, and it generally does not pay for the custodial personal care that assisted living provides. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care)" for daily activities like bathing and dressing when that's the only kind of care needed [3]. What Medicare will cover, even for someone living in an ALF, is medically necessary services delivered there or elsewhere: doctor visits, some home health services if the person qualifies, durable medical equipment, and short-term skilled nursing or rehab in a certified skilled nursing facility after a qualifying hospital stay, under Medicare Part A rules [3]. None of that pays the facility's monthly rent or personal care fee. Medicaid is a different story, but it's complicated and varies enormously by state. CMS guidance on HCBS notes that waivers can help cover certain services within assisted living-type settings (personal care, case management) in states that elect to cover them, though Medicaid generally cannot pay for the room and board portion of assisted living, only the service component [2]. Virginia's own long-term care Medicaid options, including the Auxiliary Grant program administered through the Department of Social Services, can help eligible low-income residents pay for ALF costs, but eligibility rules, payment rates, and covered facility lists change, so confirm current terms with the Virginia Department of Social Services or your local Department of Social Services office before assuming coverage.
What is the difference between assisted living and nursing home, in cost terms?
Cost is one of the clearest ways to see the difference. Genworth's Cost of Care Survey, an industry benchmark that tracked median costs across care settings nationally and by state through 2021 (Genworth discontinued the annual survey after that year), showed assisted living generally running lower per month than a nursing home semi-private room, and the gap held for years, though exact figures shift by year and region. The archived 2021 results are still viewable through the Wayback Machine's capture of Genworth's cost of care pages [4], and CMS and AARP both publish more recent long-term care cost commentary worth cross-checking against any older Genworth figures. The reason for the cost gap isn't mysterious: nursing homes carry the cost of 24-hour licensed nursing staff, more intensive regulatory compliance, and often shorter average stays tied to insurance and Medicare rehab stays, while assisted living communities staff more lightly and operate more like a residential apartment complex. That said, add-on fees for a higher level of care, secure memory care, or a second-person occupancy in assisted living can close the cost gap quickly, so a facility's base rate rarely tells the whole story.
How to start a group home (or assisted living community) in Virginia
Starting a group home or assisted living community in Virginia means choosing the right regulatory lane first, since the licensing agency, application, and rules differ depending on the population you plan to serve. First, decide your population and funding model. Serving primarily older adults who need personal care support, largely private-pay or via Auxiliary Grant, means you're likely headed toward an ALF license through VDSS under 22VAC40-73 [1]. Serving adults with intellectual or developmental disabilities through a Medicaid waiver means you're likely headed toward DBHDS licensing instead. Confirm which agency has jurisdiction over your specific population and funding source before you draft a business plan, because the buildout, staffing, and paperwork differ. Second, check zoning and building code early. Local zoning ordinances vary by county and city in Virginia, and a residential-zoned property doesn't automatically permit a licensed care facility above a certain resident count; some jurisdictions require a special use permit or treat larger ALFs as a commercial use. Confirm zoning requirements with your local planning or zoning office before signing a lease or purchase agreement. Third, work through VDSS's licensing steps: submit an application, pay the required fee (fee schedules change, so confirm current fee amounts with VDSS), complete a fire marshal and health department inspection, meet the physical plant standards in 22VAC40-73 (room size, sprinklers, exits), hire a licensed administrator, and write required policies covering admission and discharge criteria, medication management, emergency preparedness, resident rights, and staff training [1][5]. VDSS conducts an on-site inspection before issuing the initial license and conducts unannounced inspections at least annually after that [5]. Fourth, build your staffing and policy manuals before you apply, not after. Virginia's regulation requires specific written policies (infection control, emergency preparedness, resident agreements, staff training records) as part of the licensing packet, and reviewers will flag gaps. This is the stage where a lot of first-time applicants lose weeks to back-and-forth revisions. A structured packet built against the actual regulation checklist, like our $299 State Group Home Licensing Kit, can shortcut the drafting work, though it doesn't replace reading 22VAC40-73 yourself or getting your specific building and zoning questions answered by your local VDSS licensing specialist.
