Last updated 2026-07-24
TL;DR
Virginia licenses assisted living facilities (ALFs) through the Department of Social Services under 22VAC40-73. ALFs provide housing, meals, supervision, and help with daily activities for adults who can't live alone but don't need a nursing home. Medicare doesn't cover the cost; Medicaid may help through the state's Assisted Living Facility waiver track and auxiliary grants for eligible low-income residents.
What is assisted living?
Assisted living is a housing and care model for adults, usually older adults, who need help with things like bathing, dressing, medication reminders, or meals but don't need round-the-clock skilled nursing care. Residents typically have a private or semi-private room or apartment, get meals in a common dining area, and have staff on site to help with daily activities and to respond to emergencies. It sits in the middle of a spectrum. On one end is independent living or aging in place at home, where a person needs little to no help. On the other end is a nursing home (called a "nursing facility" in Medicaid terms), where residents need daily skilled nursing or rehabilitation care. Assisted living is the in-between option: more support than a retirement community, less medical intensity than a nursing home. In Virginia specifically, the state doesn't use the generic industry term "assisted living" as a separate legal category. Instead, state law and licensing rules use the term "assisted living facility" (ALF), and that's the license type that covers what most people mean by assisted living. Virginia's ALFs are licensed and regulated by the Virginia Department of Social Services (VDSS), Division of Licensing Programs, under regulation 22VAC40-73 [1].
What is an assisted living facility (and what is "assisted living facility" legally)?
An assisted living facility, under Virginia law, is defined in the Code of Virginia as "any public or private profit or nonprofit facility that maintains or operates residences for the purpose of providing housing and either or both personal care or nursing supervision" for adults who need help with activities of daily living or who need supervision because of physical or mental impairment [2]. That statutory language matters because it draws the legal line. An ALF can offer two care levels under Virginia rules: "residential living care" for adults who are fairly independent but need some help and supervision, and "assisted living care" for adults who need more consistent help with activities of daily living, including some who may need limited nursing oversight [1]. A facility can be licensed for one or both levels, and residents can be reassessed and moved between levels as their needs change, as long as the facility is licensed for the higher level. Virginia regulation also spells out who an ALF cannot serve safely. Facilities can't retain residents who need continuous nursing care, who are bed-bound for more than 14 days without a physician's order, or who have unmanaged conditions that create a health or safety risk to themselves or others, per the uniform assessment instrument requirements in 22VAC40-73 [1]. That's a key reason families sometimes have to transition a loved one from assisted living to a nursing home later on.
What is a group home, and how is it different from an ALF?
A group home is a broader term. It generally means a residential setting, often a house in a regular neighborhood, where a small number of unrelated people live together with staff support. Group homes serve very different populations: people with intellectual or developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, or, in some states, seniors needing personal care. In Virginia, group homes serving people with mental illness, developmental disabilities, or substance use disorders are typically licensed as group homes or supervised living facilities by the Department of Behavioral Health and Developmental Services (DBHDS), not by DSS [3]. That's a completely different regulatory track, with its own staffing ratios, environmental rules, and human rights protections under Virginia's licensing regulations for behavioral health providers. An assisted living facility, by contrast, is licensed by VDSS and is specifically built around personal care and supervision for adults, most often older adults, who need help with daily living tasks rather than clinical behavioral health treatment. If you're trying to figure out which license you need, the honest answer depends on who you intend to serve: a senior needing help bathing and taking medication points you toward an ALF license through VDSS; an adult with a developmental disability needing residential habilitation points you toward DBHDS licensing. Confirm the correct agency and program category with your state licensing agency before you file anything, because filing under the wrong category wastes months. If you're researching licensing paths across different populations and states, the assisted living facility overview and assisted living facilities guides break down how this varies state to state.
What does assisted living provide, day to day?
