Category Archives: Efficiency in government

Nursing Home Ads Pose As Official State Advice

by James C. Sherlock

The Virginia state government has a Department for Aging and Rehabilitative Services. 

Who wouldn’t want one of those?  

But in the case of recommending nursing homes, it would be better if it would either stop or fix its broken system. Which it pays a nonprofit, VirginiaNavigator, to run.

It is offering nothing more than free, self-written advertisements for good and bad nursing homes alike under the guise of a state recommendation to seniors. Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis — Part 2, the Business

by James C. Sherlock

Nursing homes are businesses.

Seventy percent of those in Virginia are for profit. They are run not by doctors but registered nurses with physicians on call. 

Nursing facilities very widely in size in Virginia, from the 300-bed Mulberry Creek Nursing and Rehab center in Martinsville to facilities of less than 30 beds, especially the long-term care units of a few mostly rural hospitals.

They include facilities designated as skilled nursing facilities (SNF), often post-op care and rehabilitation, and others designated as long-term-care nursing facilities (NF). Most nursing homes in Virginia have facilities and certified beds for each.

Insurer mix and staffing costs are keys to profitability.

Many of these businesses are worth what they get paid, but many are not. Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 1

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.

Good question. Continue reading

VEC Made $930 Million in “Incorrect” Payments Last Year

by James A. Bacon

Inundated by unemployment claims during the COVID-19-induced recession last year, the Virginia Employment Commission made an estimated $930 million in “incorrect” payments last year, according to an update by the Joint Legislative Audit and Review Commission.

The magnitude of wasted dollars has gone largely unnoticed as the media and the Northam administration have focused on VEC’s failure to deliver unemployment benefits to out-of-work Virginians, many of who have fallen behind on their rent payments now face eviction.

Between March 2020 and July 2021, the VEC paid out $13.9 billion in state and federal unemployment benefits, states JLARC. The number of claims jumped tenfold, and guidance for administering the gush in federal relief dollars was unclear and evolved over time. The VEC’s obsolete claims-processing software was overwhelmed. Further, the VEC compounded its problems by making forms and instructions overly “complex and confusing.” Continue reading

Can’t Anybody Here Play This Game? Virginia’s 211 – Service or Crapshoot?

by James C. Sherlock

Sometimes the government of Virginia just makes you want to scream, cry, stay under the covers, whatever.

Navigating government and private social services agencies when you need help is hard, even more so a crisis. But it is way harder in Virginia than it needs to be.

To streamline the navigation process, the Federal Communications Commission in 2000 created 211, a number reserved for helplines that offer information or referrals to health and social support programs.

Given a layup, Virginia has clanged the ball off the bottom of the rim. Continue reading

The Accelerating Scale of the Legislate-Regulate-Spend-and-Repeat Cycle Has Broken Government

by James C. Sherlock

Virginians – the state and individual citizens – have received over $81 billion in COVID-related federal funding. That comes to $9,507 for every man, woman and child in the Commonwealth.  Big money. 

That was Virginia’s share of $5.3 trillion in federal spending just on the pandemic (so far). A trillion dollars is a million million dollars. A thousand billion dollars.

For comparison, GDP was about $21 trillion in 2020  It is projected to total just short of $23 trillion this year.  The national debt is $29 trillion and growing. A little over $86,000 for every American. That figure does not include the $5 trillion in additional spending pending in the Congress.

Every day we spend $1 billion on interest with interest on the 10-year treasuries at 1.18% today. The Congressional budget office predicts 3.6% before 2027. Do the math. That is $3 billion a day — well over a trillion dollars a year — in interest. 

Relax. If you thought I was about to launch off on a discussion of drunken sailors, writing checks that our grandkids will have to make good, and the fact that inflation will drive interest payments ever upward, be reassured I am not.

This is about the demonstrated inability of many government agencies at every level to regulate, administer, oversee, spend and repeat with anything approaching efficiency or effectiveness.  Continue reading

No PAC for Disaster Preparedness and Response

Why is this man smiling?

by James C. Sherlock

Virginia’s responses to COVID were a continuing national embarrassment. 

  • Individual Virginia department and agencies had no operational pandemic response plans. They ignored specific and prescient directions to build and exercise such plans in the dormant Virginia Pandemic Emergency Plan. VDEM then attempted a coverup.
  • No PPE stockpiles. Last in testing. Last in vaccinations. Hospitals first, physicians last in every decision by the VDH. 
  • Last in distribution of unemployment checks. 
  • The General Assembly was given and took no role in pandemic response for 15 months.
  • The Canterbury nursing home scandal. State nursing home inspections that failed to report staffing shortages. The directly related shortages in staffing of state inspectors.
  • The failure to sanction teachers unions for strike threats in Northern Virginia during COVID. The officially sanctioned lapse in school accountability.
  • Poorly prepared official press conferences that often added confusion rather than clarity.