How do I start a group home if I'm serving a specialty population (IDD, mental health, recovery)?
Starting a group home for a specialty population in Virginia usually means licensing through DBHDS rather than VDSS, and the process centers on Medicaid waiver enrollment as much as it does on building standards. For IDD group homes, providers generally need to become an approved Medicaid waiver provider (Community Living or Family and Individual Supports waivers), meet DBHDS's provider licensing standards, and pass both a licensing survey and a Medicaid provider enrollment review. For mental health residential programs, the licensing category and required staffing (clinical vs. paraprofessional) depend on the acuity level the home is designed to serve. For recovery residences (substance use recovery homes), Virginia doesn't run these through the same clinical licensing structure in most cases; many operate as certified recovery residences through a state-recognized certifying body rather than a full facility license, though that landscape shifts, so confirm current certification requirements with Virginia's Department of Behavioral Health and Developmental Services before assuming which lane applies to your model. Whichever specialty population you choose, the paperwork burden is similar in kind to an ALF application: staffing plan, training documentation, emergency and medication policies, and a physical plant that passes fire and health inspection. The agency and specific standards differ, and mixing up DBHDS requirements with VDSS's 22VAC40-73 standards is one of the most common first-time-applicant mistakes.
What inspections and ongoing compliance should I expect after licensing?
After your Virginia assisted living facility opens, expect at least one unannounced inspection per year from VDSS, plus a renewal inspection tied to your license period, and additional inspections if a complaint is filed against the facility [5]. Virginia's regulation gives VDSS authority to inspect records, interview residents and staff, and review physical plant conditions during these visits [1][5]. Common citation areas in ALF inspections nationally and in Virginia tend to cluster around medication management errors, incomplete or late UAI reassessments, staff training documentation gaps, and physical plant issues like blocked exits or expired fire inspection certificates. Building a habit of internal self-audits between state visits, using the same checklist categories VDSS uses, catches most of these before an inspector does. If your facility is cited, Virginia's regulation process typically involves a plan of correction submitted to VDSS with a timeline for fixing the deficiency; repeated or serious violations can lead to license conditions, monetary penalties, or in serious cases, license revocation. None of that is something to guess your way through: read the actual citation letter language closely and respond within the timeframe VDSS specifies.
Frequently asked questions
What is assisted living?
Assisted living is a residential care option for adults who need help with daily activities like bathing, dressing, and medication management but don't need hospital-level nursing care. It combines housing, meals, and personal care support in one licensed setting. In Virginia, the formal legal term is "assisted living facility," licensed under regulation 22VAC40-73 [1].
What is a group home?
A group home is a smaller residential care setting, often a single-family style house, serving a small number of residents who typically share a specific need, like intellectual/developmental disabilities, mental illness, or substance use recovery. In Virginia, group homes for people with developmental disabilities are usually licensed through DBHDS and funded through Medicaid waivers, not through the ALF licensing track.
What is an assisted living facility?
An assisted living facility, or ALF, is the legal term for what's commonly called an assisted living community. Virginia defines it as a facility maintaining residential living units and providing personal care services to four or more unrelated aged, infirm, or disabled adults, licensed by the Virginia Department of Social Services under 22VAC40-73 [1].
What is assisted living facility care like?
It combines a private or shared living space with three daily meals, housekeeping, medication management, and help with bathing, dressing, and mobility based on an individual assessment (the Uniform Assessment Instrument in Virginia). Staff are on-site around the clock, but the facility isn't equipped for continuous skilled nursing care [1].
What is the difference between assisted living and a nursing home?
