Assisted living

Assisted living is a place where older adults live in their own room or apartment and get help with daily life. Staff are on hand day and night. Meals, housekeeping and activities are usually part of the package.^1,2

For a person with dementia, assisted living can be a good next step when home is no longer safe or the family caregiver is worn out. But it is not a nursing home, and not every assisted living community can care for dementia as it gets worse. This page explains what assisted living offers, where its limits are, how Virginia regulates it, and what it costs.

What assisted living offers

Assisted living goes by other names too, such as board and care or supported care. It sits between living on your own and living in a nursing home.¹ It usually brings together a place to live, meals, help with personal care, and some health services.¹

Most communities offer:²

• A private or shared room or apartment, sometimes with a small kitchen
• A trained caregiver on duty around the clock
• Help with daily tasks like bathing, dressing and using the toilet
• Help taking medicines
• Some or all meals
• Planned social and fun activities
• Some nursing help, which varies by state and by community

Many residents need hands-on help. In a 2025 CDC survey of residential care communities (the group that includes assisted living), about 6 in 10 residents needed help with bathing. About half needed help with dressing or walking. Almost half of residents were 85 or older.⁴

Assisted living is not regulated by the federal government. Each state writes its own rules, so what "assisted living" means in one state can differ in another.¹

Assisted living and dementia: what to know

Dementia is common in assisted living. In the 2025 CDC survey, about 37% of residents, more than 1 in 3, had Alzheimer's disease or another dementia.⁴

But dementia care is not the same everywhere. Not all communities offer programs made for people with dementia, so you need to ask.¹ In the CDC survey:⁴

• About 1 in 5 communities had a separate dementia unit or wing.
• About 1 in 10 served only people with dementia.
• Only about 4 in 10 had a registered nurse (RN) on staff as an employee.

A dementia unit is often called memory care. It may or may not be locked.¹ Learn more on our memory care page.

Where assisted living may fall short

In the early and middle stages, many people with dementia do well in assisted living. The setting is calmer and more social than living alone. Meals and medicines happen on time.

Problems tend to come later, when the person:

• Tries to leave the building or gets lost (see wandering)
• Has agitation or aggression that puts others at risk
• Needs full help to move, eat and use the toilet
• Needs nursing care all day and night

At that point, the community may say it can no longer meet the person's needs. In Virginia, the law lists specific reasons a person cannot be admitted or allowed to stay. The next section explains them.

How Virginia licenses assisted living

In Virginia, assisted living facilities are licensed and inspected by the Division of Licensing Programs at the Virginia Department of Social Services (VDSS). A licensed facility gives or arranges personal and health care and 24-hour supervision for four or more adults who are older, ill or living with a disability.⁹

Two levels of care

A Virginia license covers one or both of these levels:¹⁰

• Residential living care: for people who need only a little help with daily activities.
• Assisted living care: for adults who may have physical or mental impairments and need more help.

The state counts eight daily activities: bathing, dressing, toileting, transferring (moving in and out of a bed or chair), bowel control, bladder control, eating and feeding.¹⁰ Ask which level a community is licensed for.

The assessment before move-in

Virginia uses a standard form called the Uniform Assessment Instrument (UAI) to rate a person's needs.¹⁰ It must be done within 90 days before move-in, at least once a year, and again after any major change in health.¹¹ For people who pay privately, trained facility staff or an outside assessor may complete it. For people whose care is publicly funded, a case manager or other qualified assessor does it.¹¹

Rules for residents with serious dementia

Virginia has extra rules for residents with a serious cognitive impairment (a severe, long-lasting loss of thinking ability) who cannot recognize danger or keep themselves safe.¹⁰ There are two ways a facility can care for them.

In a safe, secure environment, awake direct care staff must be on duty in the unit at all times. The minimum numbers are:¹³

A small daytime exception lets one staff member cover a unit of 5 or fewer people if other staff in the building can respond quickly.¹³ These are minimums. Ask what a community actually staffs.

When a person cannot be admitted or must move out

Under Virginia rules, an assisted living facility may not admit or keep a person who:^3,14

• Needs a ventilator
• Has deep pressure sores (stage III or IV), unless a doctor finds a stage III sore is healing
• Needs continuous licensed nursing care
• Is an immediate physical danger to themselves or others
• Needs a feeding tube through the nose, and in most cases a stomach tube
• Is totally dependent in four or more daily activities and meets nursing home criteria, unless an independent doctor decides otherwise
• Has needs that the facility cannot meet or is not licensed for

Hospice care can be given in assisted living if the resident asks and the hospice agrees. A facility can refuse hospice only if the resident signed a statement saying so before move-in.³ See hospice care for dementia.

