Last updated 2026-07-25
TL;DR
Virginia assisted living facilities are licensed by the Virginia Department of Social Services under 22VAC40-73. Operators need a fire/health inspection, a licensed administrator, staffing that meets resident need levels, and compliance with admission and retention standards. Applications, background checks, and a pre-licensure survey all happen before DSS issues a license.
What is assisted living?
Assisted living is a category of licensed residential care for adults who need help with daily activities like bathing, dressing, medication management, or mobility, but who don't need the round-the-clock skilled nursing care a hospital or nursing home provides. It sits between independent living and a nursing facility on the care spectrum. In Virginia, the state doesn't use the term casually. "Assisted living facility" is a defined legal term under the Code of Virginia, and any home or building offering that level of care to unrelated adults for compensation has to be licensed by the Virginia Department of Social Services (DSS) [1]. The state's own regulation 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" [2]. That four-or-more threshold matters a lot for anyone planning a smaller home. Three residents or fewer generally falls outside the assisted living licensing category in Virginia, though other rules (zoning, adult foster care licensing under DSS, business registration) can still apply. Confirm the resident count and care-level triggers with your state licensing agency before you commit to a property or a business model.
What is a group home?
A group home is a broader, less legally precise term than "assisted living facility." It usually describes a residential setting, often a single-family style house, where a small number of unrelated people live together and receive some level of supervision, support, or care. Group homes serve very different populations: people with intellectual or developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, and seniors who need help with daily living. Virginia licenses these populations through different pathways. DSS licenses assisted living facilities serving aged or disabled adults under 22VAC40-73 [2]. The Department of Behavioral Health and Developmental Services (DBHDS) licenses residential programs for people with intellectual/developmental disabilities or mental illness under a separate regulatory chapter, 12VAC35-105 [3]. If you're planning a home for a population outside the aged/infirm adult category, DBHDS, not DSS, is likely your licensing authority. This is the single most common mistake new operators make: assuming "group home" and "assisted living facility" are interchangeable licenses. They aren't in Virginia. Get the population you intend to serve nailed down first, then confirm which state agency actually licenses that model. For background on how this fits into the national licensing picture, see assisted living facility requirements across states.
What is an assisted living facility (and what does assisted living provide)?
An assisted living facility (ALF) in Virginia is a licensed residential setting providing 24-hour supervision plus personal care and, in many cases, limited health care services to four or more aged, infirm, or disabled adults who aren't related to the operator [2]. Virginia regulation splits residents into two care levels: assisted living care (residents need at least a moderate level of assistance) and residential living care (residents are more independent but still need some support and supervision) [2]. What assisted living actually provides, per Virginia's licensing standards, typically includes: - Three meals a day plus snacks, with therapeutic diets when ordered
- Help with activities of daily living (bathing, dressing, toileting, mobility, eating)
- Medication administration or assistance, depending on staff qualifications
- 24-hour staff supervision
- Housekeeping and laundry
- Social and recreational activities
- Coordination of health care services, including arranging transportation to appointments What it does not provide is ongoing skilled nursing care, ventilator management, or care for residents who are bedbound for long periods without physician-approved care plans allowing it. Virginia's regulations specifically restrict who can be admitted or retained in an ALF, which we cover below.
How does assisted living differ from a nursing home?
