Residential vs. Assisted Living Care Levels in Virginia

Last verified: October 2026. Figures and rules are re-checked against primary sources.

What is the difference between residential and assisted living care in Virginia?

Residential living care is for adults who need only minimal help with activities of daily living, including people dependent only in medication administration. Assisted living care is for adults who need at least moderate help, including people documented as dependent in behavior pattern. A facility licensed for assisted living care may also serve residential-level residents.

The Virginia Department of Social Services (VDSS) licenses both under 22VAC40-73, the Standards for Licensed Assisted Living Facilities, current version effective February 1, 2018. The label on a brochure means little; the level written on the license is what counts. Ask to see it, and ask what changes in the price if your parent's needs rise from one level to the other.

Which activities of daily living does Virginia measure?

Virginia counts seven activities of daily living (ADLs): bathing, dressing, toileting, transferring, bowel control, bladder control, and eating or feeding. How much help a person needs with these, recorded on the assessment, is what places them at the residential or the assisted living level.

Think of it practically. A retired Navy chief who needs reminders for pills may be residential. His wife who needs hands-on help getting out of a chair and into the shower is not. The Uniform Assessment Instrument turns those observations into a level. Our comparison of the two levels shows how that plays out for families.

How does a Virginia assisted living facility decide whether it can admit someone?

Every admission rests on the Uniform Assessment Instrument (UAI), a physical examination report and a documented interview. The administrator must also give the resident written assurance that the facility's license covers the person's needs (22VAC40-73-310). If the license does not fit, the facility should say no at the door.

Mobility is part of that picture. Whether a facility can take someone who cannot walk or leave the building without help depends on the license and the building, so ask for the answer in writing. A person who outgrows the license later may have to move, which is why discharge rules, covered on the admission limits page, deserve a read before you sign.

What do Virginia assisted living license terms mean for families?

VDSS issues conditional, provisional, one-year, two-year and three-year licenses. VDSS describes a two-year license as going to a facility whose performance complies on a sustained basis with minimum standards and exceeds them in some areas. A shorter term or a conditional license can signal problems.

A one-year license is not always bad news, since new facilities usually begin there. Pair the license term with the actual inspection history, which you can read through the inspection report guide. A conditional license deserves a direct question to the administrator about what is being corrected and by when.

How can Hampton Roads families check a facility's license before touring?

Search the facility by name on the VDSS public assisted living search at legacy.dss.virginia.gov/facility/search/alf.cgi. The listing shows the license status and posts inspection findings, including violation notices. A copy of the most recent inspection findings must also be posted inside the facility.

Do this before you drive across the Hampton Roads Bridge-Tunnel for a tour, not after. Note the license term, the licensed capacity and the date of the last inspection, then bring those facts to the visit. If the paperwork on the wall differs from what the website shows, ask the administrator to explain the difference in writing.

How does the licensing level affect cost and choosing in Hampton Roads?

A higher licensing level generally means more staff time, and communities usually price that in. The statewide private one-bedroom median is $83,328 a year, but where a person falls within the facility's own tiers decides the real bill. Ask for the monthly total at your parent's assessed level.

If your parent may need a secured memory care unit, check that the facility has the separate approval for it. Browse the assisted living directory and then use the table below as a script for your first call. Ask which level the quoted price assumes, and what the monthly total becomes if a reassessment moves your parent up.