Last updated 2026-07-25
TL;DR
Virginia regulates assisted living facilities (ALFs) through the Department of Social Services under 22VAC40-73. Facilities are licensed as Assisted Living or Residential Living, staffed by direct care aides plus a licensed administrator, inspected at least annually, and can accept Medicaid payment only through the Commonwealth Coordinated Care Plus (CCC Plus) waiver, not standard Medicaid.
What is assisted living in Virginia?
Assisted living in Virginia means a licensed residential setting where adults get help with daily activities like bathing, dressing, medication, and meals, along with 24-hour supervision, but not the round-the-clock skilled nursing you'd find in a nursing home. Virginia calls the license category an "assisted living facility" (ALF), and it covers everything from small adult foster-style homes to large senior communities. The controlling regulation is 22VAC40-73, Standards for Licensed Assisted Living Facilities, administered by the Virginia Department of Social Services (VDSS) [1]. The code 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" [1]. That four-or-more threshold matters a lot. Smaller adult foster care arrangements, licensed separately, fall under different rules. If you're planning a small home with three or fewer residents, you likely don't need an ALF license at all, but you should confirm that with VDSS before you assume anything. Virginia also splits ALFs into two care levels: Residential Living Care and Assisted Living Care. Residential Living Care is for residents who are mostly independent but need some help and supervision. Assisted Living Care is for residents needing more physical or mental health assistance, including some who are non-ambulatory. Your license specifies which level(s) you're approved to provide, and it drives your staffing ratios and admission/retention rules [1].
What is a group home, and how is it different from an assisted living facility?
A group home, in the plain-English sense most people use, is a small residential setting where a handful of people with a shared need (intellectual/developmental disability, mental illness, substance recovery, or aging) live together with staff support. It's not a single legal category. In Virginia, whether a specific home needs an ALF license, a different DBHDS license, or no state license at all depends on who lives there and what services get delivered. Homes serving people with intellectual or developmental disabilities are usually licensed by the Department of Behavioral Health and Developmental Services (DBHDS), not VDSS, under a separate set of regulations. Homes serving adults needing personal care and supervision, four or more unrelated residents, generally fall under the ALF rules in 22VAC40-73 [1]. Recovery residences and sober living homes often operate outside formal state licensing entirely, though Virginia has a voluntary certification program through DBHDS-recognized certifying bodies. The practical lesson: don't assume "group home" and "assisted living facility" are interchangeable paperwork. Figure out your population first, then match it to the right licensing agency. If you're building out a facility for seniors or adults needing personal care, read our assisted living facility overview alongside this one, since the population served changes which regulator you're dealing with.
What is an assisted living facility, exactly, under Virginia law?
Under 22VAC40-73, an assisted living facility is a licensed congregate setting serving four or more aged, infirm, or disabled adults, providing personal care, health-related services, and supervision on a 24-hour basis [1]. The license is issued by VDSS, and it names a specific physical address, a specific licensee (the legal entity or person), and a maximum resident capacity. Every ALF must designate a licensed administrator responsible for day-to-day operations. Virginia requires administrators to hold a license from the Virginia Board of Long-Term Care Administrators, which means passing a national exam and completing required coursework, plus continuing education to renew. This is a separate individual credential from the facility's license, and VDSS will not approve an ALF without a qualified administrator named on the application. The facility license itself gets renewed periodically (check current renewal cycle and fee schedule directly with VDSS, since fee schedules change), and it's tied to inspection results, more than paperwork. A facility can lose its license, get placed on a provisional status, or face civil penalties if it falls out of compliance with the health, safety, staffing, or physical plant standards in 22VAC40-73 [1].
What does assisted living provide day to day?
Assisted living in Virginia is built around a written Individualized Service Plan (ISP) for every resident, developed within specific timeframes after admission and updated as needs change [1]. The ISP has to reflect the resident's actual assessed needs, using the Uniform Assessment Instrument (UAI), which Virginia requires before or at admission to determine what level of care a resident needs and whether the facility is even allowed to admit or retain them [1]. Services typically include help with activities of daily living (bathing, dressing, toileting, transferring, eating), medication management or administration, three meals a day plus snacks, housekeeping and laundry, social and recreational activities, and coordination of health care appointments. Facilities licensed for Assisted Living Care (as opposed to only Residential Living Care) can serve residents with greater physical dependency, including some non-ambulatory residents, under specific conditions spelled out in the regulation [1]. What assisted living does not provide, at least not as a baseline service, is ongoing skilled nursing care, ventilator management, or complex wound care requiring licensed nursing judgment around the clock. Facilities can arrange for licensed nursing services under certain conditions (through hospice, home health, or an on-site licensed nurse), but the core model is personal care and supervision, not medical treatment. Residents whose needs exceed what the ALF can safely provide have to be discharged or transferred, per the retention standards in 22VAC40-73 [1].
