Virginia is a pleasant retirement destination because of its comfortable weather, extensive history, easy access to nature, and Southern charm. In addition, Social Security benefits are not taxable in Virginia. If you’re an older adult, you can deduct up to $12,000 in other retirement income, making it a more affordable location for people to retire. Read on to discover what care options are available in Virginia, how much it costs, ways to pay, and how the state regulates long-term care communities.

Assisted Living Facility (ALF) Definitions

The Department of Social Services in Virginia licenses two levels of care in assisted living facilities. The licenses indicate the level of care the residents require: residential living care facilities and assisted living care facilities. A residential living care facility is for residents who require minimal assistance, and an assisted living care facility is for residents who require moderate assistance.  

A residential living care facility provides minimal assistance for adults that require assistance with one ADL and medication administration.

An assisted living facility is a non-medical group residential setting that provides personal care services, health care services, 24-hour supervision, and assistance for caring for four or more adults that are infirm, disabled, or aged. Assisted living care is a level of service for adults who require assistance with two or more activities of daily living (ADLs).

Facilities that provide care for adults with cognitive impairments must meet additional requirements to ensure the safety and welfare of residents who cannot recognize danger or ensure their own safety. The additional requirements are related to whether these residents can mix with residents without these impairments. Facilities that are licensed for ten or fewer residents or those that house no more than three residents with impairments are exempt from these additional requirements.

An adult foster care (AFC) facility provides room, board, supervision, and other services for up to three adults with a physical, mental, or behavioral condition.

Resident Agreements and Disclosures

The resident agreement outlines the financial arrangement between the resident or their representative and the facility. The agreement specifies the charges for accommodations, services, care, payment, refund policies, rate increases policies, and resident conduct rules.  The resident must be provided with information regarding bed hold, transfer and discharge policies, grievance policies, smoking policies, and policies relating to medication storage, dietary supplement storage, and medication administration.

Facilities are required to disclose the following as part of the resident agreement:

• Company management and ownership structure.
• The licensed capacity of the facility.
• The characteristics of the resident population.
• Staff numbers, functions, and qualifications of each shift.
• A description of all optional accommodations, services, care offered, and their costs.

Assisted Living Admission and Retention

All prospective residents and their representatives, if they have one, must be interviewed by the facility. The resident must provide the facility with a physical exam report from their physician and, if appropriate, a mental health screen. The facility will also conduct an assessment of the individual to determine the care that would be required.

Facilities are not permitted to admit or retain individuals under certain conditions. These conditions include:

• Dependence on a ventilator.
• Some stage 3 and stage 4 dermal ulcers.
• The resident/applicant requires intravenous therapy.
• The resident/applicant requires injections directly into the vein.
• The resident/applicant requires nasogastric or gastric tubes.
• The resident/applicant requires continuous nursing care.
• The resident/applicant is a danger to themself or others.
• The resident/applicant meets Medicaid nursing facility care levels.

To reside in a secure unit that cares for residents with cognitive impairments, the individual must be diagnosed with dementia. This rule is waived for a spouse, parent, sibling, or adult child who wishes to live with the individual. The resident or their representative must provide written approval to be housed in these units. A physician or a clinical psychologist must perform an assessment before entering the unit and conduct periodic reviews about whether the resident should remain in the unit.

Assisted Living Services

Facilities must provide services appropriate to the needs of the current residents. The facility can provide skilled nursing services directly, except for continuous skilled nursing, or may be contracted with a licensed home care agency. Residential living care facilities must schedule 11 hours of activities per week, and assisted living care facilities must provide 14 hours of activity.  

Facilities care programs must include the following:

• Care to meet the physical, mental, emotional, and psychosocial needs of the residents.
• Provide protection, guidance, and supervision.
• Meet the service plans of the residents.
• Periodic health care and oversight through a licensed health care professional.  

Residents of residential living care must be evaluated at least every six months, and assisted living care residents must be evaluated every three months.

Secure dementia units must provide at least 16 hours of activities every week. The activities must include cognitive stimulation, physical functioning, and sensory and social activities.

A service plan is developed for each resident before admission and must be reevaluated every 12 months and when there is a significant change in their health or physical condition.

Assisted Living Food and Dietary Provisions

The facility must provide three nutritious meals every day and snacks between meals and bedtime. A dietician or nutritionist must oversee special diets, and religious dietary practices must be respected.

Assisted Living Staffing Requirements

An administrator is responsible for the general administration, management, and day-to-day operations of the facility. Facilities are permitted to share an administrator under certain conditions.  

Other staff includes direct care staff, who provide personal care services, and certified medication aides responsible for administering medications.

A licensed health care professional must be under contract or hired to monitor the performance of the direct care staff on health-related activities. This oversight aims to assess the staff’s ability to perform their jobs and advise on the need for staff training. This licensed professional must be on-site quarterly in assisted living-level facilities and every six months at residential living care facilities.