| Licensing agency | Virginia DSS | Virginia Dept. of Health | |
|---|---|---|---|
| Medical staffing | No RN required 24/7 | RN coverage required | |
| Typical resident need | ADL help, supervision | Skilled nursing, rehab, complex medical care | |
| Medicare coverage | Generally not covered | Short-term rehab stays can be covered | |
| Medicaid coverage | Limited, via waiver programs | Covered as a Medicaid state plan benefit | If a resident's needs progress to requiring ongoing skilled nursing care, tube feeding, or ventilator support beyond what an ALF's admission and retention standards allow, Virginia regulation actually requires discharge planning to a more appropriate level of care [2]. |
Assisted living and nursing homes differ in the level of medical care provided, the staffing model, and the regulatory body overseeing them. Assisted living is a residential, personal-care model; a nursing home (skilled nursing facility) is a medical model with licensed nursing staff on-site around the clock. In Virginia, assisted living facilities are licensed by DSS, while nursing facilities are licensed by the Virginia Department of Health under separate statutes and staffing rules that require registered nurses and require a physician-directed plan of care for each resident. Nursing homes must meet federal Medicare/Medicaid Conditions of Participation set by CMS, which mandate specific RN coverage and detailed resident assessments (the federal MDS process) [4]. Assisted living facilities are not subject to those federal nursing home rules at all; they're purely a state-licensed category. Here's a side-by-side to make the distinction concrete: | Feature | Assisted Living (Virginia) | Nursing Home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room, board, or personal care in an assisted living facility. Medicare.gov states plainly that Medicare does not pay for "custodial care," which is the category assisted living falls into, if that's the only kind of care needed [5]. Medicare will pay for specific medical services a resident receives while living in assisted living (a doctor's visit, physical therapy ordered by a physician, durable medical equipment), the same way it would for anyone living at home. But it will not pay the facility's monthly rate for housing, meals, or help with dressing and bathing. Medicaid is a different story, and this is where a lot of confusion comes from. Virginia Medicaid does not pay directly for room and board in assisted living, but it can help cover personal care services for eligible low-income residents through Medicaid waiver programs, specifically Virginia's Commonwealth Coordinated Care Plus (CCC Plus) waiver, which can fund personal care, supervision, and some support services delivered in an assisted living setting under Medicaid's Auxiliary Grant and waiver structure [6]. The Auxiliary Grant program itself is a state-funded supplement (not Medicaid) that helps eligible low-income aged, blind, or disabled Virginians pay for room and board in an approved assisted living facility [7]. These are two separate funding streams operators need to understand distinctly if they want to accept residents relying on public assistance.
How do I start a group home / assisted living facility in Virginia?
Starting a licensed assisted living facility in Virginia runs through several concrete stages, and DSS lays most of them out directly in its licensing regulations and application materials [1]. 1. Decide on population and care level. Confirm whether you're serving aged/disabled adults (DSS licensing) or IDD/mental health populations (DBHDS licensing). This decision drives everything downstream. 2. Check zoning and site suitability. Local zoning ordinances vary by county and city; some jurisdictions treat a small ALF as a permitted residential use, others require a special use permit. Confirm zoning classification with your local planning or zoning office before signing a lease or purchase agreement. 3. Submit an initial application to DSS. Virginia requires prospective operators to file an application, pay applicable fees, and submit organizational documents (business structure, ownership disclosure, financial responsibility documentation). Fee schedules and specific forms change periodically; confirm current fee amounts directly with DSS Division of Licensing Programs. 4. Pass a fire safety and building inspection. Virginia regulation requires ALFs to meet the fire safety provisions applicable to their occupancy classification, coordinated with the local fire marshal and the State Fire Marshal's office as applicable, before licensure [2]. 5. Hire a qualified administrator. Virginia requires ALFs to have a licensed administrator (or in some smaller facility categories, a qualified individual meeting specific education/experience requirements) who completes state-approved administrator training [2]. 6. Develop required policies and procedures. This includes admission/retention policy, emergency preparedness plan, medication management policy, staffing plan, resident rights policy, and abuse/neglect reporting procedures, all reviewed by DSS before licensure. 7. Complete background checks. Virginia requires criminal history record checks and a search of the state's central registry for all staff who will have direct contact with residents [2]. 8. Pass a pre-licensure inspection. A DSS licensing specialist conducts an on-site survey to confirm the physical plant, staffing, and policies all meet 22VAC40-73 standards before a license is issued. 9. Maintain ongoing compliance. Once licensed, ALFs are subject to periodic unannounced inspections, complaint investigations, and renewal cycles. For operators building out the paperwork side of this process, our state-by-state licensing guide breaks down how these steps compare across states, since requirements like administrator training hours and fire inspection triggers differ meaningfully by jurisdiction.