Under Virginia's regulations, a licensed ALF has to provide (at minimum): a private or shared living space, three meals a day plus snacks, help with activities of daily living as needed (bathing, dressing, grooming, toileting, mobility), medication management or assistance, housekeeping and laundry, staff supervision around the clock, and some level of social or recreational activity programming [1]. Beyond the baseline, most Virginia ALFs also coordinate transportation to medical appointments, arrange for outside home health or hospice services when a resident's needs increase, and maintain an individualized service plan (ISP) for each resident that's updated at least annually or whenever care needs change significantly, as required under 22VAC40-73 [1]. The ISP is a big deal during inspections; surveyors check that the plan actually matches what staff are doing day to day, more than what's written on paper. What an ALF does not provide, by definition, is ongoing skilled nursing care, IV therapy, or complex wound care beyond what a licensed practical nurse can manage on a limited basis. Once a resident's medical needs cross that line, Virginia regulation requires either a physician's order allowing continued stay under specific conditions, or discharge planning toward a nursing facility [1].
What is assisted living vs. a nursing home?
| Licensing agency | Virginia Dept. of Social Services [1] | Virginia Dept. of Health, plus federal CMS certification | |
|---|---|---|---|
| Nursing staff | Not required 24/7; LPN/RN as needed for care level | RN required for at least 8 hours/day; licensed nurse coverage 24/7 under federal rules [4] | |
| Typical resident | Needs help with ADLs, stable medical condition | Needs daily skilled nursing or rehab, more complex medical needs | |
| Room type | Private or shared apartment/room | Semi-private or private room, more clinical setting | |
| Medicare coverage | No, Medicare doesn't cover room/board [5] | Medicare Part A covers up to 100 days of skilled nursing after a qualifying hospital stay, with cost-sharing after day 20 [5] | |
| Medicaid coverage | Limited, via Auxiliary Grant + waiver in Virginia | Yes, Medicaid covers long-term nursing facility stays for eligible low-income individuals [6] | Nursing homes are also federally regulated under the nursing home requirements in Section 1819 of the Social Security Act and CMS's Requirements of Participation for facilities that accept Medicare or Medicaid [4]. Assisted living facilities are regulated at the state level only; there's no federal assisted living license or certification. |
The difference comes down to medical intensity and staffing. Assisted living is personal care plus housing; a nursing home (nursing facility) is medical care plus housing, with licensed nurses on site 24 hours a day and a physician of record overseeing treatment. Here's a side-by-side comparison based on how Virginia and federal rules define each setting: | Feature | Assisted Living Facility (Virginia) | Nursing Home (Nursing Facility) |
How do I start a group home or assisted living facility in Virginia?
Starting an ALF in Virginia is a multi-step regulatory process, and skipping steps is the single most common reason applications stall. Here's the realistic sequence based on VDSS's licensing structure under 22VAC40-73 [1]: 1. Decide your care level(s). Will you offer residential living care, assisted living care, or both? This determines your staffing ratios and physical plant requirements. 2. Check zoning and building code first. Before you sign a lease or buy property, confirm with your local zoning office that a residential care facility is allowed at that address, and confirm with the Virginia State Fire Marshal's office and local building department what occupancy classification and fire safety upgrades will apply. ALFs generally fall under a specific occupancy classification in the Virginia Statewide Fire Prevention Code that triggers sprinkler and egress requirements different from a standard single-family home. 3. Submit your license application to VDSS. You'll need a completed application, disclosure of ownership, floor plans, a criminal background check and child/adult protective services registry check for all staff and the administrator, and proof of financial responsibility. 4. Hire and credential an administrator. Virginia requires ALF administrators to hold a valid license issued by the Virginia Board of Long-Term Care Administrators, which has its own education and exam requirements separate from the facility license itself. 5. Write your policies and procedures manual. VDSS reviews (and later inspects against) written policies covering admission/discharge criteria, medication management, emergency preparedness, staff training, and resident rights. 6. Pass the pre-licensure inspection. VDSS licensing staff will do an on-site inspection before issuing the initial license, checking life safety, staffing, and documentation. 7. Maintain ongoing compliance. Licensed ALFs get unannounced inspections, generally at least annually, plus complaint-driven inspections whenever VDSS receives a report. Because this checklist looks different in every state (different agency names, different fee schedules, different inspection cycles), building a state-specific packet is where most first-time operators lose weeks. That's exactly the gap our $299 one-time State Group Home Licensing Kit is built to close: state-specific checklists, policy templates, and staffing plan starters so you're not reverse-engineering a regulation PDF from scratch.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room and board or personal care services at an assisted living facility. Medicare.gov is explicit about this: Medicare covers skilled nursing facility care only under specific conditions after a qualifying hospital stay, and it does not cover long-term custodial care, the same logic that excludes assisted living room and board [5]. What Medicare will cover, even for someone living in an ALF, is medical services delivered there: doctor visits, physical therapy ordered by a physician, home health visits that meet Medicare's home health criteria, and hospice care if the resident qualifies. But the facility's monthly fee for housing, meals, and personal care assistance is out of pocket or covered by other sources. Those other sources, in Virginia, mainly break down into two paths: private pay (the most common), and Medicaid-funded support for financially eligible residents through Virginia's Auxiliary Grant program combined with Medicaid waiver services, which supplements room and board costs for low-income Virginians who qualify for both Supplemental Security Income-level income limits and an assessed need for the care [6]. This is not the same as full Medicaid nursing facility coverage; it's a state-specific supplement layered onto SSI-level benefits and requires separate financial and functional eligibility determinations through the local department of social services.
