Virginia nursing home regulations are set primarily by the state’s Rules and Regulations for the Licensure of Nursing Facilities (12VAC5-371), enforced by the Virginia Department of Health’s Office of Licensure and Certification. The rules cover licensing, staffing, the physical building, food service, infection control, resident rights, abuse reporting, and penalties for violations. Facilities that also participate in Medicare or Medicaid answer to a second layer of federal requirements on top of the state code.
Who Licenses and Inspects Virginia Nursing Homes
No one may operate a nursing facility in Virginia without a license from the Office of Licensure and Certification (OLC). The OLC reviews the application, inspects the facility before opening, and requires a written corrective action plan, signed by the person responsible for operations, for any deficiencies found during that initial review.1Cornell Law School. Virginia Administrative Code 12VAC5-371-110 – Management and Administration
Once open, the facility has to post its current license where the public can see it, and the OLC continues to inspect, review records, and investigate complaints. State-licensed nursing homes are inspected at least every two years. Facilities certified for Medicare or Medicaid receive additional federal surveys on average once a year, and those surveys are unannounced.2Virginia Department of Health. Division of Long-Term Care Services – Licensure And Certification
Any change that affects the license — a new owner, a new administrator, a different name, a different address, or a change in licensed bed capacity — has to be reported to the OLC in writing at least 30 calendar days before it takes effect.1Cornell Law School. Virginia Administrative Code 12VAC5-371-110 – Management and Administration
Staffing Rules
Virginia does not set a single nurse-to-resident ratio. Under 12VAC5-371-210, each facility has to provide qualified registered nurses, licensed practical nurses, and certified nurse aides on every shift, seven days a week, in numbers sufficient to meet the assessed care needs of every resident. Staffing is supposed to flow from individual care plans, not a blanket formula, and a nursing supervisor designated by the director of nursing must be responsible for all nursing activities in the facility or an assigned section.3Virginia Code Commission. Virginia Administrative Code 12VAC5-371-210 – Nurse Staffing
Nursing duties may only be performed by qualified RNs and LPNs, except for tasks a registered nurse may delegate to a nurse aide under Virginia’s nursing practice rules. Before a nurse aide provides resident care, the facility has to verify that the person is a certified nurse aide in good standing, is enrolled full-time in an approved training program, or has completed one and is awaiting registry placement. Anyone hired as a nurse aide must be certified within 120 days.3Virginia Code Commission. Virginia Administrative Code 12VAC5-371-210 – Nurse Staffing
All resident-care staff must receive annual in-service training. The required topics are listed in 12VAC5-371-260 and include infection prevention, fire safety and emergency preparedness, restraint use and alternatives, resident rights and privacy, care of cognitively impaired residents, and basic resuscitation. The facility has to keep written records of the content and attendance for every session.4Virginia Code Commission. Virginia Administrative Code 12VAC5-371-260 – Staff Development and Inservice Training
For Medicare and Medicaid facilities, federal rules at 42 CFR 483.12(a)(3) require criminal background and abuse-registry checks on prospective employees before they provide direct resident care.5U.S. Department of Health and Human Services Office of Inspector General. Background Checks for Nursing Home Employees
A federal minimum staffing rule finalized by CMS in April 2024 would have required 3.48 total nursing hours per resident per day and 24/7 registered nurse coverage in Medicare- and Medicaid-participating facilities. That rule was repealed on December 2, 2025, so no federal minimum hours-per-resident-day requirement is currently in effect.6HHS.gov. HHS Cleanup of Federal Nursing Home Minimum Staffing Standards Rule Expands Access to Rural and Tribal Health Care Virginia’s needs-based standard still applies.
The Building, Food, and Infection Control
Part V of 12VAC5-371 sets the physical standards. New construction, additions, renovations, and repairs must conform to the Virginia Uniform Statewide Building Code and be consistent with the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities from the Facility Guidelines Institute. Plans must be dated, stamped with a professional seal, and signed by the architect certifying code compliance.7Virginia Code Commission. Virginia Administrative Code 12VAC5-371-410 – Architectural Drawings and Specifications
Sleeping areas have minimum space requirements and generally can house no more than four residents. Bathrooms need grab bars, non-slip flooring, and accessible fixtures. Working nurse call systems have to be available to residents. Ventilation, lighting, and plumbing must be maintained to prevent hazards.
Housekeeping and waste-disposal standards live in 12VAC5-371-370, with dedicated areas for medical waste. The dietary program must meet the Virginia Food Regulations (12VAC5-421). A qualified dietitian develops menus, including therapeutic diets prescribed by a resident’s physician, and helps train staff on food preparation and sanitation. Disposable dinnerware is allowed only in emergencies, for infection control, during special activities, or when a care plan calls for it.8Cornell Law School. Virginia Administrative Code 12VAC5-371-340 – Dietary and Food Service Program Infection prevention is addressed directly in 12VAC5-371-180 and reinforced through the annual training requirement.4Virginia Code Commission. Virginia Administrative Code 12VAC5-371-260 – Staff Development and Inservice Training
Resident Rights
Under 12VAC5-371-150, residents keep a broad set of personal rights. They can participate in their own care decisions, accept or refuse treatment, review their medical records, and appoint a healthcare proxy. Facilities must obtain informed consent before administering treatments.
