Virginia assisted living facility license: VDSS levels, rules and fees

Where the license starts and what sits next to it

Virginia law defines an assisted living facility (ALF) as “any congregate residential setting that provides or coordinates personal and health care services, 24-hour supervision, and assistance (scheduled and unscheduled)” for “four or more adults who are aged or infirm or who have disabilities.”⁠¹ Anyone who operates or maintains such a facility must get a license from the Commissioner of Social Services.⁠² Operating without one, or caring for more people than the license allows, is a Class 1 misdemeanor, and each day of unlicensed operation is a separate offense.⁠⁴

The definition has four exclusions: a facility, or part of one, licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services (DBHDS); the home of a person who cares only for relatives by blood or marriage; a children’s residential facility licensed by VDSS; and federally or state-funded (HUD, USDA or Virginia Housing) housing for people 62 or older or with disabilities that provides no more than basic coordination of care. It also counts two or more places run by one entity as a single facility when together they hold four or more adults.⁠¹ VDSS also stresses that an ALF is not a nursing home. If your residents will need nursing on a continuing basis, your project belongs with the Virginia Department of Health, not VDSS.⁠¹¹

One to three residents. Virginia has no licensed small-home category below four residents. A provider who gives room, board, supervision and special services in their own home can serve up to three adults as an adult foster care provider. A local department of social services approves these providers; VDSS does not license them. The rule is explicit that “care provided for more than three adults requires licensure as an assisted living facility.”⁠³⁰

Day programs and in-home care. Daytime care for adults who go home at night is a separate VDSS license; see the Virginia adult day center license. Personal care delivered in clients’ own homes is licensed by the Department of Health as a home care organization; see the personal care guide. A home care organization licensed in Virginia may also come into an ALF to provide some care for an individual resident, such as gastric-tube care, but only at the resident’s request and when the resident’s independent physician finds it appropriate. Intermittent IV therapy may be given by a licensed health care professional under a prescriber’s treatment plan.⁠⁸

Choose your level: residential living care or assisted living care

Your application asks for one of two licensure levels: “Residential Living Care Only” or “Residential Living Care and Assisted Living Care.”⁠¹³ This is the most consequential decision in a Virginia ALF plan, because the administrator rules, training hours and some staffing rules all follow from it.

• Residential living care covers adults who need only minimal help with activities of daily living. It includes residents whose only dependency is medication administration, and residents who live independently.⁠⁸
• Assisted living care covers adults who need at least moderate help with activities of daily living. It also covers residents “dependent in behavior pattern (i.e., abusive, aggressive, disruptive)” as documented on the uniform assessment instrument.⁠⁸

You may not admit or keep anyone whose needs call for a level of care your license does not cover.⁠⁸ In practice, a small home that wants to keep residents as they decline will need the higher level from the start, or will have to apply to change it later.

Memory care is a set of added standards, not a separate license

Virginia has no separate memory care license. A facility that cares for adults with serious cognitive impairments who cannot recognize danger or protect their own safety must also meet Part X of 22VAC40-73.⁠⁸ Part X has two tracks:

• Mixed population. Residents with serious cognitive impairment live alongside other residents. At least two direct care staff must be awake and on duty in each building whenever residents are present. Facilities licensed for 10 or fewer residents are exempt from this when no more than three residents have serious cognitive impairments.⁠⁸
• Safe, secure environment (special care unit). This is a self-contained unit for residents whose serious cognitive impairment comes from a primary diagnosis of dementia. The unit can be one wing or the whole facility.⁠⁸ Before placing anyone there, you need written approval from the resident or a substitute, in a fixed order of priority.⁠⁸

Inside a special care unit, the minimum number of awake direct care staff is:⁠⁸

• Daytime and evening: two staff for 20 or fewer residents, plus one more for every additional 10 residents or portion of 10. A unit with five or fewer residents may run with one staff member if two other direct care staff are in the building and one of them is readily available.
• Night: two staff for 22 or fewer residents, three for 23 to 32, four for 33 to 40, and above 40, four plus one for every additional 10 residents or portion of 10.

