by James C. Sherlock

Delegate Rodney Willet, D-Henrico, is trying to do the right thing for the right reasons.

He has introduced HB 605 to amend § 32.1-127. (Effective January 1, 2026) Regulations.  He added a new section B. 35 to establish staffing standards for Virginia nursing homes. Del. Willett is joined by many members of the General Assembly of both parties who were stunned by the Colonial Heights Rehabilitation and Nursing Center scandal of a year ago. Discussions are underway to determine the exact staffing figures.

Whatever those staffing figures may turn out to be will prove irrelevant.

The nursing home lobby is on the other side of the negotiating table. But the author suspects that, after the negotiations, they are laughing over drinks at the bar. They know that, if passed, the bill would refer to the sanctions set forth in § 32.1-27.2. Administrative sanctions.

To the question of what sanctions a nursing home will face for failing to comply with the new staffing law, the answer is, as a practical matter, none.  

Chains, which are by far the biggest issue in nursing home performance, are not even in the conversation, much less addressed in Virginia law.

That will remain the case even if Del. Willett’s bill passes.

Current Sanctions Law                                                                                                        

A time trace of § 32.1-27.2.  Administrative sanctions follows with comments.  The major point is the number of years it takes to impose sanctions, which make them irrelevant:

A. Notwithstanding any other provision of law, the Commissioner may impose administrative sanctions in accordance with this section on any certified nursing facility if that certified nursing facility does not comply with the provisions of regulations promulgated pursuant to subdivision B 32 35 of § 32.1-127.

B. The Commissioner shall have the authority to annually determine whether or not to impose sanctions under subsection C for noncompliance with the provisions of regulations promulgated pursuant to subdivision B 32 35 of § 32.1-127, if the certified nursing facility: 1. Was affected by a declared emergency, or an act of God,… 2. Has made a concerted effort to recruit and retain direct care staff … 3. Was located in a medically underserved area …

C. Prior to restricting or prohibiting new admissions to a certified nursing facility, suspending or refusing to renew or reinstate any nursing home license, or revoking any nursing home license issued pursuant to Article 1 (§ 32.1-123 et seq.) of Chapter 5, the Commissioner shall first impose the following iterative administrative sanctions:

Year One of Non-compliance Passes

1.  When a certified nursing facility is not in compliance with subdivision B 32 35 of § 32.1-127, and the conditions under subsection B do not exist, the Commissioner shall require the submission of an annual corrective action plan by a certified nursing facility and, upon approval of such plan by the Commissioner, compliance with such plan. A corrective action plan shall only articulate strategies to be utilized to increase direct care staffing with the goal of compliance with subdivision B 32 35 of § 32.1-127 or improvement on the total nurse staffing hours metric, as defined by the Virginia Medicaid Nursing Facility Value-Based Purchasing (VBP) program. The Commissioner shall consider evidence of direct care staff hours provided in addition to the payroll-based journal report, if requested by a certified nursing facility, and may or may not impose a corrective action plan under this section. The Commissioner shall consider the following:

Year Two of Non-compliance Passes

                   a. If the annual measurement immediately subsequent to issuance of the corrective action plan shows compliance with subdivision B 32 35 of § 32.1-127, no additional administrative sanctions are warranted, and the corrective action plan is deemed inactive but shall be retained by the Commissioner pursuant to the Virginia Public Records Act (§ 42.1-76 et seq.); or

                   b. If the annual measurement immediately subsequent to issuance of the corrective action plan still shows noncompliance with subdivision B 32 35 of § 32.1-127, but the VBP program, as administered by the Department of Medical Assistance Services, indicates defined improvement on the total nurse staffing hours metric, the Commissioner shall repeat the provisions of subdivision 1; or

                    c. If the annual measurement immediately subsequent to issuance of the corrective action plan still shows noncompliance with subdivision B 32 35 of § 32.1-127, and the VBP program, as administered by the Department of Medical Assistance Services, does not indicate defined improvement on the total nurse staffing hours metric, the Commissioner shall repeat the provisions of subdivision 1 and may, under circumstances described, provide additional sanctions under subdivisions 2 and 3;

Year Three of Non-compliance Passes

2. To the extent that any consecutive annual corrective action plan is required and results articulated in subdivision 1 c are obtained a second consecutive time, the Commissioner may impose a monetary penalty of up to $50,000 for each subsequent consecutive annual period in which compliance with subdivision B 32 35 of § 32.1-127 or defined improvement on the total nurse staffing hours metric under the VBP program is not attained;

Year four of non-compliance passes, and a new Commissioner assumes office with a new Governor, if that has not already occurred.

