Nurse Staffing in Virginia Nursing Homes in July Ranked 49th in the Nation

by James C. Sherlock

The Centers for Medicare & Medicaid Services (CMS) has released its national nursing home quality data for July.

It provides summaries of nursing home performance for each state, the District of Columbia and three U.S. territories.

I sorted it for Reported Total Nurse Staffing Per Resident Per Day. I did that because Virginia’s lead nursing home lobbyist in January insisted, on video, to a hearing of an always-compliant General Assembly that the Commonwealth’s nursing homes be judged by that metric.

In July, our nursing homes ranked 49th by their own preferred total nurse staffing measure. Nurse shortages are nationwide, so that fact cannot explain it.

Those same nursing homes in those same data ranked 45th in total nurse turnover at 57.5% annually. Some of the worst individual Virginia nursing homes experience nearly 100% nursing turnover annually.

That creates a vicious cycle.

  • Virginia has too many nursing homes that are understaffed, some by design;
  • Nurses quite naturally don’t like to work in them and, with many job options, will not remain in such places;
  • When staffing falls, nurses know it from CMS data or reputation and won’t take a job where they will be overworked and unable to provide optimum care to patients;
  • The understaffed nursing homes get worse.

Federal data show that Virginia nursing home residents, the most vulnerable people in the Commonwealth, when compared to those in most states:

  • die prematurely;
  • get sicker and less able to care for themselves faster in long-term stays;
  • get well more slowly in short-term stays; and
  • too often suffer abuse and denial of their rights and dignity.

Governance. That is the direct result of a couple of long-term facts in the Commonwealth.

First, we have for many years suffered from nursing home industry capture of the General Assembly, which now seems incapable of embarrassment on anything relative to that industry.

Second, the Health Commissioner is authorized to levy administrative sanctions which include restricting new patients, court-ordered receivership and shut- down in what we would expect to be that order.

Those sanctions have been authorized since 1997. I can find no instance in which they have been levied. I have submitted a FOIA request to see if I missed any.

Even so, seeking a belt and suspenders, the nursing home industry pushed a new law through this year to take effect in 2025 that will neuter the 1997 sanction regulation. It will delay the imposition of those penalties for five years after any Commissioner may decide they are needed.

Bottom line. A captured General Assembly and a hands-off regulatory environment in Virginia have removed the risk of understaffing, which is very profitable, and by doing so have attracted too many unethical operators.

Thus Virginia’s nursing homes ranked 49th in the nation in staffing last month.

There is no possible way for significantly understaffed facilities to deliver the services for which they are paid per diem rates by the Medicare and Medicaid programs or by any other insurer.

And both state and federal governments know it.

Good thing that there are not real patients at risk. At a nursing home near you.