By Richmond Senior Advisor Care Team · October 11, 2026
Virginia's special care unit rules require at least two awake direct care staff at night for up to 22 residents, three for 23-32, four for 33-40, and more above that. Ask each Richmond-area unit for its actual overnight schedule, census and use of agency staff, and compare the answers with the rule.
Why does night staffing matter so much in memory care?
Nights are when many people with dementia are most restless, most likely to try to leave, and most likely to fall on the way to the bathroom. They are also when staffing is thinnest. A memory care unit that looks well staffed at a 10 a.m. tour can be very different at 3 a.m., and that is when families are least able to see it.
In the Richmond region, 44 of the 128 licensed assisted living facilities in our October 2026 data include a special care unit, the state's term for a secured memory care setting. Twenty are in Henrico and sixteen in Chesterfield. That is enough choice that staffing should be a deciding factor, not an afterthought.
What does Virginia require overnight in a special care unit?
The standards at 22VAC40-73-1130 set awake staffing inside each special care unit by the number of residents present. These are minimums for the unit itself, separate from the rest of the building.
| Residents present in the unit | Minimum awake direct care staff at night |
|---|---|
| 22 or fewer | 2 |
| 23 to 32 | 3 |
| 33 to 40 | 4 |
| More than 40 | 4, plus 1 for every additional 10 residents or portion |
During the day the floor is two awake staff for up to 20 residents, plus one more for each additional 10, with a narrow exception for very small units of five or fewer when other staff are in the building.
What should I ask to find out the real overnight staffing?
Ask questions that require numbers rather than reassurance:
- How many residents live on the unit this week?
- How many direct care staff are scheduled on the unit from 11 p.m. to 7 a.m. on a Saturday?
- Are any of them shared with the assisted living side of the building?
- How often do you use agency or float staff overnight, and how are they oriented to the residents?
- Who is the most senior person in the building at night, and is a nurse on call?
Compare the answers with the rule for that census. A unit that staffs exactly at the minimum is legal; one that staffs above it when residents are restless is showing judgment.
How does training factor in?
Virginia requires direct care staff in a special care unit to complete at least 10 hours of training in cognitive impairment within four months of starting, and the administrator at least 12 hours within three months. Ask what share of the current night staff have finished that training, and whether agency staff have had any dementia-specific orientation before working the unit.
What can the VDSS inspection record tell you about staffing?
Inspection summaries list each standard cited. Across all Richmond-region facilities since January 2025, rules on personal care and supervision, staff records and medication administration were among the most cited. For a memory care unit, open the last two years of inspections and look specifically for citations related to staffing, supervision or incidents; then ask what changed. You can see each facility's last inspection date and citation count in our memory care directory.
How do mixed-population buildings differ from special care units at night?
Some Richmond-area facilities admit residents with dementia without a special care unit, which Virginia calls a mixed population. Those buildings must keep at least two direct care staff awake and on duty in each building whenever residents are present, with an exception for facilities licensed for ten or fewer residents when no more than three have serious cognitive impairment. That rule covers the whole building, not a secured unit, so a resident with dementia may share overnight staff with everyone else.
What red flags should end a memory care visit early?
Strong odors in the late afternoon, residents left unattended in a locked area, exit doors propped open, staff who cannot say how many residents are on the unit, and evasive answers about the last VDSS inspection are reasons to move on. So is a community that will not let you visit at night or on a weekend before move-in. Good units expect families to ask hard questions and answer with numbers.
What else should I watch for on a memory care tour?
Watch how staff talk to a resident who is confused or upset, whether residents are engaged in something or simply seated, whether exits and outdoor areas are secure without feeling like a ward, and whether the unit smells clean in the late afternoon. Visit once announced and once unannounced near the evening shift change. Then ask for the rate sheet and the criteria that would require a move, because staffing and price are linked: higher care levels usually mean higher fees.
Frequently asked questions
How many staff must be awake at night in a Virginia memory care unit with 30 residents?
At least three direct care staff, under 22VAC40-73-1130 C.
Is memory care a separate license in Virginia?
No. It is a special care unit within a VDSS-licensed assisted living facility.
How much training do Virginia memory care staff need?
At least 10 hours of cognitive-impairment training within four months of starting in the unit.
How many Richmond-area facilities have special care units?
Forty-four of 128 licensed facilities in our October 2026 data.