What's the difference between assisted living and nursing home costs and payment sources?
Cost and payer mix is where families get tripped up, because the terms sound similar but the money flows completely differently. Nursing facility care, once someone qualifies for Medicaid long-term care, is covered under the state Medicaid plan as a mandatory Medicaid benefit for eligible individuals under federal Medicaid law [6]. Assisted living has no equivalent mandatory Medicaid benefit nationally; states cover it, if at all, through optional Medicaid waivers or state-funded supplements. Virginia's approach uses the Auxiliary Grant (a state and locally funded cash supplement for room and board) paired with Medicaid-funded personal care services delivered in ALFs approved to serve Auxiliary Grant recipients. This is administered differently than a typical Medicaid waiver in other states, so if you're building a facility that intends to accept these residents, you'll need separate approval and a provider agreement, confirm the current process and requirements with the Virginia Department of Medical Assistance Services and your local department of social services. Medicare, again, plays no role in paying for the custodial side of either setting. Its only real footprint is the 100-day skilled nursing benefit after a qualifying 3-day inpatient hospital stay, and that benefit has significant cost-sharing: a daily coinsurance kicks in starting day 21 of that benefit period, and coverage ends entirely at day 100 [5].
How are Virginia assisted living facilities inspected?
VDSS inspects licensed ALFs on a recurring schedule, generally annually at minimum, plus additional unannounced visits triggered by complaints, incident reports, or renewal cycles, under the inspection authority in 22VAC40-73 [1]. Inspectors review resident records, individualized service plans, medication administration records, staff training files, background check documentation, life safety conditions, and the physical environment. Common citation areas, based on the structure of the regulation itself, tend to cluster around medication management documentation, staff training records (especially for direct care staff completing required orientation hours), and individualized service plans that haven't been updated to match a resident's changed condition. Facilities found out of compliance get a plan of correction requirement with a deadline; repeated or serious violations can lead to admission holds, civil penalties, or license revocation depending on severity. If you're building your compliance calendar, plan for the inspection to be unannounced. Don't build policies you don't actually follow day to day, because the gap between paper policy and practice is exactly what inspectors are trained to find.
How do I choose between running an assisted living facility and a different kind of group home?
This decision should come down to the population you actually want to serve and the license you're qualified to hold, not which one sounds easier. Assisted living licensing (VDSS) fits if your target residents are primarily older adults or adults needing personal care and supervision but not behavioral health treatment or IDD-specific habilitation services. If your interest is really in serving adults with intellectual or developmental disabilities, mental illness, or substance use disorders in a home-like residential setting, that's a DBHDS-licensed group home or supervised living arrangement, an entirely different application, staffing model, and training curriculum [3]. Trying to serve a population outside your license's scope is one of the fastest ways to draw a licensing violation. For operators comparing markets or population types before committing capital, it's worth reading through the broader assisted living and facility assisted living resources, along with senior assisted living facilities near me if you're scoping local demand, and assisted living at home if a smaller, home-based model fits your situation better than a larger licensed facility.
Frequently asked questions
What is assisted living?
