For most Virginia families, the question isn’t whether to move a parent into care — it’s when, what kind, and how to pay. Each of the four major settings exists at meaningful scale in Virginia, and the urban-rural cost spread is wider than in most states.

Virginia’s four care settings

In-home care

The setting most older adults prefer and many can use until late in life. Virginia has a robust private-pay home-care market and CCC+ Consumer Directed Services for Medicaid-eligible residents. Private rates run $25–$40/hour for personal care, $40–$65/hour for skilled nursing — with Northern Virginia at the high end of those ranges. 24/7 in-home care costs $14,000–$25,000+ per month at full coverage.1

Common mistake: assuming Medicare will pay for in-home aide hours. It won’t. Medicare covers short-term skilled home health after a hospital stay; it does not cover long-term custodial care at home.

Assisted living (Adult Care Residences / Assisted Living Facilities)

Virginia licenses assisted-living facilities under the Adult Care Residence statutory framework, with assisted- living facilities operating at multiple care levels. Facilities are licensed by the Virginia Department of Social Services. Median statewide cost is around $5,200–$5,800/month, but the spread is dramatic:

Virginia’s ALF licensing structure includes care-level designations that determine what types of residents the facility may serve.2

Memory care

Memory care is specialized assisted living for residents with Alzheimer’s or other dementias. The differences from general assisted living: secured units to prevent elopement, higher staff-to-resident ratios, and programming designed for cognitive impairment. Virginia memory care typically costs $1,500–$2,500/month more than general assisted living at the same property — meaning Northern Virginia memory care can exceed $9,000-$10,000/month.

Skilled nursing (SNF)

Skilled nursing facilities provide 24-hour medical supervision and the highest level of non-hospital care. Two broad use cases: short-term rehabilitation (covered by Medicare for up to 100 days post-hospital) and long-term custodial care (paid by Virginia Medicaid for those who qualify, otherwise private pay). Virginia has approximately 290 licensed nursing homes. Costs run $8,500–$10,500/month for semi-private rooms, $9,500–$12,000 for private — with Northern Virginia at the high end.

Cost-of-care in Virginia by metro

Genworth’s 2024 Cost of Care Survey shows dramatic variation across Virginia.3 Approximate monthly costs (2024 data, rounded):

How to evaluate a Virginia facility, in practice

  1. Visit twice, including once unannounced. Different shifts, different days.
  2. Read the most recent state inspection report. ALFs/Adult Care Residences: Virginia Department of Social Services. Nursing homes: Virginia Department of Health Office of Licensure and Certification. Pay attention to deficiencies cited, plan-of-correction history, and any pattern over multiple years.
  3. Check Medicare’s Care Compare star rating for nursing homes.4
  4. Confirm license designation matches projected needs. For ALFs, ask about care-level designations and what conditions would require resident discharge.
  5. Get the contract in writing before deposit. Virginia ALF and nursing-home contracts can be negotiable on terms. Have an elder-law attorney or geriatric care manager review the contract before signing.
  6. Verify staffing levels. Care Compare publishes payroll-based staffing data for nursing homes. Compare facility-reported staffing to actual reported hours.

Memory care: when the move makes sense

The signal that an assisted-living resident may need to transition to memory care isn’t a specific cognitive score — it’s typically one of:

Most Virginia communities with both general assisted living and memory care keep the resident on the same campus during transition, which reduces relocation stress. Choosing a property with both at the outset is a common Virginia strategy — particularly in Northern Virginia where memory-care costs make planning ahead especially important.

Paying for care — the four sources

Most Virginia families fund long-term care from some combination of:

Nursing-home quality oversight in Virginia

Virginia nursing homes are regulated by the Virginia Department of Health Office of Licensure and Certification; ALFs/Adult Care Residences are licensed by the Virginia Department of Social Services.5 Three quality signals to check before selecting:

For the financial-planning side — how to plan for these costs, when Medicaid is an option, and what the spend-down process looks like — see the Virginia Medicaid guide.