The night figures are written into the statute itself, § 63.2-1802, and these unit minimums apply on top of the building-wide staffing rules.⁠⁸ Part X also sets training. Administrators need 12 hours on cognitive impairment within three months of starting. Direct care staff need six hours within four months in the mixed-population track and 10 hours within four months in a special care unit. Other staff need two hours within the first month (in a special care unit, those who have contact with its residents).⁠⁸ Exterior doors need a monitoring system, such as alarms or delayed egress, and windows residents can reach need devices that stop them from opening wide enough to climb through.⁠⁸

The administrator rule that shapes your budget

The Code requires an ALF administrator to hold an assisted living facility administrator license from the Virginia Board of Long-Term Care Administrators. Facilities licensed for residential living care only are exempt from that requirement. Anyone who qualifies as a licensed nursing home administrator is treated as qualified.⁠⁶

Every administrator must be at least 21 and may not live in the facility.⁠⁸ If yours leaves, notify the regional licensing office in writing within 14 days. An acting administrator can run a residential-only facility for up to 90 days. A facility with assisted living care gets 150 days, or 90 days if the acting administrator has not applied for licensure, plus one 30-day extension in limited cases.⁠⁸

Small operators can share an administrator. One administrator may cover up to four facilities with a combined licensed capacity of 40 or fewer, all within a 30-minute average one-way drive of each other. Each facility must have a qualified manager on site and a written management plan.⁠⁸ A licensed nursing home administrator may also run an ALF and a nursing home housed in the same building.⁠⁸

Before VDSS grants an initial license, an owner who has never owned or managed a licensed ALF must complete the Commissioner’s training. So must the administrator employed at the time of application. VDSS may issue a license on the condition that this training is finished.⁠⁸ An administrator who supervises medication aides without being a licensed nurse or registered medication aide must complete a Board of Nursing-approved course of at least 68 hours.⁠⁸

Owner qualifications, background checks and insurance

The licensee must show financial responsibility and solvency and be “of good character and reputation.”⁠⁸ For the financial check, you can submit an annual operating budget and at least one credit reference instead of opening your financial records to inspection.⁠²⁸

Every applicant goes through a background check: a sworn statement or affirmation, plus a criminal history record check through the Central Criminal Records Exchange.⁠⁵ The Commissioner will not license an applicant convicted of an offense in clause (i) of the barrier-crime definition in § 19.2-392.02.⁠⁵ Under the revised applications, the sworn statement and the State Police record, each dated within the last 90 days, stay at the facility for the inspector to review. Do not mail them in with the application.⁠¹³⁠¹⁶ Each employee’s criminal history report must be obtained within 30 days of hire, and the facility may not accept a report dated more than 90 days before employment.⁠²⁵

Liability insurance. A 2023 law required ALFs to carry minimum liability coverage. The final regulation took effect September 23, 2026.⁠¹⁹

Prospective residents can ask for a statement of coverage, and you must provide it on the VDSS form.⁠⁸

The building: classification, zoning, plan review and the details inspectors measure

Building code classification. Every ALF building must be classified under the Virginia Uniform Statewide Building Code for its use. It must also be licensed for either ambulatory residents (people who can evacuate without another person’s help) or nonambulatory residents.⁠²⁹ VDSS’s Request for Building Evaluation or Inspection form asks how many adults you will serve and the maximum number who will be non-ambulatory at any one time. The local building official then certifies the use group and maximum occupancy. You pay any costs.⁠¹⁵ A valid certificate of occupancy is a prerequisite for licensure, and you may admit only residents your occupancy classification allows.⁠⁹⁠⁸

Zoning. Under § 15.2-2291, local zoning must treat a VDSS-licensed residential facility with no more than eight aged, infirm or disabled residents as “residential occupancy by a single family.” No conditions stricter than those on an ordinary family home may be imposed.⁠²⁰ The statute says nothing about larger facilities, so for those, check your locality’s ordinance before you sign a lease or buy land.

Plan review before you build. If you are building, renovating, or using a building that has not housed this use before, send VDSS your floor plans before construction begins or contracts are awarded.⁠⁹⁠⁸ VDSS will tell you within 10 working days if the plan is incomplete. Within 20 days of a complete plan, it issues a Preliminary Approval Statement or a disapproval letter. After construction, VDSS staff inspect the building on site.⁠⁹ The rule itself warns that architects and building officials “may not be thoroughly familiar with these functional design requirements.”⁠⁹

⁠⁸

Fire and emergency power. The local fire official must inspect at least once a year under the Statewide Fire Prevention Code.⁠⁸ A facility without an onsite generator must have agreements with two separate vendors that can supply one. Any facility with six or more residents needs a permanent connection for temporary emergency power, approved by the local building official.⁠⁸ Before admission, you must tell each prospective resident in writing whether you have onsite emergency power and what it runs.⁠⁷

