by James C. Sherlock
I have written here for years about Virginiaโs worst nursing homes and the inevitable abuse that comes from ritual understaffing as a business model. The activities of the nursing home operating companies are funded by Medicare and Medicaid and overseen by federal and state health authorities.
To make short a very long story that I have been telling for those same years, government oversight hasnโt proven to work.
Here in Virginia, the General Assembly passed new legislation this year after the Colonial Heights scandal in December. ย
It took that body more than four decades to strengthen state oversight, both in increased VDH oversight authority and by increasing the staffing of its nursing home inspection program.
Secretary of Health and Human Resources Janet Kelly is leading an effort to make the Department of Healthโs Office of Licensure and Certification — the inspectors of nursing homes — not only larger, but better. Her Departments of Health, Medical Assistance Services (Medicaid) and others are engaged in the effort to improve oversight. As a member of the Governorโs new Commission on the matter, I have seen their plan and been briefed on its execution to this point. Progress in both is extraordinary.
That is exceptionally good news.
Virginia has a number of excellent nursing facilities. Just not enough of them.
Because of COPN, lack of competition drives occupancy rates very high compared to national norms. Inexplicably, the worst performing and lowest staffed facilities in Virginia are the most crowded. That will be investigated.
Worse news is that the regulators — health care people — are swimming upstream against a strong current from a HUD program that insures mortgage loans for purchase, refinancing and rehabilitation of facilities to the buyers of our worst nursing homes. There are big fees and no loan risk to the lenders. ย The only risk to the buyers in forfeiture of the property itself. Which they would not have bought without the program.
That one HUD program fully funds the massive and very high-speed penetration into the nationโs nursing home portfolio of the very people I have made a journalistic career investigating. They have come quickly to dominate the markets for nursing home acquisitions in the Mid-Atlantic states, the Midwest and recently as far west as Colorado and South Dakota.
(more…)