What is the difference between assisted living and a nursing home?
| Licensing agency | Virginia Department of Social Services | Virginia Department of Health | |
|---|---|---|---|
| Governing regulation | 22VAC40-73 [1] | Separate VDH nursing facility regulations | |
| 24-hour licensed nurse required | No, not as a blanket requirement | Yes | |
| Typical resident need level | Personal care, ADL help, supervision | Skilled nursing, post-acute recovery, complex medical needs | |
| Medicare coverage | Not covered for room and board | Covers short-term skilled stays under specific conditions | |
| Medicaid coverage | Only via CCC Plus waiver for services, not room/board | Medicaid covers nursing facility care under state plan | Families often move a loved one from assisted living to a nursing home when medical needs escalate beyond what personal care staff can safely manage, or the reverse, when a nursing home patient stabilizes and no longer needs skilled care. The Uniform Assessment Instrument is often the tool used to make that determination in Virginia [1]. |
The core difference is licensure, staffing, and medical intensity. Nursing homes in Virginia are licensed separately, under a different regulatory framework administered through the Virginia Department of Health, and they must have licensed nurses on duty 24 hours a day to handle skilled medical care, rehabilitation, and residents with complex clinical needs. Assisted living facilities, licensed by VDSS under 22VAC40-73, are not required to have a nurse on-site around the clock and are built for residents who need personal care and supervision, not hospital-level nursing [1]. Here's a side-by-side on the practical differences: | Feature | Assisted Living Facility (Virginia) | Nursing Home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board in assisted living facilities anywhere in the country, including Virginia. Medicare.gov states plainly that Medicare "doesn't cover assisted living, custodial care, adult day care" as a category of long-term custodial support [2]. Medicare will pay for specific medical services a resident receives while living in assisted living (doctor visits, some home health visits, durable medical equipment, short-term skilled nursing after a qualifying hospital stay, but at a nursing facility, not the ALF itself). What it won't pay for is the monthly cost of the room, meals, and personal care staff that make up the bulk of an assisted living bill. This catches a lot of families off guard, and it should shape how you talk to prospective residents' families if you're operating a facility. Set expectations early: private pay, long-term care insurance, and in some cases Medicaid waiver funds are the realistic payment sources, not Medicare.
Does Medicaid cover assisted living in Virginia?
Virginia Medicaid does not pay directly for room and board in assisted living facilities under the regular state plan. Coverage happens through the Commonwealth Coordinated Care Plus (CCC Plus) waiver, a home and community-based services (HCBS) waiver that can help cover personal care and support services for eligible members residing in an assisted living facility, while the resident (or another payer) still covers room and board separately [3]. CMS describes HCBS waivers generally as a mechanism letting states "furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization" [4]. Virginia's CCC Plus waiver is the specific vehicle for this in assisted living settings, and eligibility depends on both financial criteria and a functional need determination through the UAI process [3] [1]. If you're planning to accept Medicaid waiver residents, get your facility set up as a Medicaid provider separately from your ALF license. That's an enrollment process through the Department of Medical Assistance Services (DMAS), and it's distinct from your VDSS licensing application. Budget extra time for this step. It's common for new operators to assume their state license automatically makes them a Medicaid provider. It does not.
How to start a group home or assisted living facility in Virginia?
Starting an assisted living facility in Virginia runs through several parallel tracks: entity formation, zoning, licensing, staffing, and physical plant compliance. Here's the realistic sequence. First, decide your population and care level. Are you serving seniors needing personal care (ALF under VDSS), adults with intellectual/developmental disabilities (DBHDS license), or a different population? This decision determines which agency you deal with for the rest of the process. Second, check local zoning before you sign a lease or buy property. Virginia's ALF regulations don't override local zoning ordinances, and many jurisdictions have specific conditional-use or special-exception requirements for group care homes. Confirm zoning classification with your locality's planning department before committing capital. Third, submit your license application to VDSS along with required documentation: floor plans, fire marshal approval, health department approval on food service if applicable, criminal background checks and child/adult abuse registry checks for the administrator and staff, and your written policies covering admission, ISPs, medication management, emergency preparedness, and staffing [1]. Fee amounts and exact document checklists change periodically, so confirm current requirements and fees directly with VDSS rather than relying on older published lists. Fourth, hire and get your administrator licensed through the Virginia Board of Long-Term Care Administrators before you apply, since VDSS will not approve a facility without one named. Direct care staff also need training requirements met (including medication aide certification if staff will administer medications) under 22VAC40-73 [1]. Fifth, expect a pre-licensure inspection. VDSS staff will walk the physical plant, review your policy manuals, and verify staffing plans match your proposed capacity and care level before issuing the license. If you want a structured way to organize the paperwork side of this (policy manual templates, staffing plan worksheets, application checklists), our $299 State Group Home Licensing Kit is built around exactly this workflow, state by state. It won't get your application approved faster and it's not a substitute for your state's own checklist, but it saves you from building every document from scratch.
