The Canterbury Tragedy and the Failed Virginia Department of Health


Key metrics for Canterbury Rehabilitation (also known as Lexington Court). Source: Virginia Health Information

by James C. Sherlock

One of the issues we are facing with the decline of regional newspapers is the decline of investigative reporting. The few reporters left in Virginia covering the Northam administration are printing press releases as stories and reporting press conferences for what is said, not what is unsaid or wrong. The national newspapers focus on President Trump. An article in the New York Times on the Canterbury disaster failed to mention the Northam administration at all, even though that facility is Medicaid funded and the state has a responsibility to oversee (Department of Medical Assistance Services (DMAS)), inspect and license (Virginia Department of Health (VDH)) it.

States have a contract with the Centers for Medicare/Medicaid Services (CMS) to monitor those nursing homes that want to be eligible for Medicare and Medicaid.  Canterbury Rehabilitation and Health Care Center is one of those.  Nursing facilities are inspected by VDH Division of Long Term Care:

  • every 2 years for Virginia state licensure; and
  • an average of every 12 months for Medicare/Medicaid certification.

Out of a potential five stars in the rating of nursing homes by Medicare based on VDH inspections, 59 of 286 Virginia nursing homes have been rated one star, a Much Below Average rating. Nine of those have been cited for abuse.

Canterbury Rehabilitation and Health Care Center in Richmond is the location of the largest number of nursing home deaths from COVID-19 in the country.  At the onset of the COVID-19 scourge, it was rated two stars overall (Below Average) and one star (Much Below Average) in health inspections and staffing.  The Canterbury facility is about a 20 minute drive from VDH headquarters.

I had an extensive email exchange last year with VDH about one-star rated hospitals — specifically asking what the Commonwealth was doing to improve them. I recommended the state ask for letters of correction from one-star hospitals. The answer was no. They would not require letters of correction with specific actions and milestones. By VDH policy they do nothing, just inspect and report.

I reported here[1] on February 22 that the nursing home representative on the State Board of Health[2] is the CEO of Heritage Hall, a chain of nursing homes. See this for the Medicare ratings of those nursing homes. Of the 17 Heritage Hall facilities in Virginia, one is graded as having average staffing, the rest below average or much below average. In overall ratings, nine of the 17 are rated below average or much below average. Heritage Hall has contributed more than $100,000[3] to political campaigns over the years, mostly through the Virginia Hospital and Healthcare Association (VHHA).

So, no, the federal government does not ensure that Virginia’s nursing homes treat their patients well and protect them from harm. CMS levies fines for the worst offenses, but they are generally not large enough to change facility behavior. State regulators still need to take action if behavior is to be changed, such as mandating specific changes to the way the home operates by requiring a letter of correction from the operator and ensuring it is executed. It is hard to square properly corrected actions, especially staffing shortfalls, with the year-after-year one-star nursing home ratings in Virginia.

The Northam administration is directly responsible for inspection and licensing of Canterbury Rehabilitation and Health Care Center in Richmond. The facts that signaled the vulnerability of the institution to pandemic virus were gathered and reported by the Commonwealth itself. From news reports, staffing shortfalls at Canterbury were still a problem with the onset of the pandemic.

The Virginia Department of Health is a failed institution with a failed leader, Dr. Oliver.  No amount of hand waving and misdirection will change that fact.  We need a new Health Commissioner.  Too late for a new Governor.

[1] https://www.baconsrebellion.com/wp/virginias-board-of-health-and-the-virginia-way/

[2] http://www.vdh.virginia.gov/commissioner/administration/board-of-health/virginia-state-board-of-health-membership-roster/

[3] https://www.vpap.org/search/?q=Heritage%2520Hall&facet=donors

Note: Part of this column has been re-written since its original publication. — JAB


[1] https://www.baconsrebellion.com/wp/virginias-board-of-health-and-the-virginia-way/

[2] http://www.vdh.virginia.gov/commissioner/administration/board-of-health/virginia-state-board-of-health-membership-roster/

[3] https://www.vpap.org/search/?q=Heritage%2520Hall&facet=donors

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90 responses to “The Canterbury Tragedy and the Failed Virginia Department of Health

  1. Good points but what about ownership changes?

  2. ” A Washington state nursing home tied to 40 covid-19 deaths faces a fine of more than $611,000, federal inspectors said, and could also lose Medicare and Medicaid funding if it does not correct a slew of deficiencies that led to the country’s first major outbreak of the novel coronavirus.”

    does this mean that the Washington Gov was also remiss?

    What happens to all the folks in Canterbury if the Feds/State close it?

