by James C. Sherlock

This article will explore a single geographic area, Virginia Beach, to focus on what nursing home choices mean in practice to the citizenry of Virginia’s largest city.  

The quality of the nursing home inventory in Virginia Beach is illustrative of that of all of south Hampton Roads and much of Virginia. Offered below is an overview of the fifteen nursing homes in my city. The for-profit chain nursing homes here, eleven of 15, present an enormous challenge to citizens and to state oversight. The state is challenged because all are owned by out-of-state chains. 

Except as noted, all facilities listed offer both skilled nursing beds certified for Medicare and long-term care beds certified for Medicaid. Many of the beds can be flexed to either purpose. Each may accept other insurance or out-of-pocket payments. 

Virginia Beach (2) and Norfolk (2) general hospitals are all Sentara facilities. They are included among five Sentara general hospitals of the total of seven in south Hampton Roads. Both regional trauma centers are Sentara hospitals. Sentara exited the nursing home business in November of 2020, when it closed on the sale of all seven of its nursing facilities to Saber Healthcare. That healthcare system now faces the same mostly dreadful choices for patient transfers to skilled nursing after surgery as do its patients.  

Most if not all hospitals in Virginia have contracts with nursing homes and also recommend nursing home options to patients seeking one. Some, like Sentara, are vertically integrated with insurance companies that have contracts with nursing homes.  

Patients, and the government, have no idea what terms their nursing home contracts specify. Perhaps they should.

I have offered detail on the meanings and implications of each of these data points in Part One.

Virginia Beach for-profit chain facilities

Saber Healthcare – Bedford Heights, Ohio

Colonial Health & Rehab Center.

• • Inspections and validated complaints One star
  • Staffing One star
  • Beds 90; average occupancy 90%
  • Nursing turnover: Total 84% RN 84%
  • Nursing Case Mix Index (CMI) – measure of average resident needs determines Medicare and Medicaid per diems – 1.35 (state average CMI 1.4 / National 1.37)

Rosemont Health & Rehab Center.

• • Inspections and validated complaints One star
  • Staffing – One star Cited for abuse
  • Beds 116; average occupancy 94%
  • Nursing turnover: Total 47% RN 36%
  • Nursing CMI 1.35

Kempsville Health & Rehab Center.

• • Inspections and validated complaints two stars
  • Staffing 3 stars
  • Beds 116; average occupancy 93%
  • Nursing turnover: Total 40% RN 59%
  • Nursing CMI 1.43

Lifeworks Rehab (ex-MFA and Innovative Healthcare Management) – Lakewood, NJ – Largest chain in Virginia with 37 facilities. Owns infamous Colonial Heights Rehabilitation and Nursing. Lifeworks facilities national averages: Overall 1.4 stars; Staffing 1.4 stars. Out of a possible 5.0.

Virginia Beach Healthcare and Rehab Center.

• • Largest in Virginia Beach
  • Inspections and validated complaints One star
  • Staffing One star
  • Beds 180; average occupancy 97%
  • Nursing turnover: Total 83% RN 74%
  • Nursing CMI 1.41

Princess Anne Health & Rehabilitation Center

• • Banned from Medicare and Medicaid programs in August for patient care concerns. Now re-opened under a reported consent agreement with VDH limiting new patient admissions.
  • Inspections and validated complaints One star
  • Staffing One star
  • Beds 120; average occupancy – 94%
  • Nursing turnover: Total 73% RN 65%
  • Nursing CMI 1.73

Bayside Health & Rehabilitation Center

• • Inspections and validated complaints One star
  • Staffing One star
  • Beds 60; average Occupancy 96%
  • Nursing turnover: Total 92% RN 79%
  • Nursing CMI 1.66

Greentree Healthcare – Jackson, N.J.

Maimonides Health Center of Virginia Beach

• • Inspections and validated complaints three stars
  • Staffing rating two stars
  • Beds 120; average occupancy 93%
  • Nursing turnover: Total 71% RN 62%
  • Nursing CMI 1.45

Eastern Healthcare Group – Clifton, N.J.