Privacy and autonomy get specific protection. Residents have unrestricted access to mail, phone calls, and visitors unless there is a documented medical reason to limit contact. They keep control over personal possessions and finances. If the facility manages a resident’s funds, it takes on fiduciary duties, and mismanagement can expose it to legal liability.
Restraints
Physical restraints are devices or methods that restrict movement and that a resident cannot easily remove. Chemical restraints are medications used to control behavior rather than to treat a diagnosed medical or psychiatric condition. Under 12VAC5-371-330, both types may be used only after less restrictive alternatives have been tried and found ineffective, and the restraint has to be removed at the earliest possible time. A restrained resident must be continuously monitored, and restraint use and alternatives must be part of annual staff training.4Virginia Code Commission. Virginia Administrative Code 12VAC5-371-260 – Staff Development and Inservice Training
Resident and Family Councils
Residents have a federally protected right to form or take part in a resident council to raise concerns about facility policies and operations. The nursing home must provide meeting space and must listen to and act on the council’s grievances and recommendations. Family members and legal guardians can form family councils on the same footing.9Centers for Medicare and Medicaid Services. Your Rights and Protections as a Nursing Home Resident
Involuntary Discharge and Transfer
A nursing home cannot decide unilaterally to discharge a resident. Federal law limits involuntary discharge or transfer to specific grounds: the resident’s welfare requires it and the facility cannot meet the resident’s needs; the resident has improved enough that facility-level care is no longer necessary; the safety or health of other residents is endangered; the resident has failed to pay after reasonable notice; or the facility is closing. The facility has to give written notice of the reason, the proposed effective date, and how to appeal. In most situations the notice must be given at least 30 days before the discharge date.
If a Medicare beneficiary is told their skilled nursing coverage is ending, they can request a fast appeal through a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). To stay in the facility during the appeal without additional cost, the resident has to request the review no later than noon the day before the termination date on the Notice of Medicare Non-Coverage. The BFCC-QIO typically decides by the close of business the day after it receives everything it needs.10Medicare.gov. Fast Appeals
Reporting Abuse and Neglect
Under the federal Elder Justice Act, nursing homes that receive at least $10,000 a year in Medicare or Medicaid funds must report suspected crimes against residents to both law enforcement and the state health department. If the suspected abuse resulted in serious bodily injury, the report is due within two hours of forming the suspicion. For other suspected crimes, the deadline is 24 hours. Failure to report can lead to penalties against the facility and, in some cases, against individual staff members.
Residents and families can also contact Virginia’s Long-Term Care Ombudsman program, which operates under the federal Older Americans Act. The Ombudsman investigates complaints, advocates for residents, and can help resolve disputes without a formal state complaint. Facilities have to give residents access to ombudsman services.11Administration for Community Living. Long-Term Care Ombudsman Program Employees who report violations are protected from retaliation by several federal laws, including the False Claims Act and the Affordable Care Act’s whistleblower provisions.
Complaints and Penalties
Anyone can file a complaint with the OLC about a Virginia nursing home. Residents, family members, and staff can all file, and complaints can be submitted anonymously. Complaints alleging immediate danger to a resident’s health or safety are prioritized for rapid investigation, and the OLC has the authority to investigate complaints through its inspection process.1Cornell Law School. Virginia Administrative Code 12VAC5-371-110 – Management and Administration
When inspectors find violations, the facility receives a Statement of Deficiencies and must return a signed Plan of Correction within 10 days, with specific dates for completing each corrective action.12Centers for Medicare and Medicaid Services. Statement of Deficiencies and Plan of Correction CMS-2567 Deficiency reports become public within 14 days of the facility’s receipt.13Centers for Medicare and Medicaid Services. Release of CMS-2567 Statement of Deficiencies and Plan of Correction
Under Virginia Code § 32.1-27.3, the Commissioner of Health can impose civil penalties of up to $500 per violation per day, capped at $10,000 for a series of related incidents of noncompliance.14Virginia General Assembly. Virginia Code 32.1-27.3 – Sanctions Civil Penalty The Commissioner can also require directed training, install temporary management, freeze new admissions, or revoke the license for repeated or serious violations. Medicare- and Medicaid-participating facilities face parallel federal enforcement from CMS, which can suspend funding or terminate the facility from federal programs. Facilities can challenge state enforcement through an administrative hearing.
Paying for Nursing Home Care
Payment rules matter because they shape a resident’s rights at admission and during a stay. Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period. For 2026, the resident pays nothing for the first 20 days after the initial deductible; days 21 through 100 carry a coinsurance charge of $217 per day; and Medicare pays nothing beyond day 100. Coverage requires a qualifying hospital stay and an ongoing need for skilled nursing or therapy, so many long-term residents eventually shift to Medicaid or private pay.15Medicare.gov. Skilled Nursing Facility Care
Medicaid eligibility in 2026 generally requires no more than $2,000 in countable resources for an individual, or $3,000 for a couple. When one spouse enters a nursing home and the other stays in the community, federal spousal impoverishment rules let the community spouse keep between $32,532 and $162,660 in countable resources. Homes with equity below $752,000 are typically excluded from the resource count, with a maximum exclusion of $1,130,000.16Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
Federal law bars a nursing home from requiring a family member or other third party to personally guarantee payment as a condition of admission or continued stay. A facility can ask someone with legal access to the resident’s income or resources to sign an agreement to use those funds for the resident’s care, but signing that agreement does not create personal financial liability.