Staffing and training

Virginia sets no fixed staff-to-resident ratio outside Part X. Instead, you keep a written staffing plan tied to resident acuity. At least one direct care staff member must be awake and on duty in each building whenever a resident is present. The one exception is a residential-only building of 19 or fewer residents, where the night staff member may sleep if no resident needs someone awake and the call-system rules are met.⁠⁸

• Credentials for direct care staff. Within two months of hire, each direct care staff member must hold one of the listed credentials. Options include certified nurse aide, a Board of Nursing-approved nurse aide program, a personal care aide program approved by the Department of Medical Assistance Services, and the VDSS-approved 40-hour direct care course taught by an RN or LPN.⁠⁸ Direct care staff must be at least 18 unless they are Virginia-certified nurse aides.⁠⁸
• Annual training. Direct care staff need 14 hours a year in residential-only facilities and 18 hours where assisted living care is licensed; licensed professionals and CNAs need 12. At least 2 hours must cover infection control, and 4 must cover mental impairments when such residents are in care.⁠⁸
• First aid and CPR. Direct care staff must be certified in first aid within 60 days of hire. Each building needs a CPR-certified staff member at all times, plus, in facilities licensed for over 100 residents, one more for every 100 residents or portion of 100.⁠⁸
• Medications. Staff who give medications must be licensed to do so or registered with the Board of Nursing as medication aides. Medication aides can work provisionally for up to 120 days.⁠⁸ VDSS confirmed in March 2026 that an Advanced Registered Medication Aide working in an ALF is limited to the ordinary medication aide scope.⁠²⁶
• Orientation. All staff must be oriented and trained within their first seven working days.⁠⁸
• Background checks before contact. Nobody may work in direct contact with residents until their background check comes back, unless another checked employee directly supervises them.⁠⁸

Who you can admit and keep

Before admitting anyone, you need a completed uniform assessment instrument (UAI), a physical examination report, a documented interview and a mental health screening.⁠⁸ For private-pay residents, the UAI can be completed by facility staff who finished state-approved training (with the administrator’s sign-off), by an independent physician, or by a public agency assessor. It is repeated at least once a year and after any significant change in condition.⁠⁸ A comprehensive individualized service plan is due within 30 days of admission. It must be written by someone who has completed VDSS-approved ISP training, which in turn requires the private-pay UAI training first.⁠⁸

Virginia law bars ALFs from admitting or keeping residents with certain conditions. These include ventilator dependency, stage III or IV pressure ulcers (except a stage III ulcer a physician certifies as healing), nasogastric tubes, a need for continuous licensed nursing care (seven days a week, 24 hours a day), and maximum physical assistance combined with nursing facility level of care, unless the resident’s independent physician decides otherwise.⁠⁷ Hospice can serve a resident at the resident’s request, but to the extent federal law allows, a facility is not required to provide or allow it if its disclosure statement says so and the resident signed that statement before admission.⁠⁸

For an involuntary discharge, send a copy of the notice to VDSS and the State Long-Term Care Ombudsman at least 30 days ahead, except in emergencies. A resident behind on payments gets at least 30 days to catch up after notice.⁠⁷

The application, in the order VDSS works

1. Watch the two VDSS training videos. VDSS recommends “Introduction to Licensing” first, then “Introduction to Assisted Living Facilities,” before you decide to apply.⁠¹²⁠¹¹

2. Lock down the building. Get plan review if you are building or converting, then the building official’s evaluation form, a certificate of occupancy, a fire inspection report and a health department sanitation inspection. You obtain these inspection reports yourself at application and every year after.⁠⁹⁠¹³ As of July 1, 2026, ALFs caring for 12 or fewer people in a home are exempt from the restaurant regulations; the local health department decides eligibility.⁠¹⁷

3. Hire your administrator and write the required documents. VDSS publishes a list of 25 required policies and procedures, including infection control, medication management, bed hold, weapons, prevention of heat- and cold-related illness, and emergency preparedness.⁠¹⁴ Since the August 2026 revisions, you submit only the policies the regulation requires, not every policy you have.⁠¹⁶

4. Buy the AED and train staff. VDSS will not issue a license without one.⁠²

5. Assemble the attachments. The initial application (form 032-08-0100-03, revised 07/26) asks for:

   • three character references for each listed individual, dated within 12 months
   • entity documents and fictitious name registration
   • an annual operating budget and a credit reference
   • proof of the administrator’s qualifications or license
   • the building, fire and sanitation reports
   • a floor plan with exact bedroom and window measurements and fixture counts
   • your disclosure statement, an organizational chart and the staff information sheet
   • a two-week menu and a monthly activity schedule
   • the fee⁠¹³

