by James C. Sherlock

This series is being constructed specifically to support legislation in the 2026 General Assembly. To reiterate the legislative recommendations from Part 3:

Recommended legislation

Consumer protection. Right now, citizens in Virginia Beach and in other communities have no defense against poor and badly staffed nursing homes that charge too much. The good ones simply do not have nearly enough beds to support demand.

Hospitals and insurance care managers can helpfully provide more information to patients about to transfer or to their caregivers. That should include useful information on local nursing homes, such as:

• the latest inspection ratings and staffing ratings,
• average nursing CMI as a proxy for cost,
• number of beds, and
• average occupancy.

That does not happen broadly in Virginia. 

Those service providers can be required by law to provide to patients facing a nursing home stay a written handout including:

• specified CMS data tailored to hospital service areas, and
• a written explanation of the meanings of the information.

The law would not challenge those required to take the actions because the data do not change very often. It would provide a very necessary service to citizens.

Certificate of Public Need (COPN) update.  Important COPN updates will include:

• Exempt localities from nursing home COPN restrictions when the average occupancy in those localities is above 85%. The national average is 79%.
• Exempt government facilities from COPN. A publicly owned facility exemption would enable long-term competition from city or county-owned facilities. Orange County, Va.’s Dogwood Village offers a very successful example.
• Discount, for purposes of COPN regional market-penetration calculations, the long-term presence in regional markets of facilities with Medicare Compare one-star inspection and staffing ratings, including but not limited to those on the Special Focus or Special Focus Candidate lists. 

There is no bottom to a one-star inspection or staffing rating — no zero-star award.

Inspection ratings are based upon a Bell curve of Virginia facility inspection results, so the one-star facilities represent no choice at all.  

Staffing ratings are a result of a Bell curve of national results. Apologists will claim local labor markets drive their understaffing. In response, I will point out three facts:

• Many of those local markets boast facilities with adequate staffing, just not nearly enough of them.
• Most damning, some of the out-of-state chains offer facilities that are understaffed as a business model to increase profits. That drives staff turnover. Once understaffed that way, other professionals are easily smart enough to avoid them. Advertising the positions is futile. Understaffing becomes a self-fulfilling prophecy.  
• Nursing homes truly concerned about the lack of Certified Nursing Assistants (CNAs) in the local marketplace can train them on staff. Payroll-based quarterly reports of daily nurse staffing indicate that only about a third of Virginia’s nursing homes do so. Some of those are unsurprisingly the best staffed, not the worst.

Counting local concentrations of one-star facilities as fulfilling needs for nursing homes is an inadequate explanation for the dreadful local options faced by many citizens. It is a market failure driven by Virginia law.  

Competition needs not only to arrive in those locales, but to be actively recruited by the state as necessary.

Sponsorship and support for such legislation can and should be bipartisan.  

Democrats and Republicans, including indeed members of the General Assembly, will need skilled nursing homes at some point in their lives after surgery or for care of long-term conditions that progress into skilled nursing requirements. As for long-term care, most find they cannot afford it when needed. At that point, many middle-class people find their only choice is to spend down their assets to qualify for Medicaid. It happens every day.  

They should at least have a choice of capable facilities.

Bottom line. The articles so far in this series were designed to set the predicates for 2026 legislation. The very distressing Virginia Beach nursing homes article (Part Two) will be followed quickly by articles on existing nursing homes in:

• rural areas,
• Fredericksburg,
• Richmond/Henrico,
• Petersburg/Hopewell,
• Roanoke – the center of the few remaining Virginia nursing home chains,
• Charlottesville/Albemarle,
• Arlington/Alexandria/Falls Church, and
• perhaps other locales.

While the nursing home quality problem is primarily centered on out-of-state chains, their penetration into Virginia is recent (since 2020), deep, and accelerating.  

The oversight systems of both federal and state regulators are designed to oversee individual facilities, not chains. Virginia regulators are doubly challenged by out-of-state chains.

The General Assembly needs to act to protect the citizens of the Commonwealth. The recommendations here offer a modest start.