Discharge rules. A facility can make a resident leave only for set reasons, such as unmet needs, not paying, or closing. It must first try to fix the problem, unless there is an emergency.¹⁴ It must usually give 30 days' written notice that explains the reason and the right to appeal. A copy goes to VDSS and to the state Long-Term Care Ombudsman (an advocate for residents). In an emergency, notice must come within 5 days.¹⁴ During most appeals, the resident can stay.¹⁴

Resident rights in Virginia

Virginia law gives assisted living residents rights. These include privacy, having visitors, managing their own money unless a guardian or conservator has been named, and freedom from abuse, neglect and forced isolation. Restraints are allowed only in limited cases.¹⁵ Residents can complain without fear of payback. Each facility must post contact details for its licensing office, Adult Protective Services and the Long-Term Care Ombudsman.¹⁵

What assisted living costs

Prices vary a lot by place, room size and care needs. The CareScout Cost of Care Survey reported these 2025 medians (the middle price) for assisted living:⁷

Prices in your area may be higher or lower than the state median. Get local quotes in writing.

The base price may not include everything. Many communities charge more as care needs grow, and memory care costs extra. Ask for the full list of fees. For a wider view, see what dementia care costs.

Who pays for assisted living

Most families pay for long-term care out of pocket.¹ Here is what to know about other sources.

Does Medicare pay?

No. Medicare does not cover long-term care, including help with daily tasks, when that is the only care you need. Most health insurance and Medigap plans do not pay for it either.⁸ Medicare still pays for covered doctor visits, hospital care and other medical services while a person lives in assisted living. See what Medicare covers in dementia.

Does Medicaid pay?

Sometimes, for some services, but not everywhere. In the 2025 CDC survey, about half of communities (48%) could take part in Medicaid. About 1 in 6 residents had some services paid by Medicaid.⁴ Some communities accept Medicaid and some do not, so ask what happens if your loved one's money runs out.¹ See Medicaid and long-term care.

What is Virginia's Auxiliary Grant?

The Auxiliary Grant is a Virginia state and local payment for people with low income. It helps pay for care in a licensed assisted living facility or an approved adult foster care home. It is for people who do not get federal SSI or whose SSI is too low. The person must be assessed with the UAI when they move in, every year, and when their needs change. Grant recipients keep a small monthly personal needs allowance.¹⁶ Ask your local Department of Social Services about it, and ask each facility whether it accepts the grant.

Does the VA help?

The VA does not pay a veteran's rent in assisted living. It may help pay for some extra services the veteran needs there. A VA social worker can help you sort out the options.² See VA benefits for dementia.

What about long-term care insurance?

If your loved one has a policy, check whether it covers assisted living. Policies have rules that must be met before they pay.¹ Call the insurer early. See long-term care insurance.

You may also want to learn about PACE, an all-in-one care program for some older adults who qualify.

Assisted living, memory care or a nursing home?

Memory care sits between the two. It is often a special unit inside an assisted living community, which may or may not be locked.¹ Read memory care to compare.

Questions to ask before you choose

Visit more than once, at different times of day. Ask for the most recent inspection report.¹ Our tour checklist has more. Key questions include:

1. Which level of care is this facility licensed for? Does it have a safe, secure environment (locked unit)?
2. How are staff trained in dementia care? Is that training required by the state?¹
3. How many staff work on each shift, day and night? Is a nurse on site?¹
4. How do staff handle hard behaviors like pacing, refusing care or anger?¹
5. Can my loved one "age in place"? What changes in health would mean they must move?¹
6. What does the base rate include? What does each extra level of care cost?
7. Do you accept Medicaid or the Auxiliary Grant? What happens if our money runs out?¹
8. Is hospice care allowed here?¹

You can search for licensed Virginia facilities and file a complaint about one on the VDSS website.⁹

Getting help

Choosing care is hard, and many families feel guilt or grief. The Alzheimer's Association 24/7 Helpline is free at 800-272-3900. Staff can help with housing choices, moving a loved one into care and paying for it.¹⁷ When the time comes, read moving a parent into care. If you are a caregiver feeling hopeless or thinking about harming yourself, call or text 988 any time. See also caregiver stress and burnout.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.