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

If your binder still says 64 CSR 14, it is out of date. When West Virginia restructured its health department, licensing moved to the Office of the Inspector General, and the Secretary of State reassigned the assisted living rule to 71 CSR 21 and the dementia unit rule to 71 CSR 19. A new version of 71 CSR 21 took effect on May 1, 2026. The assessment and activity wording discussed below is essentially the same as in the 2024 version.⁴

Who these rules cover

71 CSR 21 applies to anyone "establishing, maintaining or operating an assisted living residence" as defined in W. Va. Code §16B-5-2. It does not apply to nursing homes or residential care communities, which have their own rules. The Inspector General designates the Director of OHFLAC to enforce it.¹

71 CSR 19 is layered on top for any facility that advertises, markets or otherwise promotes special care units or programs for people with Alzheimer's disease or a related dementia. If you say "memory care" in your brochure, read it closely.

The assessments: health, then functional needs

West Virginia requires two assessments at admission. First, a signed health assessment by a physician or other licensed health care professional, done no more than 60 days before admission or within five working days after, and at least annually. Second, the functional needs assessment:

"Within five days of admission, each resident shall have an individualized functional needs assessment completed in writing by a licensed health care professional which is maintained in the resident's medical record. At a minimum, the resident's assessment shall include a review of health status and functional, psycho social, activity, and dietary needs."71 CSR 21-6.3.2

"Psycho social" and "activity" needs are where preferences, relationships and interests belong, but the rule does not list specific topics. The admission record itself must include the resident's "marital status, and religious preference, if any" (6.2.2.a).

The service plan: seven days

"Within seven days of admission, each resident shall have a service plan based upon his or her functional needs assessment and individual needs that includes, but is not limited to, the type of assistance needed to perform activities of daily living; the ability to receive prescribed medications and treatments; the ability to follow any planned diet, rest, or activity regimen; the ability to engage in activities and programs appropriate to the individual's level of functioning; and the ability to use equipment such as hearing aids, glasses, and canes."71 CSR 21-6.3.3

Staff must have access to the plan and use it as a guide to care. The functional needs assessment and service plan must reflect current needs and be "updated annually or as indicated by a significant change in the resident's condition" (6.3.4).²

Activities

"The licensee shall provide an activity program designed to meet the interests of, and promote the highest level possible of well-being in, all dimensions of life including physical, psychological, social, and spiritual, of each resident."71 CSR 21-7.1

The program must connect residents with social, recreational and vocational activities in the community, offer at least seven hours of scheduled activities a week and one hour a day (more if residents ask), including activities suited to residents with dementia, and keep a monthly calendar with documentation of whether each activity happened. Residents also have the right "to participate in social, religious, and community activities of his or her choice" (5.3.1).

Alzheimer's and dementia special care units

This is where West Virginia asks for real life history. Under 71 CSR 19, an interdisciplinary team (unit coordinator, social worker, activities director, direct care staff and a registered nurse) must complete an initial assessment within seven days that includes "a social history; family supports;" functioning, cognition, behavior and nutrition. Within 21 days, the team and the resident or representative write an individualized care plan, signed by all of them, which must:

"Reflect the resident as a person, with family history and interests;" ... "Accurately describe specific needs, choices, problems and any inappropriate behaviors;" ... "Include opportunities for resident choice and self-management"71 CSR 19-6.3

A licensed social worker or licensed professional counselor must also provide a comprehensive social assessment that includes the resident's preferred name, past places of residence, family support system, "past employment status, career history, and educational level," place of birth, languages spoken, the names of parents, children, siblings and pets, and:

"The resident's childhood history (i.e. rural or city, religion, lifestyle, culture);" ... "The resident's adult daily routines (i.e. hour of rising and sleep, habits, etc.)"71 CSR 19-8.1.1

Activities in the unit must be "geared toward long term memory rather than short term memory" and "appropriate and meaningful for each resident, by respecting his or her cognitive level, beliefs, culture, values, and life experience." Sensory and memory enhancement activities, including reminiscing, must be offered at least daily. The assessment and care plan are reviewed at least quarterly.³

What surveyors tend to look for

Based only on what the rules say to document:

• A written functional needs assessment within five days that actually addresses psychosocial and activity needs, and a service plan within seven days that staff can use.
• Annual and significant-change updates of both.
• A monthly activity calendar showing at least seven hours a week and documentation of what took place.
• In a dementia special care unit: the three-day preliminary plan, the seven-day interdisciplinary assessment with social history, the social worker's comprehensive social assessment, a 21-day care plan that reflects the resident as a person and is signed by the team, and quarterly reviews.

Gathering a social history well

71 CSR 19's list reads like an interview guide. Even outside a dementia unit, it is a useful model:

• Start with the preferred name. It is the first item in the social assessment for a reason.
• Ask open questions. "Tell me about the town you grew up in." "What was your first job?" "What does a good morning look like for you?"
• Bring in family early. For a resident with dementia, children and siblings can supply childhood history and routines the resident can no longer recall. Record the source.
• Note comforts and triggers. A pet's name that calms, a subject that upsets. Both help staff respond to distress; 71 CSR 19 asks units to try a non-medication behavioral approach first.
• Revisit quarterly. The dementia-unit review cycle is a good time to add what staff have learned since admission.

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, including childhood, work and family, 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 social-history material these rules describe, in the resident's own words. The assessments, care plans and compliance remain your community's responsibility.

Frequently asked questions

What is the current West Virginia assisted living rule?

71 CSR 21, Assisted Living Residences, effective May 1, 2026. It was previously numbered 64 CSR 14 and was reassigned when licensing moved to the Office of the Inspector General. The dementia special care unit rule, formerly 64 CSR 85, is now 71 CSR 19.

When must West Virginia assisted living residents be assessed?

A health assessment is required no more than 60 days before or five working days after admission, and at least annually. A functional needs assessment covering health status and functional, psycho social, activity and dietary needs is due within five days of admission, and the service plan within seven days, under 71 CSR 21-6.3.

Does West Virginia require a social history in assisted living?

Not for a general assisted living residence. It does for facilities that market Alzheimer's or dementia special care units or programs: 71 CSR 19 requires a social history in the seven-day assessment and a comprehensive social assessment covering childhood history, career, languages, family, pets and adult daily routines.

How many activity hours does West Virginia require in assisted living?

At least seven hours of scheduled activities a week and one hour a day, unless residents request more, including activities appropriate for residents with dementia, under 71 CSR 21-7.2.2. Dementia special care units must also offer specified activities daily, including sensory and memory enhancement activities such as reminiscing.

Does Porchlight complete the social assessment for us?

No. Porchlight helps residents and families share life stories, routines and interests in the resident's own voice and gives staff a briefing built from them. Your social worker and interdisciplinary team still complete the assessments and care plans.