Category Archives: Long Term Care and Nursing Homes

The Registered Nurse Shortage

Posted on March 20, 2023 by | 72 comments

by James C. Sherlock

I have reported often about the severe and increasing shortages of nurses both in Virginia and nationally.

At some point in nearly everyone’s life, we literally will not be able to live without the help of a nurse, whether for injury or illness or just declining overall health.

We need both the nurses and ourselves to be safe when that happens. We will have to fill the shortages, first by recruitment and retention. Perhaps simultaneously by increased legal immigration of qualified nurses from other countries.

This article will focus first on what RNs were paid in 2021, both in Virginia and nationwide. We will examine it in absolute and in relative terms. Virginia in 2021 was competitive on pay in relative terms. But wages may be insufficient in absolute terms to address the shortages.

Then we will discuss what else needs to be done to recruit, train and retain more nurses. I mentioned in an earlier article that RN instructors in training programs are one of the biggest needs.

The Census Bureau and Bureau of Labor Statistics have captured the large increases in registered nurse (RN) pay across the board and the doubling of the pay of travel nurses in 2021. Those pay surges were driven by COVID supply and demand and funded partially by federal emergency money.

You will see that, by what I consider a useful calculation, Virginia RN’s median wage compensation is 18th among the states when adjusted for each state’s cost of living index. Virginia is the top-paying state among adjacent states and the District of Columbia.

Regardless of the reason, it was past time that we paid them more. We need the pay raises to stick. It is the only way over the long run to begin increasing the supply.

I say begin because there are other factors driving nurses away. Safety is a huge factor. Continue reading →

72 Comments

Posted in Ethics, Government Oversight, Health Care, Immigration, Labor & workforce, Long Term Care and Nursing Homes

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New Fed Policy Would Hide CMS Data on Patient Safety Records of Hospitals

Posted on July 7, 2022 by | 13 comments

by James C. Sherlock

One of the most disturbing commentaries I have read in a long time relating to federal efforts to improve hospital patient safety reports a major step backwards in that program.

I have written here many times of the power of the hospitals over Virginia’s politics. A proposed new federal rule shows that power at the federal level. It would negatively affect your ability to understand and compare the patient safety records of hospitals.

The Biden administration Centers for Medicare/Medicaid Services (CMS) proposes to hide from the public a CMS rating that helps consumers view relative patient safety grades of hospitals. As important to the hospitals, perhaps, no one would be able to report on that information.

It also proposes to waive $350 million in fines for hospitals that violated existing regulations.

CMS for the Secretary of Health and Human Services is, with this rule, exercising the extraordinary powers the Secretary gives himself by constantly extending the Declaration of Public Emergency for COVID.  And yes, that is legal.

Virginia Hospital and Healthcare Association (VHHA) submitted a 17-page letter of comment. It of course supported the waiver of fines.  On the issue of suppressing patient safety data, the VHHA wrote, unsurprisingly:

“VHHA and its members are supportive of the proposed suppression (of data) in the HVBP program.”

The letter also encouraged CMS to also suppress pneumonia mortality measure because of the potential overlap with COVID- related pneumonia.

The only way that could happen since CMS is already suppressing data with a primary or secondary COVID diagnosis is if there was no reported COVID indication in pneumonia cases.

The proposal itself represents a major scandal.  A total of 1,533 comments, now closed, were submitted on the proposed rule.

They comments from doctors and patient safety groups were unsupportive.  Hospitals were very supportive.  The Virginia Department of Health sent a short letter on the larger rule, but did not comment on data suppression.

The result: political healthcare rules courtesy of the Biden administration and the hospital lobby.

The following article is reprinted by permission of Kaiser Health News. Continue reading →

13 Comments

Posted in Consumer protection, Federal, Government Oversight, Health Care, Long Term Care and Nursing Homes, Money in politics, Political Influence, Public safety & health, Regulation, Transparency

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Medicaid, Public Health and Chronic Disease Management

Posted on May 29, 2022 by | 6 comments

UVa Hospital

by James C. Sherlock

From the CDC:

Chronic diseases have significant health and economic costs in the United States. Preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce these costs.

Virginia pays a great deal of money every year to contractors who manage the care of its Medicaid population.

It is a hard job, but even though the challenges are tough, it has appeared to me for a long time that we are not getting our money’s worth from $18 billion annually in Medicaid payments for the populations managed by these contractors.

A white paper, “Prevent Costly Chronic Disease Through Member Engagement” caught my eye as the basis for a follow up to my earlier report on public health and Medicaid managed care in Petersburg.

This is that update. Continue reading →

6 Comments

Posted in Budgets, General Assembly, Government Oversight, Health Care, Insurance, Long Term Care and Nursing Homes, Mental illness and substance abuse, Public safety & health

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Unionize Virginia’s Worst Nursing Home Chains

Posted on April 25, 2022 by | 8 comments

by James C. Sherlock

If you go back to the series of articles I published here in October of 2021, you can refresh your memory on the dangers represented by Virginia’s worst nursing home chains.

