Virginia assisted living rules: what you must document about each resident

Many states leave "social history" to the facility's own forms. Virginia writes it into the standards. Section 22VAC40-73-380 lists 23 pieces of personal and social information to gather "prior to or at the time of admission," and several are exactly the material a life-enrichment team uses. The service plan rule then names individuality and freedom of choice as principles the plan must support.

Who these rules cover

22VAC40-73, Standards for Licensed Assisted Living Facilities, applies to every licensed assisted living facility in Virginia. The "department" in the standards is the Virginia Department of Social Services. Facilities are licensed for residential living care only, or for both residential and assisted living care, and some requirements, including activity hours, differ by license type.

Dementia care in a locked unit falls under the "safe, secure environment" article (22VAC40-73-1080 through 1140). A safe, secure environment is "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."

Personal and social information at admission

Under 22VAC40-73-380, the facility must obtain personal and social information before or at admission. Alongside names, addresses, legal representatives, physicians, allergies and advance directives, the list includes:

"5. Birthplace, if known; 6. Marital status, if known;" ... "14. Name, address, and telephone number of clergyman and place of worship, if applicable;" ... "16. Service in the armed forces, if applicable; 17. Lifetime vocation, career, or primary role; 18. Special interests and hobbies;" ... "22. Current behavioral and social functioning including strengths and problems"22VAC40-73-380 A

And it is not a one-time form:

"B. The personal and social information required in subsection A of this section shall be placed in the person's record and kept current."22VAC40-73-380 B

For people with mental illness, intellectual disability, substance use or behavioral disorders, 22VAC40-73-340 also requires a psychosocial and behavioral history before admission, gathered from referral documents or, for someone coming from home, from "primary sources, such as family members, friends, or physician." If the person is admitted, that history "shall be used in the development of the person's individualized service plan."⁴

The Uniform Assessment Instrument

Virginia uses a single statewide tool, the UAI, governed by the assessment regulation at 22VAC30-110. Under 22VAC40-73-440, every resident and applicant is assessed face to face:

"The UAI shall be completed prior to admission, at least annually, and whenever there is a significant change in the resident's condition."22VAC40-73-440 A

The UAI must be completed within 90 days before admission. For private pay residents it can be done by trained facility staff (with an administrator who has also completed the training and signs it), an independent physician, or a qualified public agency assessor. Annual and significant-change UAIs are used to decide whether the facility can still meet the resident's needs.²

The individualized service plan

A preliminary plan of care covering basic health and safety needs is due on or within seven days before admission, unless the full ISP is done on the day of admission. The comprehensive ISP is written by the licensee, administrator or designee who has completed department-approved ISP training, "in conjunction with the resident and, as appropriate, with the resident's family" and others. Two principles are spelled out:

"2. The plan shall support the principles of individuality, personal dignity, freedom of choice, and home-like environment ... Whenever possible, residents shall be given a choice of options regarding the type and delivery of services."22VAC40-73-450 B

The ISP is due within 30 days after admission. It must describe each identified need, based on the UAI, the admission physical, an "interview with resident," and other sources, along with the services, who provides them, when and where, and the expected outcome. It is signed by the resident or legal representative and reviewed at least every 12 months. If a resident needs an individual activity schedule, that schedule becomes part of the ISP (22VAC40-73-520 I 6).³

Activities and recreation

22VAC40-73-520 is one of the more detailed activity rules in the country. Activities must support independence, "accommodate individual differences," and offer a weekly mix that is physical, social, cognitive or creative, productive, sensory, "reflective or contemplative," connected to nature, and outdoors when weather allows. A facility licensed for both residential and assisted living care must schedule at least 14 hours a week, no less than one hour a day (11 hours for residential-only facilities). A monthly written schedule must be posted and kept for two years, and residents are encouraged but never forced to join.⁵

The rule also asks for "unscheduled staff and resident interaction throughout the day" that promotes socialization. Knowing a resident's former career or a favorite hobby is what makes that interaction easy.