This was in its totality the biggest government scandal in Virginia history.

Continue reading

Fredericksburg’s Tree Tyrants

Sallie Daiger sits on the porch of her pre-Civil War home on Caroline Street in Fredericksburg.

by James A. Bacon

I was driving up Interstate 95 to Fredericksburg one Saturday in April when I got a call from my mother. Pick up a rental chain saw on the way into town, she said. She wanted me to cut down a crape myrtle in front of her house. I knew well the tree she was referring to. She’d planted it as a sprig twelve to fifteen years before, and it had become a nuisance. Branches slapped against the telephone lines overhead, draped over the sidewalk, and shed debris on cars parking in the street. My sister, a housekeeper and I had taken turns pruning it, but the branches quickly grew back. I agreed that it was time to take the wretched thing down for good.

I’m no expert with a chain saw, but it wasn’t a difficult job. I lopped off the branches previously amputated with a hand saw, and carved out chunks of the trunk to chest-high level. Then I attacked the base of the tree, cutting around the rim as deep as the chain saw blade would go. I’d made it about 60% of the way through the trunk when a neighbor approached me in a state of alarm.

Frank Widic was a tree steward with Tree Fredericksburg. I had to immediately stop what I was doing, he told me. The crape myrtle was located on city right-of-way, and I was forbidden by ordinance from cutting it! I protested that the city had done nothing to maintain the tree, and that it needed to come down. That didn’t matter, Widic said. He  put me on his cell phone to talk to Anne Little, president of the nonprofit Tree Fredericksburg organization.

Little was even more emphatic. City rules were very clear, she said. I had to stop. If I didn’t, she was obligated to notify the police. Whoah, thought I. This was way above my pay grade. I handed the phone to my mother, who was watching events unfold from a perch on the porch. Continue reading

Is DOJ’s Focus on Healthcare Monopolies Coming to Virginia?

by James C. Sherlock

The Acting head of the Justice Department’s Antitrust Division, Richard A. Powers, yesterday delivered a speech that described the Justice Department’s new goals, strategies and resources for criminal antitrust enforcement.

The clouds have darkened over Virginia’s healthcare monopolies.

The Commonwealth. Virginia has failed in its duty to oversee its healthcare industry.  The full extent of that failure has been detailed in previous columns.

It has failed in two major ways:

  1. The Virginia Department of Health (VDH) has been captured by the healthcare provider industry that it regulates. Indeed VDH has been actively complicit in industry evasion of antitrust statutes through its administration of Certificate of Public Need (COPN) law.
  2. The Commonwealth’s regulatory structure has a strategic vulnerability. Neither the VDH that regulates providers nor the State Corporation Commission that regulates insurers can adequately oversee integrated health care delivery and insurance companies to prevent or detect what amount to internal conspiracies in restraint of trade. In the wrong hands, integrated provider monopolies and regionally powerful insurers can serve as weapons against competitors to both.

Continue reading

Richmond Schools’ Flawed Data Threatens Federal Funds


by James C. Sherlock

The massive flows of federal and state funding to local school districts are based largely on data reported by the schools to their districts, the districts to the Virginia Department of Education (VDOE), and VDOE to the U.S. Department of Education.

In Fiscal Year 2018, the U.S. Department of Education sent more than $820 million to Virginia in support of K-12 education. Every dollar was allocated based on data collected and quality assured at the local, state and federal levels. 

The City of Richmond Public Schools (RPS) has massive problems that result in outsized contributions by the federal government. One of those problems — a serious and potentially consequential one — could imperil federal funding.

We will explore a recent event that illustrates that issue. Continue reading

Martinsville and the Reversion – Part 2

by James C. Sherlock

Dick Hall-Sizemore yesterday gave us a rather bloodless, bureaucratic, and relatively positive description of the upcoming shotgun marriage between Martinsville and Henry County. He could not seem to understand the angst on the part of Henry County.

I’ll try to help him out.

It was good to have the historical perspective that Dick always brings, but I am going to take the opportunity to offer a bit of the human side of that merger.

First, these are two profoundly poor areas. The people, white and black, are also much less healthy than the rest of the state. The tale, however, doesn’t stop there.