How do I start a group home if I'm serving a different population than seniors?
If your population is adults with intellectual or developmental disabilities, mental illness, or substance use recovery needs, Virginia routes you to a different agency (usually DBHDS) with its own licensing regulations, application forms, and staffing requirements, separate from 22VAC40-73. The overall shape of the process looks similar (entity setup, zoning check, facility approval, staff credentialing, inspection), but the specific regulation numbers, forms, and inspection standards differ. Don't try to force-fit a DBHDS-population home into an ALF license just because the paperwork looks familiar. Licensing staff will catch the mismatch, and it slows your application or gets it denied outright. Call the relevant agency early, describe your intended population and services in plain language, and ask which license category applies before you draft anything. If you're building multiple properties across different populations (say, one senior ALF and one IDD group home), keep the license applications, staffing plans, and policy manuals completely separate even if some administrative systems (payroll, background check vendor, EHR) are shared across the business.
What staffing is required in a Virginia assisted living facility?
Virginia sets minimum staffing based on resident census and care level, not a flat number for every facility. 22VAC40-73 requires facilities to maintain staff "sufficient in knowledge, skills, and abilities... to meet the day-to-day, direct resident care needs" and specifies awake staff requirements during nighttime hours for facilities with residents needing Assisted Living Care [1]. At minimum, expect these staffing elements: a licensed administrator overseeing operations, direct care staff trained in first aid and CPR, a designated staff person responsible for medication administration (who must complete Virginia's registered medication aide training unless exempted by their professional license), and awake, dedicated staff overnight if any resident requires Assisted Living Care level of service [1]. Staffing ratios aren't published as a single fixed number in the regulation the way some states do it. Instead, the standard is functional (sufficient to meet needs based on the ISPs of residents currently in the building). That means your staffing plan submitted with your license application needs to show real math: resident count, acuity mix, and shift coverage, more than a guess. Inspectors will check actual time sheets and schedules against your submitted plan during inspections, and a mismatch is one of the most common citations new operators get.
How does Virginia inspect and enforce assisted living regulations?
VDSS conducts licensing inspections at least annually, plus complaint-driven inspections whenever a complaint is filed against a facility, and follow-up inspections to verify correction of prior violations [1]. Inspectors review the physical plant (fire safety, sanitation, resident living space), resident records (ISPs, UAIs, medication administration records), staff files (background checks, training documentation, medication aide certification), and policy compliance. Violations get classified by severity. Virginia can respond with a range of enforcement tools: a corrective action plan with a deadline, a civil penalty, denial of license renewal, or in serious health-and-safety cases, summary suspension of the license while VDSS pursues revocation [1]. Inspection reports and violation histories for licensed facilities are generally available to the public through VDSS, and prospective families frequently check them before choosing a facility, so a clean inspection history is worth real operational attention, more than a compliance checkbox. The most common areas that trip up new operators, based on the pattern of standards in 22VAC40-73, are staffing documentation not matching actual schedules, incomplete or late ISP updates, medication administration records with gaps, and fire drill documentation that's missing or incomplete [1]. Build your internal audit calendar around these four areas specifically, and check them monthly, more than before the annual inspection.
What should I read next if I'm building out my licensing paperwork?
If you're still deciding what kind of facility fits your goals and your target population, start broader before you narrow in on Virginia specifics. Our assisted living overview covers the general licensing landscape across states, and assisted living facilities walks through how states typically structure their care-level categories. If you're weighing a smaller in-home model against a licensed congregate facility, assisted living at home explains how that distinction plays out operationally and legally. And if part of your business plan involves marketing to families searching for placement, understanding how senior assisted living facilities near me searches work can shape how you describe your services once you're licensed. Whatever you read next, keep one habit: every claim about fees, timelines, or specific document requirements should get confirmed against the current VDSS page or the current text of 22VAC40-73, not a cached memory of what the rule used to say. Regulations get amended, and licensing staff have zero patience for applications built on outdated fee schedules.
Frequently asked questions
What is assisted living?
Assisted living is a licensed residential care model providing help with daily living activities (bathing, dressing, medication, meals) plus 24-hour supervision, without the intensive skilled nursing care of a nursing home. In Virginia, it's regulated as a distinct license category, the assisted living facility (ALF), under 22VAC40-73, administered by the Virginia Department of Social Services.