There are no minimum staff ratios, but sufficient staff must be present to provide for the needs of the residents. At least one staff member must be awake and on duty at all times in each building that houses 20 or more residents. A staff member with a current first-aid and CPR certification must always be on-site unless a licensed nurse is on duty. Facilities that are licensed for more than 100 residents must have one additional employee on-site in addition to the first-aid staff member for every 100 residents.

At least two direct care staff must be awake and on duty at all times in a secure special care unit (SCU) when residents are present. A staff member who has been designated as responsible for managing and coordinating structured activities must be on-site at least 20 hours per week.

Assisted Living Staff Training Requirements

Every staff member must receive an orientation program within one week of employment. Each direct care staff member must receive and maintain first-aid certification within 60 days of employment. Medication aide staff must meet continuing education requirements outlined by the Board of Nursing.

The orientation program must sufficiently educate staff members on the laws and regulations and the facility policies and procedures regarding the following:

• Specific job duties and requirements of their position.
• Emergency and disaster plans, including resident evacuation plans.
• Hand-washing techniques, standard precautions, and infection reduction techniques.
• Abuse, neglect, and exploitation reporting and documentation.
• Resident’s rights and responsibilities.
• Personal information confidentiality.

Administrators must receive 20 hours of annual training on resident-specific needs or management and operations of a residential facility for adults. If the facility includes adults with mental impairments, five of those hours must be focused on meeting the needs of this resident population.

Direct care staff must receive annual training. Residential living care staff must complete eight hours of training and first-aid and CPR training. If any residents have mental impairments, two of the eight hours must be on subjects focused on mental impairment. Direct care staff in residential and assisted living care facilities must complete 16 hours of annual training and first-aid and CPR training. Four of these 16 hours must be devoted to caring for individuals with mental impairments in facilities that provide such services.

Assisted Living Housing Requirements

Apartment-style housing units are not required in Virginia. Facilities constructed or modified after 2006 can house up to two residents per room. These facilities must provide one toilet and sink for every four residents and one bathtub or shower for every seven residents. Facilities constructed before 2006 are permitted to house four residents per room.

What Is Included With Assisted Living Care In Virginia?

There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident’s health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.

Assisted Living Medication Provisions

Residents are allowed to self-administer medications if they are capable and if their rooms have a secure storage place. Medications can be administered by a licensed individual or a medication aide who has passed a Board of Nursing-approved training program, completed a competency evaluation, and registered with the Board of Nursing.

The facility must have a medication management plan approved by the Department of Social Services.

Health Care Services

In Virginia, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 53% of communities providing skilled nursing. Many have health care specialists and on-site services, with 53% of communities offering dental care. In addition, 60% of ALFs have hospice services.

Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Virginia, 86% of communities conduct depression screenings, and some offer mental health counseling. Social work programs are also found in 40% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all necessary resources.

Activities of Daily Living (ADLs) Assistance Services

A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores. 

Residents in Virginia’s assisted living facilities often receive help with their ADLs. In Virginia, 15% of residents need help eating. Other commonly used services include bed transfer (20%), toileting (33%), and walking (55.%). Caregivers in ALFs help 43% of residents dress and 57% of residents bathe.

Cost Of Assisted Living Care In Virginia

The average cost of assisted living care in Virginia is $5,250. This is $750 higher than the monthly national average of $4,500. The cost of living in Virginia is more than the national average by 1.8%, with health care costs more than the national average by 0.9% and housing costs more than the national average by 11.5%.

The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $4,625 in the Lynchburg area to a high of $5,925 per month in the Roanoke area of Virginia.

How Costs Compare In Nearby States

If you live close to one of Virginia’s borders, you may find assisted living in a neighboring state is an affordable option. All of Virginia’s neighbors have a lower average monthly cost of assisted living. The lowest cost can be found in Kentucky at $3,448 per month and in North Carolina at $4,010 per month. The highest monthly cost, but still lower than Virginia’s average, is found in Maryland at an average monthly cost of $4,900.  Tennessee also borders western Virginia and has an average cost of $4,105.

How to Pay for Assisted Living

Virginia Assisted Living Oversight

The Virginia Department of Social Services oversees assisted living communities throughout the state. The Office of the State Long-Term Care Ombudsman provides residents of long-term care communities with information, advocacy, and help to resolve care problems. For more information or help accessing the various services offered by Virginia for senior care, contact the Office for Aging Services of the Division for Community Living. 

Virginia Department of Social Services

Virginia Long-Term Care Ombudsman

Virginia Assisted Living Regulations

Virginia Department for the Aging

Legal Resources

The Statewide Senior Legal Helpline offers legal advice and assistance for people aged 60 and over. Topics include long-term care issues, abuse and neglect, public benefits, financial exploitation, and limited consumer issues. Legal aid is unavailable for criminal law cases, divorces, or lawsuits. Serving people under the Older Americans Act, the DARS’ Project 2025 provides legal services for public benefits and income issues, long-term care, housing, healthcare, abuse, neglect, and financial exploitation.