If you look at the complete spreadsheet of every Virginia nursing home from that data sorted by ownership, the bad actors jump off the page. Their business models treat understaffing as a feature, not a problem. The fact that it endangers their employees and kills their patients seems not to matter.

The Commonwealth’s executive and legislative branches have for a very long time absolutely ignored their responsibilities as the state legislature and as the state executive regulator, federal and state inspector and state licensor of nursing homes, respectively. There is as yet no sign that will improve. I have hopes the new administration will step up to those responsibilities, but we’ll have to wait and see.

For now, the only fix that appears viable is unionization of the work forces of the bad actors. I encourage their employees to do it for themselves and their patients. Continue reading →

8 Comments

Posted in General Assembly, Governance, Government Oversight, Health Care, Labor & workforce, Long Term Care and Nursing Homes, Political Influence, Unions

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A Narrative About Virginia’s Rural Hospitals that Obscures the Facts

Posted on March 8, 2022 by | 12 comments

by James C. Sherlock

Becker’s Healthcare, a widely read medical news organization, published a story on Friday, “892 hospitals at risk of closure, state by state.” Rural hospitals were the topic.

It cited as its source a report from a non-profit named The Center for Healthcare Quality and Payment Reform (CHQPR), which presents itself as “a national policy center that facilitates improvements in healthcare payment and delivery systems.”

The CHQPR report Rural Hospitals at Risk of Closing claims that twelve of Virginia’s “27″ rural hospitals are at immediate risk of closing. It certainly engaged my interest.

Another CHQPR report, The Crisis in Rural Health Care, has an interactive map where the twelve perhaps can be found.

But the sources of both reports are a mystery, at least to me.

  • First it must be noted that the Virginia Department of Health lists only 20 rural hospitals in the state.
  • Only five of them lost money in 2020 (see the column “Revenue and Gains in Excess of Expenses and Losses”).
  • Four of those are owned by large and profitable health systems that use them to feed more profitable cases to other system hospitals.

It is dangerous to the cause of improving rural healthcare to create “reports” like this. Continue reading →

12 Comments

Posted in Budgets, General Assembly, Health Care, Long Term Care and Nursing Homes

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Big Lessons from Government Data on Virginia’s 286 Nursing Facilities

Posted on October 13, 2021 by | 8 comments

by James C. Sherlock

Nursing facilities in Virginia offer an incredible mixed bag. There are heroes and villains. Much to see here.

This column will offer expansive  views of government data on each of the 286 nursing facilities in this state.  

I found out a lot things that really matter to the quality of a nursing facility in Virginia. And a lot of things about government oversight.  nd government insurance payments.

From the visualization aids I provide, so will you.

  • You will find absolutely outstanding facilities.  
  • You will find others that have fallen so short of government standards for so long that you will wonder why Virginia does not revoke their licenses.  
  • You will see the nursing homes in your region.  
  • You will see which chains deliver excellent facilities and which do not, apparently as business models in both cases. Many chains tend to be consistently good or consistently bad. They are color coded in the “Group Ownership” column based upon the overall performance of the chain.  
  • Take a look at the staffing star ratings. Those are based on quarterly filings of data that is linked to payrolls, so it is relatively up to date and relatively accurate. One- or two-star staffing is a very bad sign.
  • You will see the stunning outperformance of nursing facilities in continuing care facilities in Virginia, also as a function of business models.
  • Nursing home inputs — people — enter nursing homes in much different physical conditions and ages. You will see that where you live is a statistical predictor of health. And therefore of the nursing home challenges in areas of poor health. Which tracks with areas of poverty. And low government insurance payments.

Finally, take a look at the Inspection activity.  

It reflects the massive understaffing of the VDH inspectors. Look at the “Last standard (full) health inspection” column. You will see coded in red that 42 (15%) of Virginia’s nursing facilities have not been fully inspected since 2018.  The federal requirement is once a year.  

You will be convinced by the data that strict and timely government oversight is required to ensure, and ensure Virginians of, of nursing facility quality.  

The state must fix the statutory and budget issues that have resulted, purposely, in Office of Licensure and Inspection staffing shortfalls. Continue reading →

8 Comments

Posted in Demographics, Government Oversight, Health Care, Long Term Care and Nursing Homes

Nursing Home Ads Pose As Official State Advice

Posted on October 12, 2021 by | 9 comments

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 →

9 Comments

Posted in Efficiency in government, Governance, Government Oversight, Health Care, Long Term Care and Nursing Homes

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Virginia’s Self-Inflicted Nursing Home Crisis – Part 5 – The Best facilities in Virginia

Posted on October 4, 2021 by | 1 comment

by James C. Sherlock

To show you the list of nursing facilities that I would use to begin a search for one for me and my family, I have built a spreadsheet of the very best facilities in Virginia.

Because they are available, I made it a true list of all stars. Five stars composite rating and not a single individual rating below four stars.

There are 40 of them, surprisingly and welcomingly spread around the state. If you read my previous posts, or read the notes on the spreadsheet, I don’t have to comment extensively.

