Special care units: how Virginia regulates memory care

What is a special care unit in a Virginia assisted living facility?

A special care unit -- the regulation's term is a safe, secure environment -- is a self-contained unit for residents with serious cognitive impairment due to dementia who cannot recognize danger or protect their own safety; a facility can have one or more such units, or the entire facility can be one.

22VAC40-73-10 defines a safe, secure environment as a self-contained special care unit for residents with serious cognitive impairments due to a primary psychiatric diagnosis of dementia who cannot recognize danger or protect their own safety and welfare. A facility can have one or more units, or the whole facility can be the unit.

Serious cognitive impairment means a severe, chronic deficit in thought processes, problem-solving, judgment, memory and comprehension that interferes with reality orientation, self-care, recognizing danger and impulse control, and is not caused by acute or treatable conditions or medication reactions (22VAC40-73-10).

On the VDSS search, a facility licensed to operate one shows a Special Care Unit qualification. In the Richmond region we list every one on our memory care directory page.

How many staff must be on duty in a Richmond-area special care unit?

During the day a special care unit with 20 or fewer residents present needs at least two direct care staff awake and on duty in the unit, plus one more for each additional 10 residents; at night it needs two for up to 22 residents, three for 23 to 32, four for 33 to 40, and four plus one per additional 10 above that.

A narrow daytime exception lets one staff member cover a unit of five or fewer residents if two other direct care staff are in the building and one can reach the unit quickly. These counts are minimums set by 22VAC40-73-1130 and are separate from the staffing rules for the rest of the building.

Ask facilities for the scheduled staff on the unit for the night shift on a weekend, and compare it with the number of residents living there that week.

What training does Virginia require for memory care staff?

The administrator must complete at least 12 hours of cognitive-impairment training within three months of starting, and direct care staff working in the unit at least 10 hours within four months (22VAC40-73-1140).

Training topics cover the nature of cognitive impairment, behavior management, communication and the facility's own policies. Ask how many of the staff currently working on the unit have completed it, and how the facility trains agency or float staff who cover shifts.

Can someone with dementia live in a Virginia assisted living facility without a special care unit?

Yes, in some cases: a facility that admits residents with serious cognitive impairment outside a special care unit is a mixed-population setting and must follow separate rules, including keeping at least two direct care staff awake in each building whenever residents are present, with a small-facility exception.

Facilities that admit residents with serious cognitive impairment outside a special care unit (a mixed population) 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 10 or fewer residents when no more than three have serious cognitive impairments (22VAC40-73-1020).

Placement into a secured unit itself requires an assessment of serious cognitive impairment and written approval from the resident's legal representative, using VDSS forms for that purpose.