Assisted Living vs. Nursing Home in Virginia

Who licenses assisted living and nursing homes in Virginia?

Different agencies license them. The Virginia Department of Social Services (VDSS) licenses assisted living facilities, and the Virginia Department of Health (VDH), through its Office of Licensure and Certification, licenses nursing homes. Nursing homes that take Medicare or Medicaid are also certified by CMS, the federal Medicare agency.

The split shapes how you check a place. Assisted living inspection findings sit on the VDSS public search, and a copy of the latest findings must hang inside the building. Nursing homes also carry federal Five-Star ratings on Care Compare, which do not exist for assisted living. Complaints go to different hotlines, so keep both numbers handy; the complaints page lists them.

What care does each setting provide in Hampton Roads?

Assisted living provides a room or apartment, meals, medication help, 24-hour supervision, and hands-on help with bathing, dressing, toileting, transferring and eating. A nursing home provides all of that plus continuous licensed nursing care, which assisted living is not allowed to supply as an ongoing need.

Think of the question as one of medical complexity rather than frailty. Someone who needs help getting out of bed but is medically stable usually fits assisted living. Someone who needs skilled nursing around the clock, such as frequent injections, wound care or a feeding tube they cannot manage, tends to belong in a nursing home. A physician and the facility's own assessment make the call, not the family.

Who can an assisted living facility not admit or keep?

Virginia law bars assisted living facilities from admitting or keeping residents who need ventilators, nasogastric tubes, or continuous licensed nursing care. The list also covers stage III and IV pressure ulcers (with a narrow exception for healing stage III), airborne infections needing isolation, and anyone who is an imminent danger to themselves or others.

Other bars include most gastric tubes, ongoing intravenous therapy beyond intermittent doses managed by a licensed professional, psychotropic medications without a diagnosis and treatment plan, and a physician's certification that the placement is no longer appropriate. Maximum physical assistance on the Uniform Assessment Instrument (UAI) combined with Medicaid nursing facility level of care is also a bar unless an independent physician says otherwise. See admission limits for the full list.

How do Medicaid and the Auxiliary Grant pay differently?

Medicaid pays the nursing home bill for eligible residents, while Medicaid does not pay assisted living room and board. In Virginia, the Auxiliary Grant (AG), a state program of $2,130 a month in 2026, is what helps low-income residents in assisted living, and only at facilities that agree to accept it.

The AG leaves a resident a $87 personal needs allowance; a Medicaid nursing home resident keeps $40. Nursing home Medicaid has a 2026 income cap of $2,982 a month and a $2,000 asset limit for a single person. Because not every assisted living facility takes the grant, check acceptance before you tour. See the Auxiliary Grant and nursing home Medicaid.

When does Medicare cover a nursing home stay in Virginia?

Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period, but only after an inpatient hospital stay of at least three days. Days 1 through 20 have no coinsurance; days 21 through 100 cost $217 a day in 2026. Observation days do not count toward the three days.

That makes rehab after a hip fracture or pneumonia a realistic Medicare use, usually for a few weeks. It is not long-term care. Medicare does not pay for assisted living, and it does not pay for ongoing custodial help once skilled care ends. Families often plan an assisted living move for the day rehab stops, so ask the rehab team early when that is likely. Our Medicare page goes further.

How should a Norfolk or Peninsula family decide between them?

Start with what a physician says about nursing needs, then check whether the facility's license and assessment support that level. If daily help is the main need, assisted living is usually more home-like and costs less than a nursing home at the Virginia medians. If skilled nursing is needed daily, a nursing home is the safer choice.

Many families do both in sequence: a nursing home for rehab, then assisted living. Others begin in assisted living and later move when needs outgrow the license. Ask any community what happens at that point and who decides. You can browse assisted living and nursing homes separately.