Assisted Living in Virginia

Agency: Department of Social Services, Division of Licensing Programs
Phone: (804) 726-7157
Website: www.dss.state.va.us

An assisted living facility is a congregate residential setting that provides or coordinates personal and health care services, 24- hour supervision, and assistance for the maintenance or care of four or more adults who are aged, infirm, or disabled and who are cared for in a primarily residential setting. Maintenance or care means the protection, general supervision, and oversight of the physical and mental well-being of an aged, infirm, or disabled individual.

Facility Scope of Care:
Facilities provide residents assistance with activities of daily living, other personal care services, social and recreational activities, and protective supervision. Services are provided to meet the needs of residents, consistent with individualized service plans. Service plans support individuality, personal dignity, and freedom of choice.

Move-In/Move-Out Requirements:
The regulations list several specific criteria for residents who may not be admitted or retained, including, but not limited to, those with: (1) Ventilator dependency; (2) Some stage III and all stage IV dermal ulcers; (3) Nasogastric tubes; (4) Imminent physical threat or danger to self or others; (5) Need for continuous licensed nursing care; and (6) Physical or mental health care needs that cannot be met by a facility as determined by the facility.

Resident Assessment:
The Uniform Assessment Instrument (UAI) is the departmentdesignated form used to assess all assisted living facility residents. There are two versions of the UAI, one for residents receiving Auxiliary Grants and one for private pay residents. Social and financial information that is not relevant because of a resident's payment status is not included on the private pay version. The UAI must be completed prior to admission and updated at least once every 12 months, or more often if needed. The forms are available on the agency Web site. An individual also must have a physical examination prior to admission. In addition, if needed, there must be a screening of psychological, behavioral, and emotional functioning.

Medication Management:
Medications may be administered by licensed individuals or by medication aides who have successfully completed a Board of Nursing approved training program, have passed a competency evaluation, and are registered with the Virginia Board of Nursing. Medication aides are permitted to act on a provisional basis when certain requirements are met. Each facility must have a written plan for medication management. A licensed health care professional must perform an annual review of all the medications of each resident assessed for residential living care, except for those who self-administer all of their medications, and a review every six months of all the medications of each resident assessed for assisted living care.

Physical Plant Requirements:
Private resident bedrooms must be a minimum of 100 square feet if the building was approved for construction or a change in use and occupancy classification on or after February 1, 1996; otherwise a minimum of 80 square feet is required. Shared resident bedrooms must be a minimum of 80 square feet per resident if the building was approved for construction or change in use and occupancy classification on or after February 1, 1996; otherwise a minimum of 60 square feet per resident is required. Other physical plant requirements also apply.

Residents Allowed Per Room:
If the building was approved for construction or change in use and occupancy classification on or after December 28, 2006, there may not be more than two residents residing in a bedroom. Otherwise, there may not be more than four residents residing in a bedroom.

Life Safety:
A written plan for fire and emergency evacuation is required. This plan must be approved by the appropriate fire official. Fire and emergency evacuation drawings must be posted in all facilities. The telephone numbers for the fire department, rescue squad or ambulance, police, and Poison Control Center must be posted by each telephone shown on the fire and emergency evacuation plan or, under specified circumstances, by a central switchboard. Staff and volunteers are to be fully informed of the approved fire and emergency evacuation plan, including their duties, and the location and operation of fire extinguishers, fire alarm boxes, and any other available emergency equipment. Fire and emergency evacuation drill frequency and participation are in accordance with the current edition of the Virginia Statewide Fire Prevention Code. Additional fire and emergency evacuation drills may be held at the discretion of the administrator or licensing inspector and must be held when there is any reason to question whether the requirements of the approved fire and emergency evacuation plan can be met. Each required fire and emergency evacuation drill must be unannounced and its effectiveness evaluated. Any problems identified in the evaluation must be corrected. A record of the required fire and emergency evacuation drills is to be kept in the facility for two years. Assisted living facilities must comply with the sprinkler and smoke detector requirements of the appropriate building and/or fire codes. The International Fire Code is used.

Alzheimer's Unit Requirements:
The regulations cover facilities caring for adults with serious cognitive impairments due to a primary psychiatric diagnosis of dementia who cannot recognize danger or protect their own safety and welfare. At least two direct care staff members must be in the special care unit at all times, with an exception allowing one staff person in the unit under specified circumstances. Doors leading to the outside are required to be monitored or secured. There must be protective devices on bedroom and bathroom windows and on common area windows that are accessible to residents with dementia. Free access to an indoor walking corridor or other indoor area that may be used for walking must be provided. There are other specific requirements for special care units and who may be in them.

Staff Training for Alzheimer's Care:
The administrator and direct care staff must complete four hours of training in cognitive impairments due to dementia within two months of employment. The administrator and direct care staff must also complete at least six more hours of training in caring for residents with cognitive impairment due to dementia within the first year of employment. Topics that must be included in the training are specified. There are annual training requirements for direct care staff and for the administrator.

Staffing Requirements:
The facility must have an administrator who is responsible for overseeing its operation. The facility is required to have staff adequate in knowledge, skills, and abilities and sufficient in number to provide services to maintain the physical, mental, and psychosocial well-being of each resident, and to implement the fire and emergency evacuation plan. There must be a staff member on the premises at all times who has a current first aid certificate, unless the facility has an on-duty registered nurse or licensed practical nurse. In addition, each direct care staff member must receive certification in first aid within 60 days of employment and then maintain current certification. There must also be a staff member on the premises at all times who has current certification in CPR. In facilities licensed for more than 100 residents, there must be at least one additional employee with current CPR certification for every 100 residents or portion thereof. A licensed health care professional must be on site at least every six months to provide health care oversight for residents who meet the residential living care criteria and at least every three months for residents who meet the assisted living care criteria. There are additional requirements to meet skilled nursing and rehabilitative needs of residents.

Staff Education Training:
Staff are required to be trained in specified areas to protect the health, safety, and welfare of residents. When the assisted living level of care is provided, direct care staff must be registered as a certified nurse aide or complete one of the other specified educational curricula

Medicaid Policy and Reimbursements:
A Medicaid Alzheimer's assisted living waiver became effective in 2006.