   Only the revised forms are accepted from October 1, 2026.⁠¹⁶

6. File through VELA at least 60 days before opening. New applications go through the Virginia Enterprise Licensing Application portal; renewals do not.⁠¹²⁠⁹ If your file is incomplete, VDSS tells you in writing within 15 days. If you do not complete it within 30 days, your materials are returned and the fee is kept.⁠⁹⁠¹³

7. On-site inspection and investigation. A licensing inspector visits the facility and reviews your character, reputation and finances. Afterward, you submit a plan to correct anything found out of compliance.⁠⁹

8. Conditional license. VDSS may issue a new facility a conditional license so it can show it complies once it opens. Conditional licenses, including renewals, cannot run longer than six months in total, after which the facility must substantially meet the standards or be denied.⁠⁹ No fee is charged for the renewal at the end of the conditional period.⁠¹³

VDSS can grant a variance from a specific regulation when following it would cause substantial financial or programmatic hardship and residents’ safety would not suffer.⁠²⁠⁹

Fees as published by VDSS

Scroll the table sideways to see every column.

The total depends on capacity and license length, but VDSS bills it one year at a time. Pay by check to “Treasurer of Virginia” or through the department’s online process. A fee in the wrong amount or made out to the wrong payee is returned to you; otherwise no fee is refunded for any reason.⁠¹⁰ A returned check costs $50.⁠¹³ The State Board of Social Services opened a periodic review of this fee regulation in March 2026.⁠³¹

License length, inspections and renewal

A license can run six months, one, two or three years. The Commissioner sets the length based on the facility’s compliance history.⁠² A six-month license brings at least two inspections, one unannounced. Longer licenses bring at least one unannounced inspection every year, plus a renewal inspection.⁠³ Post the license where residents and the public can see it.⁠²

You must pay any outstanding civil penalty before VDSS will treat a renewal application as complete.⁠⁹ A license cannot be transferred: a buyer or a new location needs a new license. You must give the regional office and residents at least 60 days’ notice before a planned sale or closure.⁠⁹⁠⁸

How residents pay with public funds

The main public payment source tied to the license is the Auxiliary Grant. This state and locally funded supplement goes to eligible low-income residents of VDSS-licensed ALFs and approved adult foster care homes.⁠²² From January 1, 2026, the rate is $2,130 a month, or $2,450 in Planning District 8 (Northern Virginia), with an $87 personal needs allowance for the resident.⁠²³ You must give each recipient a written list of covered goods and services, and you may not charge the resident or their family extra for anything on that list.⁠²² Local departments of social services have 45 days to process an application. A resident who moves in before approval owes the costs until the grant is approved.⁠²⁴ Public-pay residents are assessed by a public agency assessor, not facility staff.⁠²²

What changed in 2026 and what is pending

• AED requirement (2026 Acts ch. 323). In effect since July 1, 2026, for initial and renewal licenses.⁠²⁠¹⁷ Amendments to 22VAC40-73-210, -260 and -990 take effect November 4, 2026. They add staff AED training and update the emergency response plan.⁠¹⁸ The final text published in the Virginia Register on October 5, 2026 requires the facility to have and maintain an AED, and at least one staff person with access to it at all times who has been trained in its use within the past two years. It also requires a posted list of staff trained in AED use, alongside the first aid and CPR list.⁠³²
• Electronic monitoring (2026 Acts ch. 496). Residents or their representatives may install monitoring devices in their rooms if the conditions in the law are met. Starting November 4, 2026, a new section 22VAC40-73-755 and changes to the resident agreement rule (-390) set the rules on consent, shared rooms, costs and recordings.⁠¹⁸
• Liability insurance tiers. Final rule effective September 23, 2026, with an updated Liability Insurance Statement form.⁠¹⁹
• Revised applications. Mandatory from October 1, 2026.⁠¹⁶
• Periodic review of 22VAC40-73. The State Board of Social Services took public comment from June 15 to July 6, 2026, on whether to keep, amend or repeal the ALF standards.⁠²⁷ VDSS had not published the outcome when this guide was reviewed on 2026-10-12. Before you commit to a building, ask your licensing inspector whether any change from that review or from the fee review is planned.

