If you're arranging dementia care for a parent in Virginia, the term you'll keep running into is a "safe, secure environment." That's the state's name for memory care: a locked or secured unit inside a licensed assisted living facility, with its own admission rules and staffing protections. This guide walks through what those rules require, what it costs, and how to vet a place.

In This Guide

What Memory Care in Virginia Is

When you start calling places, "memory care" gets used as if it's a single licensed thing. In Virginia, it isn't a separate license at all. It's a specific kind of unit inside an assisted living facility, and the state has a precise name for it: a safe, secure environment.

An assisted living facility, or ALF, is licensed by the Virginia Department of Social Services, not the Department of Health, which licenses nursing homes. An ALF is a residential setting that provides personal and health care, 24-hour supervision, and assistance for four or more adults who are aged, infirm, or have disabilities. A safe, secure environment is a self-contained part of that ALF, secured or locked so that residents with dementia can't wander out and into danger. That's what "memory care" usually means here on the ground.

What makes the safe, secure environment different from a regular assisted living wing isn't a marketing label. It's a set of binding rules in the Virginia Administrative Code (22VAC40-73) about who can be admitted, who has to approve the placement, and how the unit is staffed overnight. Those rules exist because a locked unit is a serious thing: it restricts a person's freedom of movement, and the state treats putting someone there as a decision that has to be justified and approved, not just sold.

One thing to settle early is how you'll pay. Assisted living in Virginia is largely private-pay, and standard Virginia Medicaid does not cover ALF room and board. The main public help is the Auxiliary Grant, a state income supplement that helps people who receive SSI, or who are aged, blind, or disabled, pay room and board at a licensed ALF up to a set monthly rate. It's separate from Medicaid and needs its own application.

The Protections Behind a Safe, Secure Environment

Here's the part most families don't know going in, and it's the part worth understanding. A facility can't simply move your parent into a locked unit because it has a bed open. Virginia sets two gates the placement has to clear first, and you can ask about both directly.

The rule requires What it means for your parent
An independent clinical assessment An independent licensed clinical psychologist or physician (not someone employed by the facility) must assess a serious cognitive impairment from a primary dementia diagnosis, with an inability to recognize danger or protect their own safety
Written placement approval, in priority order The facility must get written approval for the locked placement from the resident if able to decide, or otherwise a guardian or legal representative, an authorized relative, or an independent physician skilled in dementia, in that order
Minimum awake overnight staffing Direct-care staff must be awake and on duty through the night, with the minimum scaling up as the number of residents grows, so the unit isn't left to a single sleeping aide

The independent assessment is the protection that matters most. Because the clinician doing it can't be employed by the facility, the judgment that your parent actually needs a secured setting doesn't come from the place trying to fill it. The assessment has to find a serious cognitive impairment from a primary dementia diagnosis and an inability to recognize danger. A diagnosis of dementia alone isn't the test; the question is whether the person can keep themselves safe.

The written-approval step is the second gate. Even with the assessment in hand, the facility has to obtain written approval for the locked placement, and the rule names who can give it, in order: the resident first, if able to decide; then a guardian or legal representative, an authorized relative, or an independent physician skilled in dementia. If you're the adult child arranging this, knowing where you fall in that order tells you whether the decision is yours to make or whether it runs through a guardian or physician.

The overnight staffing rule is quieter but it's the one you feel at 2 a.m. The regulations require awake direct-care staff overnight, with the minimum rising as the unit's census grows, so a secured dementia unit isn't left to a single aide asleep at a desk. When you tour, ask exactly how many awake staff are on the unit overnight and how that changes when it's full.

What It Costs

Cost is usually what families brace for, and we'll be straight with you: there's no clean single number for memory care in Virginia. The state doesn't publish one, and because memory care isn't its own surveyed category, the industry surveys that track senior-care prices don't isolate it the way they isolate assisted living.

What we do have is a solid anchor for the base. Per the Genworth/CareScout 2024 Cost of Care Survey, the most recent state-level data, assisted living in Virginia runs a median of about $6,513 a month (roughly $78,150 a year), a little above the national figure. Memory care costs more than that, here as everywhere, because a safe, secure environment means heavier staffing, the awake overnight coverage the state requires, a secured physical layout, and dementia-specific programming. How much more depends on the facility, its size, and the level of care, and prices run higher in Northern Virginia than in rural parts of the state. Treat memory care as a premium on top of the assisted-living base rather than a fixed figure, and be skeptical of any source that quotes one precise statewide number for it.