Eight of them are for-profits.  So it can be done. Continue reading →

1 Comment

Posted in Health Care, Long Term Care and Nursing Homes

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Virginia’s Self-Inflicted Nursing Home Crisis – Part 4 – the Worst Facilities in Virginia

Posted on October 4, 2021 by | 7 comments

by James C. Sherlock

Today we are going to take a look today at a snapshot of Virginia’s worst nursing homes as rated by the Centers for Medicare/Medicaid services.

Medicare rates 54 of the total of 386 nursing facilities in Virginia as overall one star out of five.  By definition of the way that Medicare compiles records and assigns scores, they have been bad for a long time.

Don’t use them. If you have any friend or loved one in one of these places encourage them to re-locate if they can. Either way, visit them often. It helps.

The ratings are established in considerable part by the inspections conducted by the Virginia Department of Health Office of Licensure and Inspection.

Continue reading →

7 Comments

Posted in Government Oversight, Health Care, Long Term Care and Nursing Homes

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Virginia’s Self-Inflicted Nursing Home Crisis – Part 3 – McAuliffe & Herring

Posted on October 2, 2021 by | 4 comments

by James C. Sherlock

In the first two parts of this series, I wrote about the shortage of state inspectors for nursing homes in the Virginia Department of Health Office of Licensure and Certification (OLC)  and the continuing danger it poses to Virginia patients.

The problem, unfortunately, is much wider than just nursing homes.  So is the scandal.

That same office inspects every type of medical facility including home care agencies as well as managed care plans. Except it cannot meet the statutory requirements because it does not have sufficient personnel or money. And it have been telling the world about it for years.

Terence Richard McAuliffe was the 72nd governor of Virginia from 2014 to 2018. Mark Herring has been Attorney General since 2014.

We will trace below that they can reasonably be called the founding fathers of overdue inspections of medical facilities in Virginia.

VDH has been short of health inspectors since McAuliffe and Herring took office and still is .

Both of them know it. And they know that lack of inspections demonstrably causes unnecessary suffering and death.

Continue reading →

4 Comments

Posted in Consumer protection, Ethics, General Assembly, Governance, Government Oversight, Health Care, Long Term Care and Nursing Homes, Money in politics, Political Influence, Public corruption, Regulation, Scandals

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

Posted on October 1, 2021 by | 8 comments

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 →

8 Comments

Posted in Children and families, Consumer protection, Efficiency in government, Ethics, General Assembly, Governance, Government Oversight, Health Care, Long Term Care and Nursing Homes, Money in politics, Public safety & health

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

Posted on October 1, 2021 by | 15 comments

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 →

15 Comments

Posted in Children and families, Efficiency in government, Ethics, ethics, General Assembly, Governance, Government Oversight, Health Care, Long Term Care and Nursing Homes, Money in politics, Public safety & health, Uncategorized

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

Posted on August 4, 2021 by | 23 comments

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 →

23 Comments

Posted in Budgets, Disasters and disaster preparedness, Education (K-12), Efficiency in government, Finance (government), General Assembly, Governance, Government Oversight, Health Care, Housing, Long Term Care and Nursing Homes, Mental illness and substance abuse, Money in politics, Politics, Public safety & health, Scandals, Social services

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The Business and Politics of Senior Care in Virginia

Posted on March 24, 2021 by | 2 comments

by James C. Sherlock

We write here often about senior care, the companies that provide it and the politics around that business.

It is useful to understand the continuum of care to make sure we also understand the different financial situations which companies in different parts of that industry find themselves and the way they are overseen and paid in Virginia.

The larger corporations that offer these services often offer both facility and in-home care.

The basic descriptions below are offered for considering the business interests and therefore the lobbying efforts of the companies that provide the services. They are not meant for personal counseling. Continue reading →

2 Comments

Posted in Finance (government), Government Oversight, Health Care, Insurance, Long Term Care and Nursing Homes

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The Real Nursing Home Scandal in Virginia

Posted on March 23, 2021 by | 5 comments

Canterbury Rehabilitation and Healthcare Richmond

by James C. Sherlock

Mike Martz has written three excellent columns that have appeared in the Richmond Times Dispatch starting March 19.  Headline of one: “Virginia tries to move ahead of national ‘reform agenda’ for nursing homes.”

The gist of it was that a couple of national nursing home industry organizations have taken advantage of the public consciousness of the COVID tragedies to produce a “reform agenda” centered around significantly higher Medicaid payments.

Unreported so far is that they also want weaker inspections. More about that below.

We all applaud any attempt to “improve operating standards for nursing homes, initiatives to boost the facilities’ workforce, and efforts to give residents more privacy and protect them from poor-performing nursing homes” as Martz wrote. Who could oppose that?

The financials of nursing homes lead me to agree that higher Medicaid payments will be required to accomplish those goals. But the higher payments need to be accompanied by better oversight to make sure that the money brings the desired outcomes.  Continue reading →

5 Comments

Posted in Consumer protection, General Assembly, Governance, Government Oversight, Health Care, Long Term Care and Nursing Homes, Political Influence, Regulation

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