  3. The most important data point = HOW MANY WERE PUT OUT OF BUSINESS, de-licensed?

  4. How do we see the star ratings?
    I’d be curious to know how the ones in my area do, since I visit some and some are close my house.

  5. My long term health plan is easy. The spouse has strick instructions. Open the pelican clips push me through the lifelines, write in the log, “Came on deck at watch change. Spouse not here. Placed MOB distress call 0410, came about.”

  6. This is a State that granted the carriers of Long Term Health Care policies a rate increase based on their claims of rising care costs.

    LTHC benefits are FIXED.

    Think about that.

    • MedicAid only pays a fixed amount. It’s up to the resident or their family to make up the difference.

      Many who are in nursing homes and rely on Medicaid – if they have assets like a home, have to pay back when the home is sold.

      Those without homes get their care gratis.

      It is by no means, the same care that would be received if they were wealthier – the care is much better.

      This is what happens when people do not save for their long term care. It ends up being a cost to taxpayers and the reimbursement is minimal such that nursing home has to contain costs since they are not a govt facility and have to pay staff and other costs and stay in business.

      Northam is being accused of NOT exercising MORE govt regulation and top-down control… ironic.

    • LTHC is a “scam”. It is if you do not read the fine print – and hire a lawyer when they try to renege.

      It is, as you say, rife with abuses.

      However,that is no excuse for not planning for one’s own care and instead relying on the govt … which almost everyone does despite their rhetoric.

      • CAPT Sherlock made a comment to which I responded. It disappeared. I suspect he saw to whom he’d writ, and in a moment of lucitity, jerked it.

        There are better things in which to invest to provide for LTH care than the schlock products Genworth, et al, offer.

        • there apparently have been discussions about “jerking” comments. Jim can explain it if he wishes. I don’t think there is any accountability for it – to explain it was done and give a reason – it’s totally autocratic.

          and yes agree on the LTCH – but people do it. The govt offers it to their employees.. Jim has it and complained when they increased premiums. I’ve heard “advice” that it’s “better” to play games with Medicaid – i.e. shed your assets then plead poverty.

      • LTHC policies vary considerably. I converted a life insurance policy not needed because my kids are grown to a combination smaller life insurance policy and an LTHC policy that will pay till I’m gone with significant inflation coverage. The worst that happens is that the smaller life insurance policy is eaten up. The rest of my assets, such as they are, are protected.

        You need to have a good insurance agent work for you. Taking care of one’s self requires some personal effort.

  7. I agree with you that both hospitals, nursing homes, rehabilitation centers, and other medical facilities subject to regulation that receive below average inspection ratings should be put on some sort of notice that, unless the deficiencies are addressed, their licenses to operate will be revoked. Fines should be a part of these enforcement actions. The failure to take such actions has been a longstanding problem.

    It would be interesting to compare the ratings of those facilities that take mostly Medicaid patients with those facilities that cater to private insurance patients.

    I doubt that the deficiencies noted for Canterbury led to the vulnerability of its patients to the pandemic. As you noted, the facility in Washington that was the leader in deaths before Canterbury had a five-star rating.

    • I had read that some rooms had three to a room – dunno if that is allowed or not.

      I’ve been to several nursing homes over the years. Even the “good” ones are sad places… places I don’t want to be even as a visitor to be honest.

      But if you fine them – and they close down – the residents have to find other places to go – and if you have done that for someone or know someone that has done that – you know just how hard that is to do. And if your primary reimbursement is Medicaid – it’s even harder – they don’t want you unless they have no choice.

    • But the facility in Washington got hit early in the outbreak. Virginia should have learned from that mess and actively gone about testing all residents of any long term care facility where even a single case occurred. That took 3 weeks at Canterbury.

    • I have no idea what you are talking about. What comment did I make that was pulled down?

    • Canterbury was short staffed and did poorly on its inspections. Again, the problem is that the Commonwealth does nothing with the deficiency information it generates. The Washington case shows that even the best rated nursing homes can have problems even when the state does its job, but starting this crisis with known deficiencies that would make it worse as in the case of Canterbury is the state’s responsibility.

      • Just to be sure – you ARE advocating State intervention/regulation on healthcare facilities, right?

        On other threads here – we hear of the “jack boots of Govt command and control – top-down” stuff.

        right?

        so what makes this particular thing “ok” and others like COPN , not?

        why is the “free market” good for hospitals and bad for nursing homes?