For context, the same survey put a semi-private nursing-home room in Virginia at about $8,669 a month and a private room at about $9,825, both somewhat below the national medians. Those are industry-survey figures, not government numbers, so use them to set expectations, then get a specific written quote from any place you're serious about. The advertised figure is almost always a base rate. Ask each facility what the base includes, how it charges as care needs grow, how it reassesses care as dementia progresses, and how often rates rise. Two places with the same headline price can land far apart once the dementia-care fees are in.

Most families pay for this privately, since standard Medicaid won't cover ALF room and board. If your parent receives SSI or is aged, blind, or disabled, look into the Auxiliary Grant, which can supplement room and board at a licensed ALF up to a set rate, though it's a modest help against memory-care pricing and runs on its own application.

How to Vet a Safe, Secure Environment

You don't have to become an expert in dementia care to make a good decision. You have to confirm the placement is being done right and ask the questions Virginia's rules hand you.

  1. Ask whether the unit is a licensed safe, secure environment. Not every place that says "memory care" runs a secured unit under the 22VAC40-73 rules. Confirm the unit is licensed as a safe, secure environment, and ask to see how it's secured.
  2. Confirm the independent assessment happened. Ask who did your parent's cognitive assessment and whether that clinician is independent of the facility. A facility steering you away from an outside assessment is a flag; the rule exists precisely so the decision isn't theirs alone.
  3. Know your place in the approval order. Find out whether the written approval runs through you, a guardian, or a physician. If your parent can still make the decision, their consent comes first; if not, sort out who holds that authority before admission day.
  4. Pin down overnight staffing. Ask how many awake direct-care staff are on the unit overnight and how that changes at full census. Then tour once around a mealtime, when staffing and the mood of a place are hardest to stage, and watch how aides speak to residents who are confused or upset.
  5. Get the costs in writing, and read the discharge terms. Ask for a written breakdown of the base rate, what dementia care adds, how care levels get reassessed, and what triggers an increase. Bring the admission agreement home to read the refund and discharge terms without a salesperson in the room. Discharge terms matter more in dementia care, where needs change and a place may decide it can no longer meet them.

You can also check a facility's licensing status and inspection history through the Virginia Department of Social Services, which licenses every ALF in the state. Tour at least a couple of places. The goal isn't a perfect one. It's a place whose limits you understand going in.

Frequently Asked Questions

It's the state's term for memory care: a locked or secured special-care unit inside a licensed assisted living facility, governed by Virginia Department of Social Services rules (22VAC40-73). The unit is secured so residents with dementia can't wander into danger, and Virginia sets specific rules for who can be admitted, who must approve the placement, and how the unit is staffed overnight.

Two things. First, an independent licensed clinical psychologist or physician (not someone employed by the facility) must assess a serious cognitive impairment from a primary dementia diagnosis, with an inability to recognize danger or protect their own safety. Second, the facility must obtain written approval for the placement, in priority order, from the resident if able to decide, or otherwise a guardian or legal representative, an authorized relative, or an independent physician skilled in dementia.

Standard Virginia Medicaid does not pay assisted living facility room and board, and memory care here lives inside an ALF, so most families pay privately. The main public help is the Auxiliary Grant, a state income supplement that helps people on SSI, or who are aged, blind, or disabled, pay room and board at a licensed ALF up to a set rate. It's separate from Medicaid, needs its own application, and is a modest help against memory-care pricing.

There's no reliable single statewide figure for memory care alone. Use the assisted-living base as your anchor, about $6,513 a month per the Genworth/CareScout 2024 survey, and expect memory care to run higher because of the heavier staffing, awake overnight coverage, and secured setting. Prices run higher in Northern Virginia than in rural areas, and the advertised rate is usually a base that rises as care needs grow, so get a written breakdown from any place you're considering.

Virginia's rules require awake direct-care staff on duty overnight, not staff who sleep on call, with the minimum number scaling up as the unit's census grows. That's the protection behind the late-night hours, when a resident may become disoriented or try to leave. When you tour, ask how many awake staff cover the unit overnight and how that changes when it's full.

Learn More

Find personalized help comparing memory care in Virginia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.