Virginia lets home care companies go years without inspection while seniors face $6,940-a-month assisted living bills

Virginia families paying close to $7,000 a month for a parent in assisted living might assume the state is keeping close watch on the care. A new legislative watchdog report says that in much of the system, it is not.

The Joint Legislative Audit and Review Commission told lawmakers on Monday, Nov. 9, that about 90% of home care organizations have not had a routine inspection within the required two years and that some have gone more than a decade without one. "The state's regulation of in-home care by the Department of Health is abysmally weak and needs to be much stronger," JLARC Director Hal Greer said, according to WRIC.

Licenses without scrutiny

The JLARC report found the Health Department's licensing office does not deny initial home care license applications, even when they are poor quality, because no clear criteria for denial exist. When inspectors do find problems, the public is not told, the office cannot impose a fine, and there is usually no follow-up. The department has not used its power to suspend or revoke a home care license in the past three years. In-home client visits were dropped from inspections in 2012.

For assisted living, JLARC flagged 122 facilities, about 21%, whose quality is cause for concern. Of the 17 with the most serious concerns, only seven faced enforcement action in fiscal 2025 or 2026. Civil penalties are capped at $10,000 a year per facility, and the average penalty was $1,518, which licensing staff told JLARC many large facilities treat as a cost of doing business.

Rural seniors left behind

The report says older adults in Southwest and Southside Virginia have the highest care needs but some of the fewest options. Far Southwest Virginia has no licensed memory care beds. Only 6% of older adults there can afford average assisted living rates, compared with 33% in Alexandria.

Statewide, average assisted living costs reached about $6,940 a month in 2025, up 32% since 2021, and only 18% of older Virginians can afford their region's average rate, JLARC found.

The price of fixing it

JLARC recommends giving regulators authority to deny weak applicants, fine violators and post inspection results publicly, along with more inspectors, enforceable staffing minimums and more money for in-home services. JLARC analyst Joe McMahon said an additional $38 million in state funds would help, according to Radio IQ/WHRO.

The state's own licensing chief at the Department of Social Services, Tara Ragland, agreed with many of the findings but cautioned, "These carry significant fiscal implications for effective implementation."

Lawmakers will weigh the report when the General Assembly convenes in January. Before asking taxpayers for more, they can start by making sure the inspections Virginia law already requires actually happen.

Featured photo: Empty rocking chairs on a cabin porch at Shenandoah River State Park, by Virginia State Parks staff, via Wikimedia Commons (CC BY 2.0).

Alexandria is an independent city in Northern Virginia.