by James C. Sherlock

This article was revised on November 16 to provide a better view of the data.  The format the author chose wasn’t getting the job done, so he revised it.  Changes in the text are made only to reflect the updated spreadsheet.  It should provide more clarity.

This is the second article in a sub-series on nursing homes sorted by region in Virginia. The regional classifications correspond to the ones used by the Virginia Department of Health.

The comments on each region will focus on staffing because of its paramount importance, but the data offer much more information. The first was about the Eastern Region. This one is about the Central Region.  

Readers may use this article to contact their General Assembly members, members of the House of Representatives, and United States Senators with their own comments.  

These five columns (Eastern Region published, three more are coming for the rest of Virginia) are designed to be forwarded. If a reader thinks their representative would benefit from another article in the broader series to make their point, send them that one too. The author recommends consideration of this one about the scheme being run here by the worst chains.  They are public record.

Color coding.  The color coding makes the data relatively easy to scan.  Red is worst.  Tan is next, then white, then light green.  Dark green is best.

National Averages. National averages for each of the measures in the regional spreadsheets are noted in the header row.  The minimum safe staffing standards for patient safety established for the Center for Medicare and Medicaid Services (CMS) by the National Academy of Medicine are noted in that same row.  Central Region facilities lag those averages and standards in nearly every measure.

Errors in data. The data reflect what chains and independent nursing homes report to CMS. Unsurprisingly, the worst chains have a bad track record in their reporting. I have corrected the errors.

Staffing. The comments on each region will focus on staffing because of its paramount importance, but the data offer much more information.

Case-mix indices. The case-mix index data are compiled from assessments by the nursing home staff of new residents upon admission.  Higher numbers are supposed to indicate patients who need relatively more assistance with health care and activities of daily living.  The higher the number, the higher are Medicare and Medicaid payments.  Some reflect much higher average CMIs than the national and state averages.  In an isolated case of a single facility, that may prove justified briefly.  As a trend for all of the facilities of a chain, it is something else.

Rating Cycle 1 Health Inspection Dates. Health inspection surveys are supposed to happen every 12-15 months. Virginia’s inspectors, as in every state, carry out those federal inspections in conjunction with state licensing inspections.  

As reflected in the Rating Cycle 1 (latest) inspection dates recorded in CMS data, Virginia has not come close to meeting those standards. Virginia’s inspection teams have been grossly understaffed for more than four decades. That has finally been fixed at the request of Governor Youngkin by changes to the law and appropriations in 2025.  The new inspectors have been recruited, hired, and are being trained now.

On to the Central Region.

Central Region

The spreadsheet linked above is designed to be self-explanatory. The sums and averages line at the bottom shows regional results.

The spreadsheet shows that the Central Region overall has the worst nursing homes in the Commonwealth for one reason.   The worst chains in the Commonwealth have gathered a lot of facilities there.

Occupancy vs. Staffing in the Central Region.  The spreadsheet shows there are 54 facilities total in the Central Region with  6417 beds.  Average Occupancy 85.4%

Thirty-five of the facilities with 77% of the total beds are rated by Medicare Compare as either:

• much understaffed – one star (22 with 43.4% of the beds) or
• understaffed – two stars (21 with 33.4% of the beds).  

The Central Region hosts Virginia’s sole Special Focus Facility: 120-bed Henrico Health & Rehabilitation Center in Highland Springs. That means it has been so bad for so long that it is no longer given ratings. But it has posted a 93% occupancy rate. There is no better example I can think of than Henrico Health and Rehabilitation to prove that in Virginia, Medicare Compare is rarely used by regular people or the hospitals. What hospital would send its patients to such a place?

Occupancy rates are the inverse of what a properly functioning market would produce if consumers used the data available in Medicare Compare. Hospitals in particular should ensure they have it.

There is a situation rare for Virginia in the Central Region.  

South Boston is declining in population. The very large (216 beds) South Boston Health and Rehabilitation and mid-size (120 beds) Berry Hill Nursing Home each report below 50% occupancy. They also have one-star (South Boston) and two-star (Berry Hill) staffing ratings. The solution is clear. But one of the owner groups will need to blink.

Occupancy rates.  

• The average occupancy rate of facilities rated by Medicare Compare as much understaffed (one-star) in the Eastern Region was 87%.  
• Absent state-run Hiram Davis, which is closing, and outlier Saber’s South Boston Health and Rehabilitation, the one-star staffed facilities average over 90% occupancy.  
• The occupancy rate in facilities rated understaffed (2 stars), minus outlier Berry Hill, was 85%
• The four- and five-star-staffed facilities in the Central Region have a combined 1868 beds and an average occupancy rate of 78.5%.  

Across the state, generally speaking, the worse-staffed the facility, the higher the occupancy. The hospitals bear some responsibility for that.

But nursing home administrators are required by federal law and regulations to maintain adequate staffing by controlling the admission of new residents. Few do it.

For-profit, out-of-state chains plague the Commonwealth.

Chains headquartered in other states, especially New Jersey, are together responsible for the shortfalls in the average performance of nursing homes across the state. If they performed to national norms, so would Virginia’s portfolio of facilities.

Recommendations

Recommendations for federal and state actions have been offered throughout this series.  Readers can link to them in communications with their representatives at the state and federal levels.