What admission and retention requirements does Virginia set for assisted living residents?
Virginia's assisted living regulations spell out exactly who can be admitted to, and who must be discharged from, an ALF, and this is one of the most heavily enforced parts of the regulation during inspections. Under 22VAC40-73, a facility may not admit or retain individuals who require continuous nursing care, who are ventilator-dependent, who have stage three or four pressure injuries (with narrow exceptions requiring a documented hospice or physician plan), or who present an imminent physical threat to themselves or others that the facility cannot manage [2]. Residents with certain medical conditions may be retained only if a physician documents in writing that the condition is stable and the facility can safely meet the resident's needs. Every resident must have a uniform assessment instrument (UAI) completed before admission and updated at least annually (or sooner if the resident's condition changes significantly), which Virginia uses to determine appropriate level of care and staffing needs [2]. This assessment is not optional paperwork; DSS inspectors check UAI completion and accuracy as a routine part of licensing surveys, and a facility retaining a resident whose UAI shows a need beyond the facility's licensed scope is a common citation.
What are Virginia's staffing requirements for assisted living facilities?
Virginia requires assisted living facilities to maintain staffing levels sufficient to meet the scheduled and unscheduled needs of residents at all times, with the specific ratio driven by resident count and acuity rather than a single fixed number. The regulation requires at least one direct care staff member awake and on duty at all times in facilities with residents who need assistance during night hours, and staffing plans must account for residents' assessed care levels from their UAIs [2]. Direct care staff must complete Virginia's required orientation and ongoing in-service training, including topics like resident rights, infection control, emergency preparedness, and abuse/neglect recognition and reporting. Medication aides who administer medications must complete state-approved medication aide training and registration through the Virginia Board of Nursing, unless a licensed nurse is administering medications directly. Administrators must complete a state-approved administrator training program and, depending on facility size and resident acuity, may need to hold a Virginia assisted living facility administrator license issued through the Virginia Board of Long-Term Care Administrators . Smaller facilities meeting specific criteria may qualify for a "qualified individual" pathway with different education and experience thresholds instead of a full administrator license; confirm current thresholds with the Board directly, since facility-size cutoffs get updated periodically.
What inspections does Virginia require before and after licensing?
Virginia requires a pre-licensure inspection covering fire safety, building and physical plant standards, and program compliance before DSS will issue an initial license. After licensure, DSS conducts at least one unannounced inspection per year, and often more frequently for larger facilities or facilities with prior compliance issues, plus complaint-driven investigations whenever DSS receives a report alleging a violation [2]. Fire safety inspections are coordinated separately from DSS's programmatic review. Local fire marshals or the Virginia Department of Fire Programs may be involved depending on your jurisdiction, and facilities must maintain compliance with the Virginia Uniform Statewide Building Code and applicable fire code provisions on an ongoing basis, more than at initial licensure. During inspections, expect reviewers to check resident records (UAIs, care plans, physician orders), medication administration records, staff files (training certificates, background check documentation, TB screening results), emergency preparedness plans, and physical plant conditions (exits, smoke detectors, sprinkler systems where required, water temperature, kitchen sanitation). Facilities found out of compliance receive a plan of correction requirement with a deadline; failure to correct can lead to fines, admission holds, or license revocation in serious cases. Building a policy manual that maps directly to what DS inspectors check, rather than a generic template, saves real time during your first survey. This is one area where a purpose-built state group home licensing kit built around actual state checklists can shortcut months of drafting from scratch, though the regulatory judgment calls (staffing ratios for your specific resident mix, physical plant modifications) still need a licensed professional's sign-off.
What does it cost and how long does licensing take in Virginia?