3. To the extent that a certified nursing facility is out of compliance with subdivision B 32 35 of § 32.1-127 or fails to show defined improvement on the total nurse staffing hours metric under the VBP program after three consecutive corrective action plans, the Commissioner may place the nursing home or certified nursing facility on probation.

The origin and effects of § 32.1-27.2. Administrative sanctions.

The General Assembly prostituted itself in the passage of that law. The people of Virginia are embarrassed by both. 

It was written by industry lobbyists, who think it is cute, a resume builder. It was enacted by the House of Delegates in 2023 in one of the most disgraceful committee hearings in the history of that body.

In addition to a time schedule guaranteed to make sanctions meaningless, the Commissioner is authorized to give a facility a pass if it:

2. Has made a concerted effort to recruit and retain direct care staff …

3. Was located in a medically underserved area …

Advertising for staff is not the same as having staff. Many facilities are understaffed because they are terrible places to work. Nurses are well informed about which ones they are. Residents in medically underserved areas need proper care like everyone else. The minimum staffing standards are designed to preserve residents’ health and safety.

What possible difference could either of those excuses make to the residents of those facilities?

However, key concerns are hidden from public view and not addressed in Virginia law.

The first is that facility administrators have absolute control over the number of nursing hours per patient per day. They control the “per patient” part of the formula. If staffing cannot support additional residents, administrators may deny admission to new residents until the ratios permit it. Few do so.  Virginia law must hold them accountable.

The second is the biggest issue in Virginia nursing homes.

Oversight of nursing home chains

Nursing home chains are by far the biggest factor in Virginia’s substandard nursing homes, yet Virginia law makes no mention of them.  As this column has repeatedly shown, many out-of-state chains with Virginia facilities make understaffing a cornerstone of their business models.

In 2025, those chains combined their resources to become Virginia’s second-largest PAC by campaign contributions. They will have spent nearly $500,000 on lobbying here in one year. The $50,000 fine under the current sanctions law is not a concern, even if they had to pay it. For ten times that amount in one year, they want Virginia’s laws to leave them unmentioned and for the Health Commissioner to pretend they do not exist.

That is exactly why it is crucial to draft legislation to hold chains accountable.

Too many of Virginia’s out-of-state chain managers and investors are unwilling to comply with any staffing dictates. Understaffing is a key driver of their profit-maximization models.

Another reason to avoid the spotlight is that some chains own both the operating LLC and the real estate LLC for each facility. The operating LLC receives funds from Medicaid and Medicare and remits them to the real estate LLC, which is owned by the same people. They appear as costs in the operating company’s financial statements and are considered when setting Medicare and Medicaid payments for the following year.

If rents are artificially inflated, the Medicare and Medicaid payments go up, and the real estate LLC can borrow more than it otherwise could. The owners can use the excess loan proceeds as capital or pocket them. The only losers are taxpayers and facility residents. Rinse and repeat.

There are additional elements to their profit models that cannot withstand the light of day, and the chains don’t want any attention drawn to them.

Half a million dollars in campaign contributions is a bargain.  

On that note, Attorney General Jones is new and may not be familiar with the donors’ background. He may wish to return the $25,000 that those guys gave to his inauguration fund.

Bottom Line

1.  The Virginia General Assembly should act urgently to rewrite the sanctions law. It remains an embarrassment to that body and an immediate danger to thousands of Virginians.

2.  Chains must be addressed in every Virginia law governing nursing homes. The worst out-of-state actors here operate in Virginia, North Carolina, and Maryland, and not in their home states, precisely because state laws and enforcement are so weak. They make generational fortunes doing it.

Those two challenges may take a special session to accomplish. But people continue to die from neglect and abuse in nursing homes. It is worth the time of their General Assembly to protect them.