Assisted living is housing plus personal care support for adults who need help with daily activities like bathing, dressing, or medication but don't need full-time skilled nursing care. In Virginia, this is licensed as an "assisted living facility" (ALF) by the Department of Social Services under 22VAC40-73.
What is a group home?
A group home is a residential setting where a small number of unrelated people live together with staff support, most often people with intellectual/developmental disabilities, mental illness, or substance use disorders. In Virginia these are usually licensed by DBHDS, a different agency than the one that licenses assisted living facilities.
What is an assisted living facility?
Under Virginia law, an assisted living facility is any public or private facility providing housing plus personal care or nursing supervision for adults who need help with daily activities or supervision due to physical or mental impairment, as defined in the Code of Virginia and regulated under 22VAC40-73.
What is the difference between assisted living and a nursing home?
Assisted living provides housing and personal care help without required 24/7 nursing staff. A nursing home provides that plus continuous licensed nursing care and is federally certified under CMS Requirements of Participation when it accepts Medicare or Medicaid patients. Nursing homes handle more medically complex residents.
Does Medicare cover assisted living facilities?
No. Medicare does not cover room, board, or custodial personal care at assisted living facilities. It only covers medically necessary services delivered there, like physician visits or qualifying home health and hospice care, per Medicare.gov coverage guidance.
Does Medicaid pay for assisted living in Virginia?
Not through a standard mandatory benefit. Virginia uses its Auxiliary Grant program, a state and local cash supplement for room and board, combined with Medicaid-funded personal care services, for financially and functionally eligible residents in approved ALFs. Confirm current eligibility rules with the Virginia Department of Medical Assistance Services.
How do I start a group home?
Identify the population you'll serve, confirm which state agency licenses that type of home, check local zoning and fire code requirements before signing a lease, hire a qualified administrator, write policies covering admission, medication, and emergencies, then apply for the license and pass the pre-licensure inspection.
How do I start an assisted living facility in Virginia specifically?
Decide your care level (residential or assisted living care), confirm zoning and fire code compliance, submit a license application to VDSS with floor plans and background checks, hire a licensed administrator through the Virginia Board of Long-Term Care Administrators, finalize your policy manual, and pass the pre-licensure inspection under 22VAC40-73.
What does assisted living provide that independent living doesn't?
Assisted living adds staff-provided help with activities of daily living (bathing, dressing, medication management), 24-hour supervision, and prepared meals, none of which independent living or retirement communities typically include as a built-in service.
Who licenses assisted living facilities in Virginia?
The Virginia Department of Social Services, Division of Licensing Programs, licenses assisted living facilities under regulation 22VAC40-73. This is separate from the Virginia Department of Health, which oversees nursing homes, and DBHDS, which licenses group homes for behavioral health and IDD populations.
Can an assisted living facility keep a resident who needs nursing home level care?
Generally no. Virginia regulation restricts ALFs from retaining residents who need continuous nursing care or who are bed-bound more than 14 days without a physician's order allowing it, per 22VAC40-73. Residents whose needs exceed the facility's licensed care level typically must transition to a nursing facility.
What's the difference between residential living care and assisted living care in Virginia?
Residential living care serves adults who are fairly independent but need some help and supervision. Assisted living care serves adults needing more consistent daily help, including limited nursing oversight in some cases. A facility must be specifically licensed for whichever level, or both, it provides under 22VAC40-73.
Sources
- Virginia Department of Social Services, 22VAC40-73 Standards for Licensed Assisted Living Facilities: Virginia's assisted living facility licensing standards, care levels, staffing, and inspection requirements
- Code of Virginia, § 63.2-100 Definitions: Statutory definition of assisted living facility in Virginia
- Virginia Department of Behavioral Health and Developmental Services, Licensing Regulations: Group homes serving IDD, mental health, and substance use populations are licensed by DBHDS, not DSS
- 42 CFR 483.30, Nursing services requirements for long term care facilities: Federal nursing facility staffing requirements including licensed nurse coverage
- Medicare.gov, Skilled Nursing Facility Care Coverage: Medicare Part A skilled nursing facility coverage limits, the 100-day benefit, and cost-sharing after day 20
- Medicaid.gov, Nursing Facilities: Medicaid coverage of nursing facility care for eligible low-income individuals