Application fees, renewal fees, and processing timelines for Virginia assisted living licensure change periodically and vary by facility size (number of licensed beds). DSS publishes current fee schedules directly; confirm the exact dollar amounts and current processing timeframes with the Virginia DSS Division of Licensing Programs before budgeting, since quoting a fixed number here would go stale fast and isn't something we can verify against a static source. What we can say with confidence: the timeline from initial application to licensed operation in Virginia typically involves multiple sequential steps, not a single approval event. Application review, background check processing, physical plant inspection, fire marshal sign-off, and the pre-licensure survey each take real calendar time, and delays in any one step (an incomplete application, a failed fire inspection item, a background check flag) push back the whole sequence. Building slack into your opening timeline, rather than assuming a fixed number of weeks, is the more realistic way to plan a launch budget and staffing hire date.
What zoning and property issues come up for Virginia assisted living operators?
Zoning classification for a small assisted living facility varies significantly by Virginia county and city, and this is a step operators skip at their own risk. Some localities treat a home serving a small number of residents as a permitted residential use by right; others require a conditional use permit, a special exception, or additional site plan review, especially once resident count crosses certain thresholds tied to the Fair Housing Act's protections for group homes serving people with disabilities. Virginia's assisted living regulation itself is agnostic on zoning; that's handled entirely at the local government level. Before signing a lease or purchase contract, contact the zoning or planning department for the specific county or city where the property sits and ask directly whether the intended resident count and care model qualifies as a permitted use, and whether any building permit or occupancy classification change is required. Physical plant requirements from DSS layer on top of zoning: minimum square footage per resident, bathroom-to-resident ratios, accessible egress, and fire-rated construction depending on resident mobility levels are all spelled out in 22VAC40-73 [2]. A property that clears local zoning can still fail the DSS physical plant review if bedroom sizes or exit paths don't meet the standard, so get both reviews done, or at minimum confirmed on paper, before committing capital to a purchase or a build-out.
How does Virginia's process compare to other states?
Virginia's core structure, a DSS-issued license under a dedicated assisted living regulation chapter, an administrator licensing requirement, and a mandatory pre-licensure inspection, mirrors the general pattern most states use, but the specifics (fee amounts, training hour minimums, resident-count thresholds triggering licensure) differ meaningfully state to state. The four-resident threshold Virginia uses to define an ALF, for example, isn't universal; some states set the threshold at three residents, others license any paid care arrangement regardless of count. Administrator licensing requirements also vary: some states require only a training certificate, others (like Virginia, for larger facilities) require a full state board license through a separate credentialing body. If you're evaluating multiple states before choosing where to open, or you're expanding an existing Virginia operation across state lines, our assisted living facilities comparison guide and facility assisted living resource walk through how these thresholds and requirements shift by jurisdiction, so you're not assuming Virginia's rules apply somewhere they don't.
Frequently asked questions
What is assisted living?
Assisted living is licensed residential care for adults who need help with daily activities like bathing, dressing, or medication management, but who don't need full-time skilled nursing care. In Virginia, any congregate setting providing this care to four or more unrelated aged, infirm, or disabled adults must be licensed by the Virginia Department of Social Services under 22VAC40-73.
What is a group home?
A group home is a general term for a residential setting where a small number of unrelated people live together with some level of support or supervision. In Virginia, the specific license required depends on who lives there: DSS licenses homes for aged/disabled adults, while DBHDS licenses homes for people with intellectual disabilities or mental illness.
What is an assisted living facility?
An assisted living facility (ALF) is a state-licensed residential setting providing 24-hour supervision, personal care, and coordination of health services for four or more aged, infirm, or disabled adults. Virginia defines and regulates ALFs under 22VAC40-73, distinguishing between residential living care and the higher-need assisted living care level.
What does assisted living provide?
Assisted living typically provides meals, help with bathing and dressing, medication administration or assistance, 24-hour supervision, housekeeping, social activities, and coordination of medical appointments. It does not provide ongoing skilled nursing care; Virginia regulation restricts admission and retention of residents whose needs exceed what an ALF is licensed to provide.
What is the difference between assisted living and a nursing home?
