Starting a care business in Virginia

Housing and care for adults starts at four residents. A residential setting that gives personal and health care and 24-hour supervision to four or more aged, infirm or disabled adults needs an assisted living facility license from VDSS. Sites run by one entity are added together, and operating without a license is a Class 1 misdemeanor. Virginia has no licensed small-home category. Room, board, supervision and special services in your own home for up to three adults is adult foster care, and the local department of social services approves the provider instead of VDSS licensing them. The sources reviewed do not say whether a private-pay home of one to three adults needs that approval, so ask your local department. ALF applicants choose either residential living care only or residential and assisted living care. Only the second level lets you keep residents who need moderate help with daily living, and it requires an administrator licensed by the Board of Long-Term Care Administrators. Memory care is a set of added standards (Part X of 22VAC40-73), not a separate license.

An adult day center license comes from the same VDSS division and uses the same fee table: $14 for a one-year license at 12 or fewer participants, up to $600 for three years at 201 or more, billed one year at a time. The Code's definition covers centers that give part-day care to four or more adults who live elsewhere and that are run for profit or ask to be licensed. A nonprofit planning to open without a license should get the regional office's position in writing first. Centers serving only PACE enrollees need no license. Each building is licensed for either ambulatory or nonambulatory participants, so decide whom you will serve before you sign a lease.

In-home care runs on one license with three service lines. A home care organization (HCO) license from the VDH Office of Licensure and Certification covers personal care, home health and pharmaceutical services. Organizations providing only companion, homemaker or chore services fall outside the rule. Once aides feed clients, give bed baths, transfer or lift them, the agency is giving personal care and needs the license. Running an unlicensed HCO is a Class 6 felony. Every applicant pays $1,500 for a three-year license and must show a three-month operating budget backed by reserves for the same period. Skilled agencies must hold the state license and serve clients before seeking Medicare certification. CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026, for six months with possible extensions. The state license is not frozen.

Virginia's child care licensing standards moved from VDSS to VDOE on July 1, 2021. On July 1, 2026 the Code renamed the "family day home" as home-based child care, though VDOE's forms, portal and rules still use the old name. Care in a home for 5 to 12 children under 13, not counting your own or resident children, needs a home-based child care license. With four or fewer you may register voluntarily, but a license or registration becomes mandatory if more than four children under age 2 are present once your own are counted. Two or more children in a building that is not a home, or 13 or more anywhere, make a child day center. Centers run by religious institutions may file for exemption instead. Family day homes in Alexandria, Arlington, Fairfax and Norfolk may also be approved under local ordinance instead of holding a state license, so check with the local office there before applying.

Several rules are changing. VDOE is not collecting child care application fees, initial or renewal, through December 2027, and the State Board of Education has proposed replacing the center standards (8VAC20-780) with a new chapter, 8VAC20-781, which was not yet in force on October 12, 2026. For assisted living, the AED requirement has applied to initial and renewal licenses since July 1, 2026, regulation changes adding AED training and resident electronic-monitoring rules take effect November 4, 2026, new liability insurance tiers took effect September 23, 2026, and VDSS has periodic reviews of both the ALF standards and its fee regulation open.