Residential living care vs assisted living care in Virginia

What are the two levels of care in a Virginia assisted living facility?

Virginia law defines two levels a licensed assisted living facility can provide: residential living care, for adults who need only minimal help with daily activities, and assisted living care, for adults who need at least a moderate level of help; a facility's license says which level or levels it may serve.

The definitions sit in Va. Code § 63.2-100 and are fleshed out in the State Board of Social Services' standards, 22VAC40-73. Residential living care: a level of service for adults who need only minimal assistance with activities of daily living (§ 63.2-100). 22VAC40-73-10 defines minimal assistance as dependency in only one activity of daily living, or in one or more instrumental activities of daily living, as documented on the Uniform Assessment Instrument.

Assisted living care: a level of service for adults who require at least a moderate level of assistance with activities of daily living (§ 63.2-100). Moderate assistance means dependency in two or more activities of daily living on the Uniform Assessment Instrument (22VAC40-73-10).

On the VDSS roster you will see a facility described as residential only or as licensed for assisted living (which in practice includes the residential level too). Our Richmond directory shows that split for every facility.

How does a Richmond facility decide whether a resident needs residential or assisted living care?

The level is set by the Uniform Assessment Instrument (UAI), a state form completed face to face before admission, at least once a year and whenever a resident's condition changes significantly; the count of activities of daily living a person depends on drives the result.

Activities of daily living are bathing, dressing, toileting, transferring, eating and continence; instrumental activities include things like managing medications, money, meals and housekeeping. Dependency in one ADL, or only in instrumental activities, fits residential living care. Dependency in two or more ADLs moves a person to the assisted living level.

For private-pay residents a trained facility staff member, an independent physician or a public agency assessor can complete the UAI; for people receiving an Auxiliary Grant a case manager or qualified public assessor does it.

What happens if a resident in a residential-only Richmond home starts needing more help?

If a reassessment shows the person now needs assisted living care and the facility is licensed only for residential living care, the facility cannot keep serving them at that level, and discharge planning to a facility licensed for assisted living has to begin.

Virginia's discharge rule requires the facility to start planning immediately, tell the resident and family the reason, and normally complete the move within 30 days, with written notice of the actual date and destination at least 14 days ahead except in emergencies. Asking up front which level a home is licensed for avoids a second move a year later.