Safe, secure environments (dementia units)

Before admission to a safe, secure environment, an independent licensed clinical psychologist or qualifying physician must assess the resident in writing, covering cognition, thought and perception, mood, behavior, speech and appearance (22VAC40-73-1090). The facility must document why placement is appropriate, and review continued placement six months after admission and annually after that, in consultation with the resident, family, staff and clinicians as appropriate (22VAC40-73-1110).⁶

Activities increase to at least 21 scheduled hours a week, no less than two hours a day, with multiple short activities where attention spans require them. A designated activities coordinator must be on site at least 20 hours a week and:

"shall maintain personal interaction with the residents and familiarity with their needs and interests"22VAC40-73-1120 F

What surveyors tend to look for

Based only on what the standards require you to document:

• A complete 22VAC40-73-380 record at admission, including vocation, interests and hobbies, military service and place of worship where applicable, and evidence it has been kept current.
• A UAI done before admission, annually, and at significant changes, by a qualified assessor.
• A preliminary plan by admission and a signed comprehensive ISP within 30 days that shows the resident was interviewed and involved.
• Annual ISP reviews, and individual activity schedules in the ISP where needed.
• Posted monthly activity schedules with the required weekly hours and variety, kept for two years.
• In safe, secure environments, the independent assessment, placement reviews, 21 weekly activity hours and a qualified coordinator.

Gathering vocation, interests and life story well

A line that says "retired, likes gardening" meets the letter of 22VAC40-73-380 but gives staff little to work with. Some better habits:

• Turn each field into a question. "Tell me about the work you were proudest of." "Where did you grow up, and what was the house like?" "What did you do in the service?"
• Take two or three conversations. Use the 30 days before the ISP is due rather than one intake meeting.
• Include family, with the resident's agreement. The ISP rule already invites family participation "as appropriate."
• Write down what to avoid. Military service or a lost spouse can be a source of pride or of pain. Record which.
• Refresh at the annual UAI and ISP review. The rule says "kept current," so ask what has changed.

How Porchlight can help

Porchlight is a life-story tool for senior-care communities. A resident taps one large button on a tablet, a life question is read aloud and shown in large type, and they talk; the answer is recorded and transcribed. More than 800 human-written questions are organized by life chapter, any question can be skipped, and nothing is scored. Staff can record profile facts, including topics to avoid. Family get a private page to listen, reply by voice and add their own questions and photos. Staff get a "Know Your Resident" briefing with conversation starters, story highlights, a printable biography and a Monday email digest.

It helps you gather and keep the vocation, interests and personal history that 22VAC40-73-380 and the ISP draw on, in the resident's own words. The UAI, the ISP and compliance with the standards remain your community's responsibility.

Frequently asked questions

What personal and social information must a Virginia assisted living facility collect?

Under 22VAC40-73-380, prior to or at admission the facility must obtain 23 items, including birthplace, marital status, clergy and place of worship, service in the armed forces, lifetime vocation, career or primary role, special interests and hobbies, and current behavioral and social functioning. The information must be placed in the resident's record and kept current.

When is the individualized service plan due in Virginia assisted living?

A preliminary plan of care is due on or within seven days before admission, and the comprehensive individualized service plan must be completed within 30 days after admission, under 22VAC40-73-450. It must be reviewed and updated at least once every 12 months and as needed for a significant change.

How often is the UAI completed for Virginia assisted living residents?

The Uniform Assessment Instrument is completed face to face prior to admission, at least annually, and whenever there is a significant change in the resident's condition, under 22VAC40-73-440.

How many hours of activities does Virginia require in assisted living?

At least 14 hours of scheduled activities a week, no less than one hour each day, in a facility licensed for both residential and assisted living care, and 11 hours in a residential-only facility, under 22VAC40-73-520. A safe, secure environment requires at least 21 hours a week, no less than two hours each day, under 22VAC40-73-1120.

Do the federal nursing home rules apply to Virginia assisted living?

No. The federal nursing home requirements in 42 CFR Part 483 apply to certified nursing facilities. Virginia assisted living facilities are licensed by the Virginia Department of Social Services under 22VAC40-73.

Does Porchlight complete the UAI or ISP?

No. Porchlight helps residents and families share vocation, interests and life stories in the resident's own voice and gives staff a briefing built from them. Your qualified staff still complete the UAI and write the individualized service plan.