Sources

1. 1
   Virginia General Assembly, Code of Virginia § 63.2-100 (Definitions) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Virginia General Assembly, Code of Virginia § 63.2-1701 (Licenses required; issuance, expiration, and renewal) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Virginia General Assembly, Code of Virginia § 63.2-1706 (Inspections and interviews) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Virginia General Assembly, Code of Virginia § 63.2-1712 (Offenses; penalty) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Virginia General Assembly, Code of Virginia § 63.2-1721 (Background check upon application for licensure) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Virginia General Assembly, Code of Virginia § 63.2-1803 (Staffing of assisted living facilities) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Virginia General Assembly, Code of Virginia § 63.2-1805 (Admissions and discharge; mandatory minimum liability insurance) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Virginia Administrative Code, 22VAC40-73, Standards for Licensed Assisted Living Facilities Checked 12 Oct 2026 · Back to text ↑
9. 9
   Virginia Administrative Code, 22VAC40-80, General Procedures and Information for Licensure Checked 12 Oct 2026 · Back to text ↑
10. 10
    Virginia Administrative Code, 22VAC40-160-10, Fee Requirements for Processing Applications Checked 12 Oct 2026 · Back to text ↑
11. 11
    Virginia Department of Social Services, Assisted Living Facilities (ALF) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Virginia Department of Social Services, Apply for Licensure Checked 12 Oct 2026 · Back to text ↑
13. 13
    Virginia Department of Social Services, Initial Application for a License to Operate an Assisted Living Facility (form 032-08-0100-03, 07/26) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Virginia Department of Social Services, Assisted Living Facility Required Policies and Procedures Checked 12 Oct 2026 · Back to text ↑
15. 15
    Virginia Department of Social Services, Request for Building Evaluation or Inspection (form 032-05-0341-05) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Virginia Department of Social Services, Revisions to Initial and Renewal Applications (memo, August 27, 2026) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Virginia Department of Social Services, 2026 Legislative Information (memo, April 21, 2026) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Virginia Department of Social Services, Notice of Publication: ALF Exempt Action, 2026 Legislative Changes (September 15, 2026) Checked 12 Oct 2026 · Back to text ↑
19. 19
    Virginia Department of Social Services, ALF Final Action: Liability Insurance (memo, August 24, 2026, updated September 23, 2026) Checked 12 Oct 2026 · Back to text ↑
20. 20
    Virginia General Assembly, Code of Virginia § 15.2-2291 (Assisted living facilities and group homes of eight or fewer; single-family residence) Checked 12 Oct 2026 · Back to text ↑
21. 21
    Virginia General Assembly, Code of Virginia § 32.1-102.1:3 (Medical care facilities and projects for which a certificate is required) Checked 12 Oct 2026 · Back to text ↑
22. 22
    Virginia General Assembly, Code of Virginia § 51.5-160 (Auxiliary grants program) Checked 12 Oct 2026 · Back to text ↑
23. 23
    Virginia Department of Social Services, Auxiliary Grant rate letter (effective January 1, 2026) Checked 12 Oct 2026 · Back to text ↑
24. 24
    Virginia Department for Aging and Rehabilitative Services, Auxiliary Grant Checked 12 Oct 2026 · Back to text ↑
25. 25
    Virginia Department of Social Services, 22VAC40-90, Regulation for Background Checks for Assisted Living Facilities and Adult Day Centers Checked 12 Oct 2026 · Back to text ↑
26. 26
    Virginia Department of Social Services, Advanced Registered Medication Aides Working in Assisted Living Facilities (memo, March 4, 2026) Checked 12 Oct 2026 · Back to text ↑
27. 27
    Virginia Department of Social Services, Periodic Review of 22VAC40-73 (memo, June 15, 2026) Checked 12 Oct 2026 · Back to text ↑
28. 28
    Virginia General Assembly, Code of Virginia § 63.2-1702 (Investigation on receipt of application) Checked 12 Oct 2026 · Back to text ↑
29. 29
    Virginia General Assembly, Code of Virginia § 63.2-1705 (Compliance with Uniform Statewide Building Code) Checked 12 Oct 2026 · Back to text ↑
30. 30
    Virginia Administrative Code, 22VAC30-120-10, Adult Services Approved Providers: Definitions Checked 12 Oct 2026 · Back to text ↑
31. 31
    Virginia Department of Social Services, Periodic Review of 22VAC40-160, Fee Requirements (memo, March 9, 2026) Checked 12 Oct 2026 · Back to text ↑
32. 32
    Virginia Register of Regulations, Virginia Register, Vol. 43 Iss. 4: 22VAC40-73 Standards for Licensed Assisted Living Facilities (final exempt action, October 5, 2026) Checked 12 Oct 2026 · Back to text ↑

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