by Jim Wright

So, who’s the real culprit?

Eighteen nurses were recently arrested at Colonial Heights Nursing Home, charged with elder abuse and falsification of records. Surely, there was wrongdoing here, but does the blame belong to 18 nurses only?

In my experience as a nursing-home medical director, I’ve learned that sometimes the first “culprit” you identify is really not the culprit at all. If you want to get to the root of a problem, you have to keep asking the question “why?” Why did 18 nurses falsify records?

When nurses give bad care, it’s not necessarily because they’re bad people, but very often because they become demoralized and jaded in a setting where they simply do not have enough staff.

Colonial Heights is known to staff at levels far below what is considered safe. A government study performed in 2001 found that once a facility’s nursing-aid presence drops below about 2.5 hours per patient per day, residents experience an increase in disease and harm. Colonial Heights supplied nurse’s aides for only one hour and 38 minutes per resident per day. Registered- nurse presence should be 33 minutes per patient per day. Colonial Heights supplied only 18.

So, let’s keep asking: Why would Virginia allow nursing homes to operate with staffing levels that have been shown to harm residents?

Because, surprisingly, it’s legal. Virginia is one of a minority of states that has no minimum staffing requirements. Is this safe? Of course not. Legal? In Virginia, yes.

But we need to keep asking: Why does Virginia not have minimum staffing requirements? It’s not for lack of trying. Delegate Vivian Watts and later state Senator Jen Kiggans brought staffing bills to the General Assembly for 20 years. At every committee and subcommittee hearing, who was there to help table, bury or defer effective legislation? Lobbyists for nursing-home owners: The Virginia Healthcare Association (VHCA), and more recently, Leading Age.

Even when the General Assembly was finally forced to pass staffing standards after the devastation of the COVID pandemic, these lobbyists ensured that legislators set Virginia standards way below the minimum safe levels established in 2001. Where the federal study determined that every patient needs at least four hours of staffing presence per day, Virginia’s new law set to go into effect in July gives them only about three hours (HB1446).

But we need to ask one final “why.” Why would operators of nursing homes want to operate with unsafe staffing levels? This one’s easy: profits. Staffing is the biggest line item in any nursing home’s budget and being free to cut your staffing is a huge gift to owners and shareholders. In its most recent financial statement, Colonial Heights made over $3.5 million in profits (VHI.org). Even half of that would have gone a long way to rectify its dangerous staffing problems. Instead, it went into the pockets of shareholders.

Unfortunately, this is not just a Colonial Heights problem, this is a crisis throughout the Commonwealth. Within the past five years, Virginia has become a haven for private equity firms fleeing other states that have implemented safe staffing. New Jersey passed staffing standards in 2020. Since that time, just three New Jersey companies have snatched up 20% of Virginia’s nursing homes, most of them of the lowest one-star quality. You can be sure that it wasn’t an outpouring of compassion for Virginia’s elderly that prompted the buying spree. The VHCA has turned Virginia’s nursing homes into ATMs for New Jersey millionaires.

The nurses at Colonial Heights may have done something wrong. But in Virginia, we are not going to arrest and punish our way to a solution as long as we continue to allow for-profits and the VHCA to determine appropriate staffing levels. If we want better care for our parents, our spouses and ourselves, we need to hold the for-profits that own the vast majority of Virginia’s nursing homes accountable, forcing them to staff nursing homes at safe levels.

Safe staffing standards may be coming to Virginia, thanks to the Federal Minimum Staffing Standards passed into law last year and set to be implemented in 2026. The nursing home industry and our own Attorney General Jason Miyares, however, are currently asking the Trump administration to drop the rule altogether, leaving the care of our elders in the hands of for-profits and shareholders – poor caregivers indeed.

So who’s the real culprit here – 18 nurses or out of state profiteers and their VHCA enablers? Let’s keep asking why, Virginia.

James L Wright is a Richmond-area physician practicing in long-term care.