What is a group home?
"Group home" is a general term for a small residential setting where several unrelated people with a shared support need live together with staff. It's not one legal license type. Depending on the population (seniors, IDD, mental health, recovery), a Virginia group home might be licensed as an ALF by VDSS, licensed separately by DBHDS, or in some cases not require a state license at all.
What is an assisted living facility?
Under Virginia's 22VAC40-73, an assisted living facility is any congregate residential setting providing personal care, health-related services, and 24-hour supervision for four or more aged, infirm, or disabled adults. It's licensed by the Virginia Department of Social Services and requires a designated licensed administrator and an individualized service plan for every resident.
What is the difference between assisted living and a nursing home?
Assisted living provides personal care and supervision without requiring 24-hour licensed nursing staff; nursing homes must have licensed nurses on duty around the clock for residents with skilled medical needs. In Virginia, ALFs are licensed by the Department of Social Services under 22VAC40-73, while nursing homes are licensed separately through the Virginia Department of Health.
Does Medicare cover assisted living facilities?
No. Medicare.gov states Medicare does not cover assisted living or custodial care as a category. Medicare may pay for specific medical services a resident receives (doctor visits, some home health, short-term skilled nursing in a nursing facility after a qualifying hospital stay), but it never covers assisted living room and board.
Does Medicaid cover assisted living in Virginia?
Standard Virginia Medicaid does not cover assisted living room and board. Coverage for services (not room and board) is available through the Commonwealth Coordinated Care Plus (CCC Plus) home and community-based services waiver for eligible members, based on financial and functional eligibility determined partly through Virginia's Uniform Assessment Instrument.
How do I start a group home in Virginia?
Start by identifying your target population, since that determines your licensing agency (VDSS for senior/personal-care ALFs, DBHDS for IDD populations). Then confirm local zoning, submit a license application with floor plans and staffing/policy documentation, get an administrator licensed through the Board of Long-Term Care Administrators, and pass a pre-licensure inspection.
What does assisted living provide day to day?
Assisted living typically provides help with activities of daily living, medication management, meals, housekeeping, social activities, and 24-hour supervision, all organized around a written individualized service plan for each resident. It generally does not include ongoing skilled nursing care, though some licensed nursing services can be arranged under specific conditions.
What staffing does a Virginia assisted living facility need?
Virginia requires a licensed administrator, direct care staff sufficient to meet residents' assessed needs (not a single fixed ratio), a trained medication aide or licensed staff for medication administration, and awake overnight staff if any resident requires Assisted Living Care. Staffing plans submitted with the license application must reflect actual projected census and acuity.
How often does Virginia inspect assisted living facilities?
The Virginia Department of Social Services conducts licensing inspections at least annually, along with additional inspections triggered by complaints and follow-up visits to confirm correction of prior violations, under the standards in 22VAC40-73.
Can a Virginia assisted living facility keep a resident who needs nursing home care?
No, not indefinitely. Virginia's assisted living regulations include specific retention standards tied to the Uniform Assessment Instrument. If a resident's needs exceed what the facility is licensed and staffed to provide (for example, requiring 24-hour skilled nursing), the facility must arrange discharge or transfer to an appropriate setting.
What is the difference between Residential Living Care and Assisted Living Care in Virginia?
Residential Living Care is for residents who are largely independent but need some supervision and occasional help; Assisted Living Care is for residents needing more substantial physical or mental health assistance, including some non-ambulatory residents. A facility's license specifies which level(s) it's approved to provide, which drives its staffing and admission requirements.
Do I need a license to open a small group home in Virginia?
It depends on resident count and population. Virginia's ALF definition applies to settings with four or more unrelated aged, infirm, or disabled adults; smaller adult foster care arrangements may fall under different rules. Always confirm your specific situation with the Virginia Department of Social Services before assuming you're exempt from licensing.
Sources
- Virginia Department of Social Services, 22VAC40-73 Standards for Licensed Assisted Living Facilities: Definition of assisted living facility, care levels, staffing, ISP/UAI requirements, inspection and enforcement standards
- Medicare.gov, Long-term care coverage: Medicare does not cover assisted living or custodial care
- Code of Virginia, Title 32.1 Chapter 10, Department of Medical Assistance Services: Virginia's Medicaid program, administered by DMAS, covers home and community-based waiver services including personal care for eligible members, separate from room and board
- Centers for Medicare & Medicaid Services, Home & Community-Based Services 1915(c): Definition and purpose of HCBS waivers to help beneficiaries avoid institutionalization
- 42 CFR 441.301, Home and community-based services waiver requirements: Federal regulatory requirements governing what states must include in a Medicaid HCBS waiver application, including services covered and settings requirements