        • Larry, you are spinning yourself into the ground. My column above reported that a year ago I contacted VDH trying to get them to do something that was easy – require a letter of correction from 1-star hospitals. That agency rejected any responsibility to do so without even saying whether they thought it was a good idea. That is the very definition of a passive (avoiding saying lazy) regulatory agency. If you think government inspection of healthcare facilities has anything – repeat anything – to do with COPN – in which the government grants and denies billion dollar permission slips, awards regional monopolies and actively blocks competition resulting in higher prices and lower access – I have failed in my mission to educate.

          • Jim – this goes to the issue of govt regulation and one’s own views of what govt’s role should be in the free market.

            I believe the govt has a valid role in regulation – whether it be COPN or Nursing Homes.

            But I also reject the idea that Northam is responsible for “failures” that occur in the various agencies of Va govt that have operated for decades and who are governed by the General Assembly.

            Blaming Northam for “congestion” in NoVa or CSO failures in Richmond or VDH failures in nursing homes is a bridge too far.

            He does preside over these agencies but these agencies operate according to how the GA has laid out the Va code not Northams personal views or behavior.

            If you want change – it has to come from the GA. You know that.

          • Jim – these state agencies are run according to Va Code. The Gov is a caretaker…

            You talk about one-star facilities – that’s a FEDERAL GOVT thing not a state thing!

            Northam DOES have the ability to have some control over the state agencies – agreed but to blame him for things that have been ongoing in Virginia for decades is just not reasonable.

            If VDH needs to be reformed – I’d like to see JLARC say so AND some proposed GA legislation to do it.

            That’s how COPN would have to change. You know that.

            Are you blaming Northam for COPN? why not?

  8. So, have we tested every resident and every care giver in every long term care facility in Virginia? That would let us isolate the asymptomatic carriers before the next Caterbury fiasco. As for reopening – half of Virginia’s COVID-19 cases are in long term care facilities. Nobody questions whether long term care facilities need special rules, treatment and attention during the COVID-19 outbreak. But shouldn’t those cases be separately tracked for purposes of choosing a date to start reopening the economy?

    So, which facilities have COVID-19 cases? Virginia state law prevents that disclosure. Let that sink in. Why should that information be secret? Could it be that the grifters in our General Assembly don’t want to antagonize campaign donors or potential donors? Or do they prefer that their hapless attempts at regulation of these facilities remain “under the radar”? Both would be consistent with The Virginia Way. And if Northam can suspend the US Constitution with his emergency powers can’t he also decide to publish the long term care facility data?

    As for journalism in Virginia – the Miami Herald is suing the state of Florida in an effort to force the state into disclosing the details of the COVID-19 outbreak at long term care facilities. But Virginia is controlled by Democrats so I think we can assume that none of the left-funded so-called media outlets will go down that path. Maybe BaconsRebellion should sue for this information. Oh yeah – Virginia’s FOIA laws are a joke. And the beat goes on …

    https://www.npr.org/sections/coronavirus-live-updates/2020/04/14/834453156/half-of-virginias-coronavirus-outbreaks-are-in-long-term-care-facilities

    • so we test everyone in long-term care. What do we do when they test positive?

      Is it then a government responsibility?

      re: disclosure – Medicare and Medicaid do disclose… it’s out there no matter the state.

      If you do know this – then what’s the real beef?

      but again – what happens if Northam closes Canterbury?

      what happens to the people in that facility?

      whose responsibility if that?

      • When they test positive you isolate them so that they don’t infect others – either at the facility or elsewhere.

        It is the government’s responsibility to ensure there is adequate testing capacity. Right now, there is not. As has been described countless times, Virginia is particularly far behind on testing capacity. So, in a world where there are too few tests relative to the need for testing it is the government’s role to set priorities. Given that half the outbreaks are in long term care facilities I would think those facilities would be a high priority. But that’s a question for Northam.

        Whether to close Canterbury and what to do with the residents is a question for the regulators, i.e. the Northam Administration. If overcrowding is a problem then some residents will need to be moved. How many state colleges and universities have empty dorm and cafeteria facilities right now. This is why Northam should ask for help. Somebody who can get things done across government agencies needs to be pushing the whole long term care facility strategy in Virginia. How about Bill Bolling? VDH certainly seems overmatched.

        • It’s the govt responsibility? Haven’t you been ranting about jack-boot government?

          Why, if this is a private business the govt should decide these issues or be responsible?

          do you have a consistent view towards the role of govt or does it vary according to circumstances?

          it’s wrong/incompetent for Northam to tell businesses to close but right for him to tell nursing homes what to do?

    • right. That’s no excuse guy – given the timeframe – what weeks?

      what exactly was Cantebury supposed to do even if they tested?

      what would they do with the infected?

      whose responsibility? Are you so willing to lay blame here?

