How Nursing Homes Are Overseen and Rated in Virginia

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

Who regulates nursing homes in Virginia?

The Virginia Department of Health (VDH) Office of Licensure and Certification (OLC) licenses nursing homes. When a nursing home accepts Medicare or Medicaid, it is also certified by the federal Centers for Medicare & Medicaid Services (CMS). That is a different system than assisted living, which the Department of Social Services licenses.

The practical difference is that nursing homes face federal standards and the federal Five-Star rating, while assisted living does not. If you want to complain, the OLC complaint line is 1-800-955-1819. For assisted living, see our inspection reports guide. For how the two settings differ, compare assisted living and nursing homes.

What do Care Compare star ratings measure?

Medicare's Care Compare gives each certified nursing home an overall rating of one to five stars built from separate ratings: health inspections, staffing and quality measures. Five is best. The overall star blends the three, so a good overall score can hide a weak area.

Look at the individual pieces. Inspections reflect what surveyors found during visits, staffing reflects nursing hours per resident, and quality measures reflect outcomes such as how residents are doing on certain clinical measures. For example, a home with five stars overall but two on staffing may feel thin on the floor in the evening. The underlying data come from CMS, whose provider data site is data.cms.gov/provider-data, and you can download it if you want to compare many homes at once.

What is a special focus facility and should I avoid one?

A special focus facility is a nursing home that CMS has identified as having a history of serious quality problems and placed in a program of closer oversight. Care Compare marks these homes. A home on the list should be a strong reason to look elsewhere unless you get convincing answers.

If a facility you are considering is on the list, ask what has changed, who the current administrator and director of nursing are, and when the next inspection is due. Also check whether it has recently graduated from the program, because a recent improvement is different from a current problem. Do not rely on the label alone; read the inspection details and compare them with what you see on a visit. A home can be improving or sliding, and the dates tell you which way.

How should Hampton Roads families use nursing home ratings?

Use the ratings to build a short list, then verify with visits. Search the facilities near the hospital and the family, since visits matter more than a star. Compare the three component ratings and read the narrative on the latest inspection. Visit at different hours, including a mealtime and an evening.

The geography matters here. A home on the Peninsula can be hard for a Southside family to visit regularly because of tunnel and bridge traffic, so weigh distance honestly. Judge the people too: ask about nurse turnover and how family concerns are handled. Look at the nursing home directory to see what is nearby. Call ahead to ask about visiting hours, parking and whether staff can meet you at a time that suits a working family.

What are the limits of star ratings?

Star ratings are a snapshot built mostly from reported data and periodic surveys, so they lag behind current conditions. They also cannot show how a particular unit feels or whether staff know your mother's name. New management or a hurricane evacuation can change a home faster than the rating shows.

Ask the ombudsman, whose offices are listed on the complaints page, whether they have concerns about a home you are considering. Residents and their relatives are often the best source. Hospital discharge planners in Norfolk or Newport News can also tell you which homes tend to respond well to families. Medicare coverage of the stay is covered at what Medicare pays, including the three-day inpatient rule that surprises many Peninsula and Southside families after a hospital stay.

How do nursing homes connect to Medicaid payment in Virginia?

Most long-stay residents who run out of private funds rely on Medicaid, and a home must be certified to accept it. Ask on the first call whether the home takes Medicaid, whether your parent would have to change rooms, and how it handles the switch from private pay.

Nursing facility Medicaid limits and spousal protections are laid out on the nursing home Medicaid page. Ask for the Medicaid policy in writing before you sign an admission agreement. A home that is certified but has few Medicaid beds can still be a poor fit.