Assisted living is a personal-care residential model licensed by state social services agencies; nursing homes are medical facilities licensed under separate rules requiring 24-hour RN coverage and meeting federal Medicare/Medicaid Conditions of Participation. In Virginia, DSS licenses assisted living while the Department of Health licenses nursing facilities.
Does Medicare cover assisted living facilities?
No. Medicare does not cover room, board, or personal care in assisted living because it's classified as custodial care, per Medicare.gov guidance. Medicare will pay for specific medical services (doctor visits, ordered therapy) a resident receives while living there, but not the facility's monthly rate.
Does Medicaid pay for assisted living in Virginia?
Virginia Medicaid doesn't pay facility room and board directly, but eligible low-income residents may get help through the CCC Plus waiver for personal care services, plus Virginia's state-funded Auxiliary Grant program, which helps cover room and board costs for qualifying aged, blind, or disabled residents in approved facilities.
How do I start a group home in Virginia?
Confirm your population and which state agency licenses it (DSS for aged/disabled adults, DBHDS for IDD/mental health), check local zoning, submit a DSS application with required documentation, pass fire and building inspections, hire a licensed administrator, complete background checks, and pass a pre-licensure survey before DSS issues the license.
How much does it cost to get an assisted living license in Virginia?
Fees vary by facility size and change periodically, so confirm current amounts directly with the Virginia DSS Division of Licensing Programs before budgeting. Beyond the state application fee, expect real costs for fire code upgrades, background checks, administrator training, and physical plant modifications to meet 22VAC40-73 standards.
How many residents can live in a Virginia assisted living facility without a license?
Virginia's assisted living licensing threshold applies to settings caring for four or more unrelated aged, infirm, or disabled adults. Homes serving three or fewer generally fall outside this specific licensing category, though other state licensing rules and local zoning requirements can still apply, so confirm with DSS directly.
Who can't be admitted to a Virginia assisted living facility?
Virginia regulation bars admission or retention of residents who need continuous nursing care, are ventilator-dependent, have stage three or four pressure injuries without a documented physician or hospice care plan, or pose an imminent danger the facility can't safely manage. Every resident needs a uniform assessment instrument on file confirming appropriate care level.
Does Virginia require a licensed administrator for assisted living facilities?
Yes. Virginia requires ALFs to have an administrator who completes state-approved training, and larger or higher-acuity facilities require a license through the Virginia Board of Long-Term Care Administrators. Some smaller facilities may qualify for a 'qualified individual' pathway with different requirements; confirm current thresholds with the Board.
How often does Virginia inspect assisted living facilities?
Virginia DSS conducts at least one unannounced inspection per year for licensed assisted living facilities, plus additional inspections for larger facilities or those with prior compliance issues, and complaint-driven investigations whenever a report is filed. Fire safety compliance is monitored on an ongoing basis alongside DSS's programmatic reviews.
Sources
- Virginia Department of Social Services, Assisted Living Facilities licensing page: DSS is the licensing authority for assisted living facilities in Virginia
- Virginia Administrative Code, 22VAC40-73 (Standards for Licensed Assisted Living Facilities): Definition of assisted living facility, care levels, admission/retention standards, staffing, UAI, and inspection requirements
- Virginia Administrative Code, 12VAC35-105 (DBHDS licensing regulations): DBHDS licenses residential programs for individuals with intellectual/developmental disabilities or mental illness
- CMS, State Operations Manual, Appendix PP (Nursing Home Conditions of Participation): Nursing homes must meet federal Conditions of Participation including RN staffing requirements
- Medicare.gov, Long-Term Care coverage page: Medicare does not cover custodial care such as assisted living room and board
- Virginia Department of Social Services, Auxiliary Grant Program: Virginia's Auxiliary Grant is a state-funded supplement helping eligible low-income residents pay for assisted living room and board
- Virginia Board of Nursing, Medication Aide Registration: Medication aides administering medication in Virginia assisted living facilities must complete state-approved training and registration