Page Reviewed / Updated - May 2019
This webpage will help Virginia residents understand assisted living, home care and adult day care costs throughout the state. It also explores the payment options and financial assistance programs available to assist in caring for the elderly, be that in residential care or for aging in place at home.
As of 2019, the average monthly cost of assisted living in Virginia is $4,451. This works out to an annual cost of $53,412. While expensive relative to the national average, which is $4,000 / month, the good news is that within Virginia there are certain areas of the state where the cost is considerably lower. These parts include Harrisonburg, Roanoke, Lynchburg, and Staunton, where the average annual costs are $2,412 - $9,072 less. Residents of Richmond, Virginia Beach, Winchester, and Blacksburg should be aware that they live in the most expensive areas for assisted living. In these areas, the average annual costs can reach between $55,356 and $60,576. Residents might consider moving to other areas of the state to save money.
For persons who have Alzheimer’s disease or a related dementia, there are also Alzheimer’s units or memory care units within assisted living facilities. These units specialize in dementia care and offer a higher level of supervision and care, and given this, the approximate monthly cost is an additional $890 to $1,335 over the cost of traditional assisted living.
Home care costs, like assisted living, fluctuate considerably based on one's geographic location within Virginia. The average statewide hourly cost in 2019 is $20.00, which has increased by $2.00 / hour since 2015. However, this is still below the national level of $21.00 / hour. Harrisonburg, Virginia Beach, Roanoke, and Winchester see costs closer to $17.75 - $19.25 / hr. Richmond and Lynchburg are pretty much on par with the statewide average, with an hourly cost between $20.00 and $20.75. The costliest home care can be found in Charlottesville, with an approximate hourly cost of $23.00. It is worth noting that these costs are for non-medical home care.
Care in the home, provided by medically trained professionals is also available, and statewide will generally cost $1.00 more per hour. However, one exception is the area of Roanoke, where the average hourly cost for this type of care is approximately $2.00 more than is non-medical home care.
Statewide, in 2019, the average daily cost of adult day care is $70. Unfortunately, in some rural areas of the state, adult day care services are not available. In those areas where it is available, adult day care is generally less costly than the national average, which is $72 / day. Therefore, residents might consider this a more affordable option relative to assisted living. One will find the most affordable day care in Blacksburg, Harrisonburg, and Winchester, where it is approximately $56 - $61 / day. On the other hand, the most expensive adult day care can be found in Charlottesville and Staunton, where the average daily cost is $80.
Medicaid is a health insurance program intended for lower income Americans. The federal government sets certain guidelines for the program and within those guidelines the states are free to manage the program as they see best for their residents. Each state has different types of Medicaid programs, some for families, some for children, and others specifically for the elderly or those requiring long-term care.
For purposes of relevance, we will focus on Long Term Care Medicaid, which is sometimes called Institutional Medicaid, implying that the program will only cover the cost of nursing home care. While Virginia’s state Medicaid plan will cover the cost of nursing home care and limited personal care, the state also offers Medicaid waivers, which provide home and community based services to avoid or delay nursing home placement.
As of 2019, Virginia has one relevant waiver
s for the elderly. Make note, unlike the state Medicaid plan, Medicaid waivers have enrollment limits. This means that being eligible for services does not guarantee enrollment into the program. Once a program has reached its participant enrollment cap, there will be a waitlist for services.
The Commonwealth Coordinated Care Plus Medicaid Waiver (CCC+) is the combination of two former waivers, the Elderly or Disabled Waiver with Consumer Direction (EDCD) and the Technology Assisted Waiver. CCC+ provides independent living services for seniors and disabled individuals who require a nursing home level of care, but wish to remain living in the community. Benefits may include personal care assistance, respite care, durable medical equipment, assistive technology, skilled nursing, and more. Via the option of consumer direction, also called self-direction, program participants are able to hire their own caregiver, including friends and some relatives.
In addition to the functional need of services and benefits, Medicaid evaluates senior candidates based on their income and assets. In 2019, the monthly income limit for long-term care Medicaid is $2,313. (This figure is equal to 300% of the Federal Benefit Rate, which changes on an annual basis). The asset limit is $2,000, but this excludes the value of a home (up to $585,000), a vehicle, household furnishings, and certain other personal effects.
Being over the income and / or asset limit(s) does not equal automatic Medicaid disqualification. For instance, if one has high medical bills relative to their income, they still can become income eligible. This is called a Spenddown Program and is also known as time limited coverage. Basically “excess income” (the income over the limit) is spent on medical expenses and once one has spent their income down to the limit, they will be eligible for Medicaid for the remainder of the spenddown period.
Unfortunately, the above program does not assist one in spending down assets over the asset limit. However, there are also ways to do this, such as paying for home reparations and modifications. One must proceed with caution when dealing with excess assets. It’s extremely important that one does not give away assets or sell them for less than they are worth in order to meet the asset limit. Doing so violates Medicaid’s look-back period, a 60-month period from the date of Medicaid application in which all past asset transfers are reviewed. If one is found in violation of the look-back period, a penalty in the form of an ineligibly period will result.
Persons near or over these financial limits, as well as married couples, may want to consult with a Medicaid Planning Professional prior to application. Medicaid eligibility is complicated and this ensures the best possibility of acceptance into the program. Learn more.
Virginia has two relevant state assistance programs for elderly residents: Adult Services (AS) and Auxiliary Grant (AG).
Adult Services is a program intended to help frail elderly persons remain living in their homes and delay / avoid nursing home placement. It achieves this by providing a variety of supports, such as chore services, adult day care, shopping, and housekeeping. Learn more about Virginia Adult Services.
The Auxiliary Grant program shares a goal with the Adult Services program, which is to reduce nursing home placements. However, this program does not support individuals at home, rather it provides a cash grant to help them pay for the fees associated with assisted living or adult foster care. Provided assistance in these settings include housecleaning, personal care assistance, and meals. Read more.
Additional assistance may be available under the Older Americans Act. Typically this is non-medical support available to elderly persons in their homes, such as meal assistance and chore services. Benefits will vary dependent on the region in which one resides and the Area Agency on Aging (AAA) that services them. Find your local AAA here.
In addition to the state specific options that help pay for elderly care, there are many non-profit and federal options that are also available. To find the best program for your situation, make sure to use our Resource Locator Tool to find other programs that help pay for or reduce the cost of care. There are also programs that help veterans with assisted living and there are eldercare loans available in Virginia.
Given the large variance Virginia sees in the hourly cost of home care and the monthly cost of assisted living, one of the best ways to manage the cost of care is to find the most affordable care. To help families do so, we've partnered with several organizations that provide free services that match an individual's specific care needs with care providers in their preferred geographic area. Click here to find affordable care.
For more information about the costs and resources available in Virginia cities, click on the links below.