by James C. Sherlock
None of us ever knows when we will need a nursing home for ourselves, our parents or our kids. Yes, kids.
While long-term nursing care is mostly for older patients, skilled nursing facilities are needed for patients of all ages, including children, for shorter term post-op treatment and recovery.
The patients in many of Virginia’s nursing homes suffer greatly from a combination of known bad facilities and a lack of government inspections. The health and safety of patients in those facilities are very poorly protected by the state.
In this series of reports I am going to point out some nursing homes (and chains) whose records will anger you. Government data show some have been horrible for a very long time in virtually every region in the state.
Those same records show that Virginia is years behind on important, federally mandated health and safety inspections.
VDH’s Office of Licensure and Certification doesn’t have enough inspectors — not even close. And the government of Virginia — officially based on budget data — not only does not care but is directly and consciously responsible.
When I am done reporting on my research I suspect you will demand more inspectors.
You will also reasonably ask why the worst of them are still in business when the Health Commissioner has the authority to shut them down.
Follow the money. Political decisions driven by campaign dollars from the nursing home industry have starved the state’s healthcare inspection agency of personnel for years.
The industry has so far given nearly $850,000 to state candidates in 2020-21. Democrats are the recipients by a more than two-to-one margin over Republicans. But both get more than enough to open doors. I question their ability to claim poverty when they have that much laying around to pay politicians.
American Healthcare LLC of Roanoke has given almost $200,000 of that total — almost all of it to Democrats. Leading donors are here. Leading recipient was McAuliffe for Governor at $42,500. Ten thousand dollars to Herring for Attorney General. American Healthcare LLC is led by our old friend Tommy East.
Did I mention that Tommy is on the Board of Health?
Inspections are crucial. The full standard inspection criteria for a nursing home are pretty much everything you would hope. Based upon my research, the inspection teams that Virginia has put in the field have done excellent work. There are simply not enough of them.
The standard inspection includes detailed reviews of:
- Staffing and the quality and morale of staff — sufficient staff with sufficient qualifications to provide adequate care. (Staffing data are also derived through quarterly nursing home reports to CMS. Those reports is spreadsheet format are required to account for daily staffing reflecting daily payroll data to ensure accuracy.)
- Managing medications
- Protecting residents from physical and mental abuse
- Storing and preparing food properly
The inspection team looks thoroughly at all aspects of life in the nursing home including:
- The care of residents and the processes used to give that care;
- How the staff and residents interact; and
- The nursing home environment
Inspectors also review the residents’ clinical records, interview residents and family members, as well as caregivers and administrative staff.
COVID-related inspections for infection control and prevention employ a small subset of the full yearly standard inspection criteria.
Virginia Inspectors are good at their jobs. I have reviewed the CMS State Operations Manual and Virginia inspectors application of that manual. Trust me, you want any nursing home you or a loved one plan to use to be inspected this way. And by people like those employed by OLC.
Virginia’s teams, when they make an inspection, do a very good job. I have read perhaps a hundred of their reports and they are excellent. The data bear that out. They average 50% more citations per inspection than the national average.
There are just not enough of them. And the current ones regularly work weekends and holidays to preserve the surprise in their inspections.
Donations influence the state budget for inspector positions. The Governor, the Secretary of Health and Human Resources and the Health Commissioner, with access to very detailed nursing home data, appear to not be bothered by it.
A majority of General Assembly members appear at best ignorant of the matter. At best.
Those are the only conclusions to be drawn from their lack of action to fund inspection staff in spite of the blunt and explosive FOIA-responsive assessment by the Director of the VDH Office of Licensure and Certification that she does not have the resources to carry out her responsibilities.
The General Assembly will not have that excuse when these reports are complete.
I will name names of nursing homes in each district — both good and bad.
Staffing shortfalls cripple nursing home inspections. OLC under contract to CMS is required to conduct annual health and safety inspections of nursing homes for compliance with Medicare and Medicaid regulations. The inspection agency in each state does this work because of state responsibility for Medicaid and the fact that they can combine state licensure inspections with federal inspections.
The federal survey and certification regulations require that each skilled nursing facility (SNF) and nursing facility (NF) be subject to a standard full survey no later than 15 months after the last day of the previous standard survey. The statewide average interval between standard surveys of skilled nursing facilities and nursing facilities may not exceed 12 months.
(CMS suspended standard nursing home surveys March 23, 2020. They were partially restored June 1, 2020 and fully restored on August 17, 2020. A five- month hiatus. I have factored that into all of my assessments.)
Virginia’s intervals for full inspections in some cases currently approach three years. Since Virginia’s inspectors issue an average of a dozen citations per full inspection visit, that deficit is at least a dangerous to patients as you think it is.
OLC may inspect nursing homes more often if the nursing home is performing poorly, or if there are complaints or facility reported incidents. Since COVID, it has at CMS direction increased inspections for infection control only, reducing even further their ability to conduct complete inspections.
As the OLC Director explained, she does not have nearly enough nursing home inspectors to carry out statutory inspection requirements.
So. from a deficient start, OLC has gotten very much further behind during COVID and has no capacity to catch up.
By my count using CMS data, the OLC had in calendar year 2021 carried out 41 standard full nursing home inspections by August 25th. At that rate, they will inspect around 60-65 facilities this year. The federal government requires OLC to inspect all 286 Medicare/Medicaid certified nursing homes in Virginia each year.
On that same date of August 25, there were 42 nursing homes in Virginia that were last fully inspected in 2018.
Turnover in OLC, as you will expect, far exceeds that of the rest of VDH.
Conclusions and future reporting. Nursing home reimbursement rates from Medicare and Medicaid need to increase to sustain the businesses.
But nursing homes need to be inspected to make sure they earn the higher reimbursements and do the right thing by their patients.
I have compiled extensive government data for each of the 286 nursing homes in Virginia. Some of it is frightening, and I use the word advisedly.
Virginia will not be able to perform its vital inspection function under current policy and law. Not even close.
Next, I will provide enough background on the business and inspections so that readers can interpret the data.
Then I will start the reporting on that data with a column that focuses on South Hampton Roads, which may be the most poorly served area in the state. I will move from there to columns reporting on nursing homes across the state.
I suggest we fix this. Perhaps the gubernatorial and Attorney General candidates have some ideas.