Assisted living serves people who need daily living support but can direct much of their own care; nursing homes serve people who need continuous, hands-on skilled nursing and medical care. In Virginia, the Department of Social Services licenses ALFs while the Department of Health licenses nursing facilities, and Medicare rules for coverage differ sharply between the two [1][3].
Does Medicare cover assisted living facilities?
No. Medicare does not pay for assisted living room and board or for custodial personal care. Medicare.gov states Medicare doesn't cover long-term custodial care [3]. Medicare may still pay for medically necessary services delivered to a resident, like doctor visits or short-term skilled rehab after a qualifying hospital stay, but not the facility's monthly fee.
Does Medicaid cover assisted living in Virginia?
Sometimes, partially. Medicaid generally does not pay for room and board in assisted living, but Home and Community-Based Services waivers can cover certain services, and Virginia's Auxiliary Grant program can help eligible low-income residents with ALF costs [2]. Eligibility and payment rates change, so confirm current terms with the Virginia Department of Social Services.
How much does assisted living cost compared to a nursing home?
Assisted living generally costs less per month than a nursing home semi-private room, largely because nursing homes staff around-the-clock licensed nursing care. Genworth's Cost of Care Survey tracked these figures by state and setting through 2021 before the survey was discontinued; treat that data as a historical benchmark and check current state or AARP long-term care cost data for up-to-date numbers [4].
How do I start a group home in Virginia?
Decide your population and funding model first (older adults on Auxiliary Grant or private pay usually means an ALF license through VDSS; IDD or mental health populations on Medicaid waivers usually mean DBHDS licensing). Then confirm zoning, complete required inspections, hire a licensed administrator, and submit your application with required policy manuals under 22VAC40-73 [1].
How do I start an assisted living business specifically?
Apply for an ALF license through the Virginia Department of Social Services, Division of Licensing Programs. You'll need to meet physical plant standards, pass fire marshal and health inspections, hire a licensed administrator, write required policies (medication management, emergency preparedness, resident rights), and pass VDSS's pre-licensing inspection under 22VAC40-73 [1][6].
What's the minimum number of residents for a facility to need an ALF license in Virginia?
Virginia's regulation defines an ALF as serving four or more unrelated aged, infirm, or disabled adults [1]. Smaller arrangements below that threshold may fall under a different category or exemption. Confirm the exact resident count rules and any exemptions with the Virginia Department of Social Services before assuming your smaller home is exempt.
How often does Virginia inspect assisted living facilities?
VDSS conducts an inspection before issuing an initial license and then conducts unannounced inspections at least annually, plus additional visits triggered by complaints [6]. Facilities cited for deficiencies typically submit a plan of correction with a timeline for fixing the issue.
Can an assisted living facility in Virginia provide memory care?
Some can, but only if they hold a specific dementia-care or "safe, secure environment" designation under Virginia's ALF regulation, which comes with additional staffing, training, and physical plant requirements beyond a standard ALF license [1]. Not every licensed ALF automatically qualifies to advertise or provide secure memory care.
Sources
- Virginia Department of Social Services, 22VAC40-73 Standards for Licensed Assisted Living Facilities: Definition of assisted living facility, resident count threshold, staffing, UAI assessment, and physical plant requirements
- Medicaid.gov, Home and Community Based Services 1915(c) waivers: Medicaid HCBS waivers can cover certain assisted living services but generally not room and board
- Medicare.gov, Long-Term Care: Medicare does not cover custodial long-term care such as assisted living room and board
- Genworth, 2021 Cost of Care Survey (archived), via Internet Archive Wayback Machine: Multi-year survey benchmarking assisted living and nursing home costs by state and setting, discontinued after 2021
- Code of Virginia, 63.2-1701, Licensure required of assisted living facilities: Statutory requirement that assisted living facilities obtain a license from the Virginia Department of Social Services
- Code of Virginia, 63.2-1706, Inspections and investigations: VDSS authority to inspect facilities, including unannounced annual inspections and complaint-based investigations