  9. sherlockj. Ownership changes are entirely relevant. The obvious question is why had we not heard of Canterbury before? Why do they stand out as perhaps the deadliest epicenter of Covid 19? What is the timeline? You seem way too interested in laying this at the door of state regulators. If they made mistakes, fry them but to give private companies a pass is absurd.

    • The three week delay between the first case at Canterbury and full testing of all residents sure seems like a problem. Who should have ordered those tests? By the time the tests were finally done 60% of the residents tested positive. Northam needs to be put on the spot over this. If he thinks it was a failure of the facility operator he can say that. But I’ll bet none of the so-called journalists at his press conference will put him on the spot. First, it’s not The Virginia Way to criticize a member of the plantation elite and second, left-funded outlets like Virginia Mercury are not in business to embarrass Democrats. Nor are their left-funded enablers like VPAP.

      The bigger immediate question, of course, is what is being done to prevent the next Canterbury. I suppose you could send an e-mail to every facility operator and wait for a response or just ask the governor and his VDH who take tax money to supposedly regulate these facilities.

      • Who is responsible for that if it is a private sector facility?

        Was that a requirement of other nursing home facilities in other states?

        Why are you so intent in just one facility in one state. Do you have an objective view ?

        If Cantebury and Virginia are different in a wrong way from other states, have at it – but if you’re focusing just on the Govt of Va, you lack credibility. You know this. Are you this biased?

        • “Why are you so intent in just one facility in one state. Do you have an objective view ?”

          Because it has more COVID-19 fatalities than any other long term care facility in the United States despite the fact that Virginia has not been particularly hard hit by COVID-19 relative to places like NY.

          What failures in oversight caused the fiasco at Canterbury and why won’t those same failures happen again at another Virginia-based long term care facility?

          Why is this hard for you?

          • is it any more or less deficient than other facilities ? Do
            you know or have an objective perspective or is this just whatever
            you can use against Northam?

            Why, if this is a private business is this Northams responsibility?

        • Once Northam suspended the Constitution under a declaration of emergency he became responsible for all COVID-19 related matters – especially regarding long term care facilities he and his administration are supposed to regulate. Uneasy lies the head that wears a crown. King Ralph shut down the private sector and put he and his government in charge.

          • Isn’t that true of ALL governors then?

            why is Northam “supposed” to regulate a private business?

            be consistent – is what you say – supposed to be that way across the board?

            and if the Govt regulates and there is a violation – it’s the govt fault that it’s a violation?

            So al these restaurants that Va regulates – when one “fails” that’s Northams fault?

            really?

    • Peter, I am not giving private companies a pass, I am pointing out the state responsibilities that were ignored by the VDH. You and I may not have heard of Canterbury before the tragedy, but the state inspects it annually. It is a 20 minute drive from VDH headquarters. Since the state by policy takes no action against poorly performing nursing homes, what difference would it make who owned it. If VDH was anything but entirely passive, the CEO of Heritage Hall would not have been appointed by the Governor to the state Board of Health.

  10. There’s a certain phony contradiction here that is SOOO Virginia. In normal times, regulators impede the wonderful free market. In abnormal tines, regulators are not tough enough and is the fault of our moderate, Democratic governor.

    • almost… it’s the govt fault that they regulate to start with but when something that is regulated “fails”, it’s also the govt fault and in this case – Northams personally.

      Standard Conservative Theology apparently.

  11. Jim S. I posted my last comment before i saw your latest, reasonable response. Re:canterbury there needs to be a thorough look at both public and private responsibility. I can work with you on such a project if you want.

  12. “I reported here[1] on February 22 that the nursing home representative on the State Board of Health[2] is the CEO of Heritage Hall, a chain of nursing homes. See this for the Medicare ratings of those nursing homes. Of the 17 Heritage Hall facilities in Virginia, one is graded as having average staffing, the rest below average or much below average. In overall ratings, nine of the 17 are rated below average or much below average. Heritage Hall has contributed more than $100,000[3] to political campaigns over the years, mostly through the Virginia Hospital and Healthcare Association (VHHA). …

    The Northam administration has been directly responsible for inspection and licensing of Canterbury Rehabilitation and Health Care Center in Richmond. The facts that signaled the vulnerability of the institution to pandemic virus were gathered and reported by the Commonwealth itself. The administration did nothing about it before the pandemic because it chose not to do so.”

    This tells me all I need to know. The Virginia Way strikes again. And Heritage is far from an isolated case, as Jim S. post makes clear. More good reporting. Plus Canterbury never made the recent Wall Street Journal article’s long list of nursing home deaths across the nation. Now we know why. And see the Virginia Way yet again in action.

