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 will be 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.

This one is about the Eastern 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 articles (four 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. Eastern 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.  There were 406 errors in the Virginia Provider data on 290 nursing homes. It matters.  All were descriptors. None were statistics. All were traceable to errors induced in the system by flawed reporting by chains.  They were clustered in the worst chains.

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 Eastern Region.

Eastern Region

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

You will see that the Eastern region, particularly South Hampton Roads and Virginia Beach specifically, is plagued by chains that underperform as a business model.  Riverside facilities help bring the averages up on the Peninsula. 

Occupancy Rates vs. Staffing in Eastern Region. The spreadsheet shows there are 68 facilities total in the Eastern Region with 7,106 beds. Average Occupancy 87%

Sixty-five percent of the facilities with 70% of the total beds are rated by Medicare Compare as either:

• much understaffed – one star (23 with 37% of the beds) or
• understaffed – two stars (21 with 33% of the beds).  

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.

• The average occupancy rate of facilities rated by Medicare Compare as much understaffed in the Eastern Region was 91.3%.  
• The occupancy rate in facilities rated understaffed was 87.5%.
• The better-staffed facilities in the Eastern Region have a combined occupancy rate of 80.2%.  

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.