What is the difference between assisted living and a nursing home in Virginia?
Assisted living facilities are licensed by the Virginia Department of Social Services to provide personal care, supervision and help with medications in a residential setting, while nursing homes are licensed by the Virginia Department of Health and certified by CMS to provide 24-hour skilled nursing and rehabilitation.
A nursing home has licensed nurses on duty around the clock and a physician-directed plan; assisted living provides health care oversight but not continuous skilled nursing.
| Assisted living | Nursing home | |
|---|---|---|
| Regulator | VDSS Division of Licensing Programs | Virginia Department of Health; CMS |
| Nursing | Health oversight, no 24-hour skilled nursing | 24-hour licensed nursing |
| Public rating | No state rating | CMS stars |
| Medicaid | No room and board; AG instead | Covers long-term care if eligible |
How do costs compare between assisted living and nursing homes in Virginia?
CareScout's 2025 Virginia medians put assisted living at about $6,944 a month and a semi-private nursing home room at about $10,250 a month ($11,680 private), but Medicaid pays for long-term nursing home care for eligible people while it does not pay assisted living room and board.
That payment difference is why some families with limited savings end up in a nursing home sooner than care needs alone would suggest. The Auxiliary Grant is the main public help for assisted living.
How can I compare quality between Richmond assisted living and nursing homes?
Nursing homes carry CMS's official 1-to-5-star ratings plus health inspection, staffing and quality data on Care Compare, while Virginia assisted living has no star rating, only VDSS inspection reports listing violations and standards cited.
Our directory shows both side by side: CMS ratings for the region's nursing homes and VDSS inspection counts for each assisted living facility.
When does a Richmond assisted living resident need to move to a nursing home?
A move is usually needed when a resident requires skilled nursing on a continuing basis -- for example complex wound care, frequent injections that staff cannot give, ventilator or tube-feeding care, or two-person help for most transfers -- or when the facility determines through the Uniform Assessment Instrument that it can no longer meet the person's needs.
Virginia's assisted living standards list conditions a facility cannot serve, and each facility's own policy can be stricter. Ask during the first tour which needs would trigger a move, and get the answer in writing in the resident agreement.
Many families avoid a sudden move by choosing a continuing care community in the West End or Midlothian that has a CMS-certified nursing center on the same campus. Check that nursing center's CMS ratings as carefully as the assisted living's VDSS record, because the two parts of a campus can perform very differently.
Can someone go from a nursing home back to assisted living in Virginia?
Yes, when a short-term nursing home stay for rehab ends and the person no longer needs daily skilled care; a new Uniform Assessment Instrument then confirms the assisted living level before readmission.