  13. Larry, stop digging. Gov. Northam has been chief executive for more that two years. Being chief executive means the executive departments of state government work for him. It is constitutionally preposterous to say that they work for the General Assembly. The recommendation that I made to the VDH on the subject of the failing (1-star) hospitals they regulate would have cost nothing. A short email from the Commissioner requiring a letter of correction. VDH did not send the message because it did not want to, not because they were somehow prohibited by the GA from doing so. Dr. Oliver, the Health Commissioner with whom I had that email exchange, has been invisible in that job until now. Now he shows up at Northam’s press conferences because the Governor does not want to answer questions personally. Dr. Oliver, who I am sure is a nice guy, has been promoted past his level of competence. He needs to resign or be fired. This pandemic is not going away next week, and we (and the Governor) need a competent leader to address it at VDH.

    • Jim – you are a critic. Correct? You believe that things like COPN and the way that VDH operates are wrong. Correct? You believe that what happened at Canterbury was a failure, correct?

      Do you think that Northam can change the way that COPN works? Won’t it take the GA to do that?

      If Cantebury has had documented problems and got a one-star rating from the Feds and the Feds have the ability to shut them down – do you also consider that failure the responsibility of Medicare/Medicaid to not act?

      Why do you just target Northam on these issues?

      • Again, you want to keep changing the subject to COPN. I have written several columns on COPN in this space, but that is not the subject here. Canterbury got those one-star staffing and health inspections ratings based on state inspections, which the Long Term Care Division of VDH does for both state licensing and CMS Medicare/Medicaid certification. In the case of non-state operated nursing facilities like Canterbury, the federal rule is that the State conducts the survey and certifies compliance or noncompliance. The State’s certification is final. The State Medicaid agency determines whether a facility is eligible to participate in the Medicaid program.

        • No, the issue is WHY should the govt regulate nursing homes but not COPN?

          why one and not the other?

          Cantabury, at this point, is a one off. Did Virginia have a pattern of nursing home problems across the state due to lax or incompetent VDH performance?

          And no – the state does not overrule the Medicare and Medicaid CMS ratings. If CMS gives it a low rating and wants changes, then the state can and should act but CMS all by itself can – and does pull Medicaid funding.

          What I object to is a lack of balance here. There is a singular focus instead of any context of the overall system in Virginia.

          Again – if we had/have a statewide pattern – yes that would indicate a state level problem but if we do not, and we have but one nursing home with a big problem – but not so big that CMS has not acted and pulled funding – this becomes just another targeting exercise at the state in general.

          New York has dozens of nursing homes all over the state that has coronavirus issues but no one is blaming the state or Cuomo.

          Nursing homes in many other states are also having problems.

          Nursing Homes were not set up to deal with something like the Coronovirus. I guess we can call that a failure but it’s not a failure of individuals or even leadership – it’s a failure across the industry.

          • WHY should the govt regulate nursing homes but not COPN

            You’re comparing apples with oranges. State government should regulate the health and safety standards of nursing homes because protecting the public health and safety is a legitimate function of government.

            COPN, a form of economic regulation, adds nothing to the health and safety. It’s all about regulating the supply of hospital beds, equipment, and facilities, and it is subject to regulatory capture and abuse.

          • Reed Fawell 3rd

            Correction:
            “State government should regulate the health and safety standards of nursing homes because protecting the public health and safety is a legitimate function (and obligation) of (state) government.

            This is why States are fighting so hard to protect states rights of police power of US Constitution, re this virus crisis, but Northam shirks his concurrent obligations.

          • I want to make sure I understand what Jim is saying – that he FAVORS regulation when it involves public health – correct?

            How about regulation that protects taxpayers from having to pay for uncompensated care at the hospitals?

            Who should pay for uncompensated care? Is that an ecoonomic issue also?

          • Reed Fawell 3rd

            Jim answered your question conclusively, and I buttressed it but you refuse to understand it. This of course is your well established MO to get attention.

  14. “Dr. Oliver, who I am sure is a nice guy, has been promoted past his level of competence. He needs to resign or be fired.”

    Now there is an outrageously novel concept in Va. State government to go along along with the novel Coved-19 crisis. Who’s ever heard of such a thing?

    • No. I understand it but it’s inconsistent with respect to regulation.

      He has made arguments over and over against regulation that DID affect public health – and now makes a distinction here on this one.

      COPN regulation is about who pays for uncompensated care. If you oppose COPN but do not address the uncompensated care issue -it’s not an honest discussion if we don’t deal with the entire issue.

