Virginia's Department of Social Services has established a comprehensive set of regulations that assisted living care communities statewide must follow. Below are some of the key state regulations governing assisted living operations you should be familiar with.

Assisted Living Service Plan Requirements

In Virginia, assisted living community staff are required to create an individual service plan for each resident. This is most often done when the resident moves into the community, and they must be updated at least once a year. Plans are drafted by facility staff in conjunction with the resident and the resident's doctor, family, caregiver and other concerned parties. Plans are split into major sections, according to needs and how the care is to be delivered. Individual care plans cover:

Activities of daily living (ADLs) refer to residents' personal needs, which must be delivered on an individual basis. These include:

• Bathing
• Dressing
• Toileting
• Transferring
• Bowel and bladder control measures
• Eating and feeding assistance

Instrumental activities of daily living (IADLs) are more group-oriented activities and include:

• Meal preparation
• Housekeeping
• Laundry
• Money management

Ambulation refers to how the resident can get around, both inside and outside of the community property.

Hygiene and grooming goes over the plan for helping residents with personal care needs, specifically:

• Shampooing, combing and brushing hair
• Shaving
• Trimming fingernails and toenails (if medically appropriate)
• Skin care

• Arrangement for transportation
• Arrangement for shopping
• Use of the telephone
• Correspondence

Assisted Living Admission Requirements

The State of Virginia sets certain requirements for admission and retention of assisted living care residents. Before a senior may be admitted to one of the state's licensed communities, staff must certify that:

• an individual treatment plan has been completed and submitted for the resident.
• the resident's personal care physician has agreed that assisted living is the appropriate level of care, as opposed to memory care or skilled nursing.
• the resident has had a mental health screening.
• staff have met with and designated a contact person who can act for the resident in the event of emergencies and/or incapacity.

Assisted Living Scope of Care

The State of Virginia licenses assisted living care communities to house residents and provide limited amounts of non-medical assistance. To keep licensure, communities must stay within their designated scope of care, neither falling short nor exceeding it. At a minimum, Virginia's assisted living communities must provide safe, clean and comfortable living conditions, emergency assistance in case of a fall or other injury, regular meal service and help with ADLs. Because assisted living is not considered medical care, staff may only assist residents taking medication if the resident can largely self-administer the treatment, such as pills or oxygen.

Assisted Living Medicaid Policy

Some assisted living communities in Virginia accept Medicaid as a form of payment from prospective residents who qualify for benefits under PACE. Seniors in Virginia who receive SSI/SSDI may be able to use that to cover their housing costs. Remember to check with your community if you plan to pay for assisted living using these benefits, and be sure to ask staff at the communities you’re considering whether they can process PACE, Medicare, Medicaid and/or SSI/SSDI benefits as payment.

Assisted Living Facility Requirements

Virginia requires assisted living care communities to meet a variety of facility requirements to ensure safety and accessibility for residents and visitors. In general, the physical requirements for assisted living buildings must meet or exceed the standards for the Virginia Uniform Statewide Building Code. Care-specific requirements include:

• Nonslip surfaces in all common areas
• Season-appropriate outdoor furniture available to residents in pool and patio areas
• Enclosed walkways between rooms and common areas, such as dining halls and game rooms
• Central heating and air conditioning for every room
• Fixed thermostats or movable thermometers to monitor temperatures; temperatures during the day are to be set at 72 degrees Fahrenheit. Night temperatures no lower than 68 degrees.
• Single-occupancy rooms may have their own temperature controls, provided the resident can safely operate them
• Facilities are to be free of insect, rodent and other vermin infestations

Medication Management Regulations

Staff at Virginia's assisted living care communities may be called on to assist residents with some aspects of medication management. All staff must be trained in the appropriate procedures and scope of care allowed for assisted living in Virginia. Not all medical interventions are allowed, but some assistance can be given for largely self-administered medication. Examples include reminders to take medication on time, application of medicated topical creams and ointment, providing residents with over-the-counter medication that has not been prohibited by a doctor, such as analgesics or decongestants, and some emergency interventions, such as rescue inhalers for residents having an asthma attack. Residents can also generally get help crushing up pills if they usually mix their medication into food or drinks but need assistance with the preparation.

Staffing Requirements

Virginia law requires a minimum of two staff members to be awake and on duty at all times when residents are present. For live-in communities, this is a permanent staffing requirement. For facilities with sizable populations, the staffing requirements scale upward, but the general requirement is to keep enough staff on hand to operate the facility without leaving residents without immediate assistance, if needed.

For excursions outside of the community, such as medical visits and day trips, the assisted living community must designate an 'appropriate' number of staff to travel along with residents. This requirement is also geared toward having enough people on hand to ensure residents' safety throughout their trip.

Staff Training Requirements

Administrators at Virginia's assisted living care communities must, within three months of hire, undergo at least six hours of training in working with residents who have cognitive impairments. Staff members must undergo similar training within four months of their hire date. Both staff and administrators must also have at least two hours of training in the care needs of cognitively impaired residents during their first month on the job. Annual recertification is required for each of these training modules, with evidence of completion submitted to the state.

Background Checks for ALR Staff in Virginia

Background checks are standard for all employees who have access to the grounds of a Virginia assisted living care community. This check is included in the standard character and reputation investigation communities must conduct prior to each hiring. Individuals with felony backgrounds and/or domestic violence convictions, as well as certain offenses related to moral turpitude — such as sex crimes, whether felony or misdemeanor — are permanently barred from employment in Virginia's assisted living properties.

Requirements for Reporting Abuse

Elder abuse includes any instances of physical, sexual or emotional abuse, caregiver neglect or financial abuse. Managers of assisted living care communities are mandated reporters under Virginia state law and must report any suspected case of elder abuse, regardless of their opinion about the credibility of the allegation or evidence. Staff members are also trained to recognize and report cases of abuse or neglect.