Bay Pointe Rehabilitation and Nursing

• • Inspections and validated complaints One star
  • Staffing One star
  • Beds 112; average occupancy 90%
  • Nursing turnover: Total 25% RN 53%
  • Nursing CMI 1.69

Birchwood Park Rehabilitation

• • Special Focus Facility Candidate (long-term record of especially bad care)
  • Inspections and validated complaints one star
  • Staffing two stars – Cited for abuse
  • Beds 150; average occupancy 85%
  • Nursing turnover: Total 48% RN 48% Nursing
  • CMI 1.35

Thalia Gardens Rehabilitation and Nursing

• • Inspections and validated complaints one star
  • Staffing two stars
  • Beds 138; average occupancy 85%
  • Nursing turnover: Total 33% RN 44%
  • Nursing CMI 1.37

Cypress Pointe Rehabilitation and Nursing

• • Inspections and validated complaints One star
  • Staffing One star
  • Beds 90; average Occupancy 91%
  • Nursing turnover: Total 45% RN 64%
  • Nursing CMI 1.46

Independent for-profit 

Seaside Health and Rehabilitation @ Atlantic Shores – Senior living, assisted living, long term care, skilled nursing, other services. Non-residents granted access to skilled nursing if space available. Medicare/No Medicaid

• • Inspections and validated complaints 4 stars
  • Staffing 4 stars
  • SNF Beds 50; average occupancy 76%
  • Nursing turnover: Total 33% RN 44%
  • Nursing CMI SNF only: 1.32

Not-for-profits

Westminster-Canterbury on the Chesapeake Bay – Senior living, assisted living, long term care, skilled nursing, other services. Non-residents granted access to skilled nursing if space available. Medicare/No Medicaid

• • Inspections and validated complaints 5 Stars
  • Staffing 5 stars
  • SNF Beds 50; average occupancy 87%
  • Nursing turnover: Total 33% RN 44%
  • Nursing CMI: 1.20

Our Lady of Perpetual Help – Long term care (LTC) only. Medicaid. Medicare does not pay for LTC

• • Inspections and validated complaints 4 stars
  • Staffing 4 stars
  • LTC Beds 30; average occupancy 76%
  • Nursing turnover: Total 46%
  • Nursing CMI: 1.31

Government

Jones & Cabacoy Veterans Care Center – Virginia Department of Veterans Services (DVS) Long-term skilled nursing care, dementia/memory care, and short-term rehabilitative care for veterans

• • Ratings – Not available – new
  • Beds 128

Bottom line

This represents a quiet crisis. Perhaps the City of Virginia Beach can build a couple. Orange County has done that very successfully and their facility operates on its own money.  

 The data show that Virginia Beach citizens face a dilemma that is beyond their individual power to solve. That is true in many other communities.

In Virginia Beach we have 1,582 nursing home beds certified for Medicare and Medicaid and available for other payments.

• 1,056 of those beds are in facilities rated one star in inspections and complaint validations — at the bottom of the Bell curve — compared to other nursing homes in Virginia.
• 1,176 beds are rated “understaffed” or “much understaffed” compared to nearly 15,000 nursing homes in America.

The best inspection results and better staffing are in facilities designed for specially designated or paid member populations. They beyond the reach of many citizens.

• The two best rated facilities understandably give priority to members of their very expensive communities.
• The only true charity has only 30 beds. The only government facility is for veterans only.

When those are taken out of the equation, as they are for most citizens, the rest offer a dreadful dilemma just at the point they are needed. Key characteristics include:

• The worst are somehow the most crowded. The reason for that is worthy of investigation.
• The worst report their residents need the most care and thus are paid more than the best.
• They then fail to staff the facilities to care for them. Also worthy of investigation.

They have for years gotten away with it. The profits are enormous. In Virginia we have documented based on their own reporting north of 20% profit margins for chains in a 3% business. VDH, which licenses nursing homes, is trying new and innovative strategies to rein in the worst chains. I applaud them.

But full accountability requires federal action to enforce the Social Security Act and related regulations. Since CMS, the federal regulator, is floundering in understanding chains, it will require a combined effort by multiple federal law enforcement agencies with state participation to bring the worst of them to justice.