      Right now, we expect hospitals to treat EVERYONE , no matter who, turn no one away – and how do they pay for that? The COPN folks don’t seem to give a rip, it’s all about their ideology.

      This is NOT about left or right except in the minds of those who want COPN and want to cast it that way.

      Most normal, intelligent people would want to hear both sides of this and they’d want to know what the hospitals would do if they could not make a profit on some services to mitigate uncompensated care. That’s the whole issue – it’s how that issue is debated in the General Assembly.

      It’s not an unreasonable question, yet the COPN want none of it – they say they’re all about the “free market” and lower costs services – no matter if the hospitals end up having to figure out how to pay for their uncompensated care.

      That’s not reasonable in my view and it’s not partisan.

      .

  15. Canterbury got those one-star staffing and health inspections ratings based on state inspections, which the Long Term Care Division of VDH does for both state licensing and CMS Medicare/Medicaid certification. In the case of non-state operated nursing facilities like Canterbury, the federal rule is that the State conducts the survey and certifies compliance or noncompliance. The State’s certification is final. The State Medicaid agency determines whether a facility is eligible to participate in the Medicaid program. Nothing in that rule prevents the state from taking any corrective action it wishes. VDH by internal policy did not take any action. I hope that clears that question up.

  16. SherlockJ,
    Your patience with the ankle-biters here is commendable.

    You have done an excellent job of laying out some real flaws in both the regulation of these homes as well as the accountability and efficacy of the regulators. Thank you for your post.

    • naw… we’re further up than the ankles! 😉

      Jim knows some stuff – no question about it but I do question his objectivity to be fair and non-partisan.

      Unless nursing home monitoring and inspections have suffered under VDH since Northam took office – then we’re on a mission here.

      If VDH , HAS fallen down – and JLARC confirms – then yes, time for a change but if not and we’re in the middle of this coronavirus mess – then these complaints seem not fair or relevant. We don’t get to cherry-pick “flaws” that are one-offs to try to discredit VDH nor Northam. It won’t fly.

      If you took a poll on this – you’d strike out big time and for good reason – you’re just way off the mark.

  17. Non-partisan? You are advocating that?
    If that were to be the standard for comments on this blog it would improve their value immeasurably.
    But I have been reading your comments for years and you would rank in the top 5 of the most consistently partisan.
    Are you planning to change that?

    • Nope. I respond to posts that are invariably partisan!

      And no, you’re not paying attention but no surprise there.

      You will NOT find me defending on advocating for Pelosi nor Biden – but
      we do have folks who dream about it…

      If you think that giving an alternative view to some hard right Conservatism is “partisan” you may not actually understand what it is or is not.

      You should post here more often… I understand you do have an “interest”, no? I’d surely engage with you – no name calling but straight up debate. Game?

  18. SGillispie. My comments are partisan. So what? Who are you to judge?

  19. Maybe you believe what you wrote above but you are only fooling yourself.

    “Hard right conservatism” has been recast by you to mean anything that doesn’t fit your liberal paradigms which is pretty much everything right of center-left so far as your comments and devils advocating have gone here.

    • Grade A bullfeathers. Are you afraid to post your views and allow others to comment? Put up or go back into hiding and take potshots from the dark.

  20. Count on you Galuzka to miss the point when partisan comes into play and there is an opportunity to put someone down whom you think is a deplorable. Reread the posts and you might understand.

  21. Gillispie. My name is Galuszka. Please respect the spelling.

  22. Mr. Galuszka, Please accept my apology for the misspelling.

  23. I’d like Mr. Sherlock and Gillispie to comment on this:

    https://projects.propublica.org/nursing-homes/state/VA

    how about it? anything partisan?

    Does this look like a VDH problem?

    • Excellent work by Pro Public. The data are Lexington Court Rehabilitation & Health Care Ctr listed on the Pro Public spreadsheet is now Canterbury. Unfortunately the latest report on the sheet for Lexington Court was from Oct 25, 2018.
      Fines are a cost of doing business for Medicaid nursing homes. There are two major expenses that owners of such nursing homes can control – personnel and food. Medicaid simply does not pay enough for nursing home owners to meet their standards. So cutting back on the requirements is what a lot of them do. Nurses in particular are in short supply nationwide. Integrated healthcare systems are paying $15,000 signing bonuses. As for the people in nursing homes who clean the premises, prepare the food and help with activities of daily living elderly people who can no longer do many of those things for themselves, let your imagination be your guide. So I will prepare a column on all of this. It is not a uniquely American phenomenon, but one that is in its fullest blooming here, that some families must and some families choose to warehouse their parents and grandparents in nursing homes. We as a nation focus on this maybe an hour a year, but there is an entire subculture in the legal profession that will help families strip grandma of assets to qualify for Medicaid funding for her nursing home stay which can be decades. Private care is north of $200,000 a year. Poor people send grandma to a nursing home because she will get better care there, regardless of the details, than they can provide her at home. Some not so poor do it because they run a rather impersonal cost-benefit analysis, however they may justify it to themselves. The planners with assets bought long term care insurance to pay for what they hope is better than Medicaid care.
      In any case, we should be able to count on the states to ensure that minimum standards are maintained, and in Virginia we can’t. This is not because of the state inspectors, who I personally know and admire, but rather because of what their superiors do or don’t do with the information those inspections generate.

