Virginia assisted living levels of care are set by the UAI assessment, not the brochure — how Arlington, Fairfax and Alexandria families should read it.
By DC Senior Advisor Care Team · October 23, 2026
Walk into a community in Ballston, Old Town Alexandria or Vienna and the first thing handed across the table is a price sheet with tidy tiers — level one, level two, level three, sometimes a points system that converts a parent's needs into a monthly surcharge. That sheet is a billing document. It is not what the state means by levels of care. Virginia assisted living levels of care are a licensing matter, and the UAI assessment — the Uniform Assessment Instrument — is the form that decides which one applies to your parent. The Virginia Department of Social Services licenses assisted living facilities under 22VAC40-73, and each license specifies whether the building may serve residents at the residential living level, the assisted living level, or both. A community can price its care in nine tiers if it wants to. What it cannot do is accept a resident whose UAI places them above the level of care that building is licensed to provide.
The practical consequence catches families off guard, usually at the worst moment. A daughter in Falls Church finds a place she likes, puts down a deposit, and then learns the UAI came back at the assisted living level while that particular house is licensed for residential living only. The deposit is refundable; the three weeks are not. Reading the license first — and asking what the UAI is likely to show before anyone signs — turns the assessment from an obstacle into the planning tool it was meant to be.
The distinction turns on activities of daily living. Virginia's residential living level covers residents who need help with fewer of the core daily tasks — bathing, dressing, toileting, transferring, eating, mobility — and who can generally direct their own care. The assisted living level covers residents who need hands-on help with more of those tasks, or who have cognitive limitations that mean they cannot reliably make their own decisions about care. The UAI walks through each function and records whether the person is independent, needs mechanical help, needs human help, or needs both. The tally, not a nurse's impression, produces the level. Staffing requirements follow from it: a building serving residents at the assisted living level must have more direct-care coverage and licensed nursing oversight than one limited to residential living, which is a large part of why the monthly rate in Arlington or Tysons jumps between the two.
Both of those levels sit below nursing home care, which is a different license from a different agency — the Virginia Department of Health licenses nursing facilities, not VDSS. If the UAI shows needs that exceed what any assisted living license permits, the honest answer is that assisted living is the wrong setting, and the conversation shifts to a nursing facility at roughly $10,000 to $14,000 a month in this market, or to building enough in-home care at $30 to $40 an hour to keep someone at home. Assisted living across Northern Virginia generally runs $5,500 to $8,500 a month, with McLean and parts of Arlington at the top of that band and Springfield and the outer Fairfax suburbs lower.
This is the detail that matters most and gets explained least. For a private-pay resident, the UAI may be completed by qualified staff at the facility itself — often the same person who gave the tour. For a resident whose care will be paid with public funds, including anyone seeking the Auxiliary Grant, the assessment must be completed by a public human services agency, not by the facility. In practice that means the local department of social services or the area agency on aging rather than the building's admissions director. Families in Arlington work through the Arlington Area Agency on Aging; in Alexandria, the Division of Aging and Adult Services; in Fairfax, McLean, Reston, Vienna and Springfield, the Fairfax Area Agency on Aging. Starting that assessment early matters, because a public assessment cannot be backdated to cover a move-in that already happened.
The split exists for an obvious reason: when the facility both assesses the resident and bills for the level it assessed, the incentive runs one way. That does not make facility-completed assessments dishonest, and most are careful. But a private-pay family is entitled to ask how the assessor reached each rating, to supply hospital discharge paperwork from Virginia Hospital Center, Inova Alexandria or Inova Fairfax, and to request a second look if the form describes a parent who sounds more capable on paper than at home. Ask for a copy of the completed UAI. It is about your parent, and you should not be reading it for the first time in a dispute.
Northern Virginia families searching for memory care often assume it is a third license tier. It is not. Virginia regulation treats a secured dementia unit as a safe, secure environment within an assisted living facility — a locked or otherwise restricted setting that carries extra requirements for staff training, activity programming, and the physical building. A resident may be placed in one when the assessment shows a serious cognitive impairment that leaves them unable to recognize danger or make basic decisions for their own safety. That determination has its own documentation requirements beyond the ordinary UAI, including a qualified professional's assessment, and a family has the right to see what supports the placement.
Because it is a setting rather than a license level, the price is set by the market rather than by the regulation, and in this region that means roughly $7,500 to $11,000 a month, with Tysons, McLean and the Clarendon-Ballston corridor at the high end. Two communities a few miles apart in Fairfax County can both be licensed for the assisted living level while offering very different dementia programs — one with a dedicated household, trained staff and a secured courtyard, the other with a hallway and a keypad. The license will not tell you which is which. A long weekday visit, a look at the activity calendar, and a question about how many staff are on the unit at 7 p.m. will.
The UAI is not a one-time hurdle. Virginia requires reassessment at least annually and again when a resident's condition changes significantly, which is precisely when families are least able to focus on paperwork. The reassessment is what triggers a rate change, a move within the building, or in some cases a discharge notice because the resident's needs have outgrown the license. A family who treats the annual UAI as a formality can be blindsided by a notice that reads like an eviction. A family who knows the reassessment is coming can get ahead of it: document what has changed, involve the primary care physician, and ask early whether the community can meet the new level or whether a move is coming.
If you believe a level was set wrong, or a discharge is being pushed for reasons that have more to do with staffing than with your parent, there is somewhere to go. The regional licensing office of the Virginia Department of Social Services investigates complaints against assisted living facilities and inspects them, and inspection reports are public records worth requesting before you sign anything. Where the concern is neglect, exploitation or abuse rather than a licensing dispute, adult protective services in Virginia is run by the Department for Aging and Rehabilitative Services, reachable at 1-888-832-3858 — not by VDSS, a distinction that sends a surprising number of calls to the wrong place. For help thinking through options without a sales incentive attached, the local area agency on aging in Arlington, Alexandria or Fairfax is free and does this every day.
Free, no pressure, and no one rushing you. We answer to families, not to facilities.
Or call (571) 497-4418
DC Senior Advisor