Selected differences

Martinsville

  • The 2020 population of Martinsville was 13,821. The median age was 42.7 compared to the state average of 37.8. The population was 53.5% female. Percentage in civilian workforce 54.9%.
  • The median household income in Martinsville, VA in 2019 was $35,405, which was 115.9% less than the median annual income of $76,456 across the entire state of Virginia.
  • The FY 2021 budget for Martinsville was $103 million, of which $27.6 million is school-related for 1,881 pupils. Totals: $7,452 per citizen, $14,673 per pupil. Black student 2019 SOL pass rates: Math, 74%, Reading, 59%.
  • Persons under 18 years: 25.4%
  • Persons over 65 years: 18.1% because of much lower life expectancy
  • Building permits 2020: 1

Continue reading

More on the Martinsville Reversion

Uptown Martinsville

by Dick Hall-Sizemore

Like Jim Sherlock, the decision of the city of Martinsville to revert to town status caught my interest.

There are several  clarifications, as well as context, needed in response to his post on this subject, which would be too long for a comment. Therefore, I have decided to use a separate article.

To begin with, Martinsville has not led the way in its decision to revert to a town. As noted by several commentators,  the City of South Boston, now the town of South Boston in Halifax County, was the first city to revert to town status. The reversion was effective in 1995. The city of Clifton Forge (Alleghany County) followed in 2001 and lastly, there was the city of Bedford (Bedford County) in 2013. All three former cities are now towns. Here is the list of reversions, along with the reports of the Commission on Local Government regarding these reversions.

For detailed analyses of the reversion process in Virginia and how it works, see here and here. Continue reading

The One-Sided Decision in the Reversion of Martinsville – the Start of a Trend?

by James C. Sherlock

The Martinsville Bulletin, perhaps the best remaining newspaper in the state for local coverage, published a must-read article on the reversion of Martinsville from city to town and joining Henry County.

Overview

Martinsville’s current city logo, above, was perhaps prescient. Martinsville has been hemorrhaging population, losing more than 18% in the past 10 years, and was financially stressed before that loss.

Reversion in Virginia is a one-handed game. The small cities hold all of the cards.

Henry County is vocally opposed but feels helpless to stop it. The Henry County Supervisors voted to skip the legal process to avoid the costs. They called the reversion MOU “the best we could hope for and voted for it to avoid years of court battles”.

They are right  What they avoided was the special court that would have overseen the reversion under Virginia law had they not come to an agreement. The county would have been a defendant in a trial.

The rules for that court specified in that law give the small cities every advantage in a trial. That same special court would have overseen the transition for a decade. Every decision.

The changes reversion portends for city and county residents are massive. Now that his has happened, does anyone think this will be the last reversion? Continue reading

Vertically Integrated Health Providers/Insurers – Weak State Oversight But New Federal Authority

by James C. Sherlock

In the contest between Virginia’s disorganized attempts to oversee vertically integrated health care and health insurance businesses, Sentara being the most prominent example, and Virginia’s regional monopolies’ defenses against effective regulation and legislation, the monopolies have won.  

This piece discusses Virginia’s failed legislative and regulatory oversight structures. I will recommend structural changes to both to deal with the issues that fall between the cracks.

There is, however, very recent good news.

A new federal antitrust law gives federal courts full authority over integrated healthcare/health insurance business structures operated in restraint of trade. I will briefly describe the potential effects of that change. Continue reading

The Day-Late-and-a-Dollar-Short Administration

Image pulled from the VEC website.

by James A. Bacon

So much dysfunction…. at so many levels.

The federal government has been throwing trillions of dollars into COVID-19 relief. Many billions have flowed into Virginia. Despite this unprecedented peace-time spending, thousands of Virginians are being evicted from their homes, and thousands more are lining up at food pantries and soup kitchens. Why? Because government agencies can’t get the relief money to them in a timely fashion.

Look, I understand. Times of crisis require time to adapt, whether you’re a government agency or a private company. There’s no magic wand to wave to make massive economic dislocations painlessly disappear. But we can legitimately compare the performance of Virginia to other states. And by the basic criteria of handing out unemployment insurance payments to people who have lost their jobs, the Commonwealth appears to be doing a colossally poor job.

“Virginia continues to rank last in the country in key performance metrics tracked by the U.S. Department of Labor,” reports The Virginia Mercury. “The federal data shows the situation has only gotten worse as the pandemic continued, even as businesses have begun reopening and new claims have dropped.” Continue reading