  24. I don’t understand your point.
    I did understand Sherlock’s article to say that there have been an appalling number of deaths in one facility which was known by the regulators to be at risk and even when initial cases appeared, were unwilling or unable to do anything about that.

    I also understood him to say that, since the Governor is the Chief Executive of these agencies, he and his administration dropped the ball on this one. Presumably, he would say the same thing if it were another governor of another party. For the record I agreed with everything Sherlock wrote.

    You, I understood to be suggesting remedial action might close a facility and leave people stranded and so you are against remedial action. You also seemed to suggest that since you perceive some to criticize excess regulation, they would have no right to criticize lax regulation or something like that. Beyond that you seemed to have taken a position that criticism is unfair or unwarranted, that accountability is injurious, and so nothing can really be done anywhere about anything.

    • re: ” You, I understood to be suggesting remedial action might close a facility and leave people stranded and so you are against remedial action.

      No I’m not at all. If the situation is that bad action should be taken. I’m pointing out that this is a private sector business that is being regulated by the state. Do state taxpayers pay the costs if we close it? You favor that?

      “You also seemed to suggest that since you perceive some to criticize excess regulation, they would have no right to criticize lax regulation or something like that. Beyond that you seemed to have taken a position that criticism is unfair or unwarranted, that accountability is injurious, and so nothing can really be done anywhere about anything.”

      Nope – not at all. I’m asking what criteria is used to argue against regulation for COPN but in favor of regulation for nursing homes?

      How do you differentiate?

      You guys argue out the wazoo against regulation – from dawn to dusk and here you are arguing FOR IT …….. AND you want taxpayers to bail out the private sector business. How can that be when you guys are opposed to regulation and govt bailouts?

      I’m also not opposed to legitimate accountability I do know the difference between partisan “accountability” and legitimate accountability.

      Got a JLARC report about VDH? How about CMS analysis of VDH?

      Got ANYTHING that is truly objective or just your own beliefs of what ought to be?

  25. My point is that is ONE facility out of more than 280 in the state.

    Is VDH remiss in it’s mission with respect to all nursing homes in the state?

    If they have done a reasonable job on over 200 other nursing homes why is
    this one due to their performance and no others?

    And no – you do not blame the GOv because VDOT still has congestion or the school don’t graduate everyone.

    That’s just partisan – it’s clear ya’ll are out to tar VDH and Northam over this one nursing home.

    Again – if there was a pattern – across the State of a failure of VDH – I would agree – but there is not – and its clear what you guys are up to.

  26. I have watched your exchanges in these blogs long enough to know that you are never about reaching an understanding or clarity on a course of action, you are only about obstructing and provoking and slipping an occasional insult to your hated “hard right” correspondents when you can. Whatever good points you have, they are lost in your obstruction.
    I think this has been beaten to death.
    No further comment.

    • Right – that’s what I expected. Judgement from on high then run away and hide.

      I’d say the same about you but I won’t but I do not respect your hit and hide behavior.

      Either you stand up for your positions or you apparently are afraid to defend them and prefer to insult others as “liberals”. tsk tsk…

  27. Awright you guys! Enough of this foolishness as Jim S. surely made a terrific point and the ankle-biters are piling on his post for totally unrelated reasons. His point, repeated:

    “Canterbury got those one-star staffing and health inspections ratings based on state inspections, which the Long Term Care Division of VDH does for both state licensing and CMS Medicare/Medicaid certification. In the case of non-state operated nursing facilities like Canterbury, the federal rule is that the State conducts the survey and certifies compliance or noncompliance. The State’s certification is final. The State Medicaid agency determines whether a facility is eligible to participate in the Medicaid program. Nothing in that rule prevents the state from taking any corrective action it wishes. VDH by internal policy did not take any action.”

    To which Larry asked, “what causes CMS to withdraw funding? The state recommendation?”

    I’d really be interested in the answer to that question. Why is VDH given a pass by the federal bureaucrats when, by its own admission, it does absolutely nothing to enforce its ratings? And re the earlier discussion of whether the Gov. or GA is on first, another question: does VDH currently have an obligation or responsibility under existing State law to do more than merely inspect, that is, to assure the safety and health of nursing home inmates.

    • Acbar – I posted this: https://projects.propublica.org/nursing-homes/state/VA

      take a look. Does this support the idea that VDH is remiss in it’s mission?

      and read this:

      ” The day after Canterbury Rehabilitation & Healthcare Center announced the first two deaths from COVID-19 at the skilled nursing facility in western Henrico County, Henrico emergency management officials said they offered kits to test all residents and staff.

      But the biggest obstacle wasn’t test kits.

      Canterbury already had secured rapid testing technology from the same Innsbrook-based company used by the county, but the push to test everyone in the stricken rehabilitation facility was stymied by then-current guidance from national and state public health officials to reserve tests for those showing symptoms of the disease.

      “I don’t think we understood at that point how much spread could be by asymptomatic individuals,” said Dr. Danny Avula, director of the state health department’s Henrico and Richmond districts, who has worked closely with the center’s medical staff since the first confirmed COVID-19 case there on March 18.

      Canterbury and health department officials realized the magnitude of the policy miscalculation after testing everyone at the center a week later and discovering that more than half of the residents infected with COVID-19 — 54 out of 92 confirmed cases — showed no symptoms of the coronavirus.

      “This is a disease that spreads when nobody knows it’s there,” Avula said in a conference call interview with Henrico officials on Wednesday. “It’s a grim situation for nursing homes.”

      Does this sound like VDH dropped the ball?

      Bigger question – did VDH drop the ball at the other 280 nursing homes in Virginia?

      Top question – how can anyone look at this and decide that VDH was incompetent and Northam was to blame?

    • This is classic. I otherwise would hope this “conversation” goes on for weeks and weeks to make a point of today’s gross incompetence and lack of seriousness, including on this blog, except it is so disgusting. What an illustration of our sick society, over the internet and particularly that of the government bureaucratic mind, except in this case 30+ elderly folks, somebody’s mother, father, grandmother, are dead in a a low rent nursing home apparently within nearly walking distance of the Virginia Health Department, a fact the state of Virginia appears to have hidden from public knowledge, and a few people here are playing with this monstrosity like children tossing balls around for fun. I am thoroughly disgusted. Give these dead people some God damn respect, and at least shut up.

  28. Everyone likes to throw in their 2 cents. Here’s a nickel, inflation ya know.

    Virginia needs a self-reporting coronavirus website/800#. If you have symptoms, then you can report the start and end dates, and which set of symptoms, name and contact info.

    It builds a database of likely positive antibody candidates for test scheduling and gives an estimate of the total number of sickened.

    Oregon has done this.

    • I kind of like the APP where those that test positive get their phone “tagged” and everyone else with phones that comes into contact with them directly or indirectly gets notified and goes get tested… and if they test positive – it sets off another complete contact trace.

      That APP could also easily do what NN is advocating.

  29. Gillispie asked if this happened to someone like McDonnell that he also would get the blame.

    Let’s say this – if the charge of incompetence was brought by Dems against McDonnell – it would still be legitimate?

    For some reason, some posters here on BR seem to think that if someone disagrees with their premise that it automatically makes them a partisan and/or liberal?

    Really? Is that a legitimate way of thinking? Just slap that liberal label on them and be done with it?

    I don’t know where these folks come from – but it’s kinda like the Wallys World of politics.

  30. Posted on behalf of Roy Fauber:

    Mr. Sherlock’s article headlined “The Canterbury Tragedy and the Failed department of Health” leads the reader to believe that VDH bears responsibility for the failure. Here’s a quote from the Virginia Department of Health document regarding nursing homes:

    “State governments oversee the licensing of nursing homes. In addition, states have a contract with CMS [Center for Medicare and Medicaid Services, an agency of the Federal Dept. of Health and Human Services] to monitor those nursing homes that want to be eligible to provide care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid. These requirements are broadly outlined in the Social Security Act (the Act). The Act also entrusts the Secretary of Health and Human Services (DHHS) with the responsibility of monitoring and enforcing these requirements.”

    Another quote: “Depending on the nature of the problem, CMS can take action against the nursing home.”

    Sounds like CMS , with authority from Congress and the Social Security Act, is in the driver’s seat regarding “monitoring and enforcing.”

    Seems to the reader that there is a discrepancy between the Bacon’s Rebellion headline and article versus the VDH article.

    Can you reconcile this observation?

  31. I will answer this question with a new column today.

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