The Virginia Board of Health and Nursing Homes – A Strange Appointment

by James C. Sherlock

I am starting to lose my sense of humor about the whole Virginia nursing home thing.

The Virginia Board of Health (VBOH) writes state regulations for every health facility and health services provider in Virginia, including nursing homes.

There is a statutory seat on the VBOH for a nursing home representative. (Of course there is.)

The incumbent, appointed by Governor Northam, is Melissa Green, RN. I am sure she is a good nurse and a good person.

But Ms. Green is also one of the three founders and the Chief Clinical Officer (CCO) of Trio Healthcare.

Trio is rated by the Centers for Medicare and Medicaid Services (CMS) as one of the worst nursing home chains in the entire country and the worst in Virginia.

The senses of humor of all of us are once again threatened by The Virginia Way.

Trio Health Care. The following data were downloaded from CMS on June 28, 2023 unless otherwise noted.

Trio, which has all of its nine nursing homes in Virginia, is rated 590th out of 616 chains in the country and the worst in Virginia in overall CMS 5-star rating.

  • Its chain-average overall rating is 1.4 out of five vs. the national average of 2.9;
  • It was only slightly better at 1.67 out of five in July of 2020 when Ms. Green was presumably being vetted.

Those are just numbers. What of Trio’s patients? From the June 28, 2023, download:

  • The average percentage of long-stay residents whose ability to move independently worsened was double the national average;
  • The average percentage of long-stay residents whose need for help with activities of daily living has increased was almost double the national average;
  • Long-term patient hospitalizations, outpatient emergency department visits, use of antipsychotic medicines, patient falls, pressure ulcers, loss of urinary control, and loss of bowel control all exceeded national averages;
  • Influenza and pneumonia vaccinations were below national averages for both long-stay and short-stay residents;
  • COVID vaccination rate for all patients was half of the national average.

Bottom line – this appointment. I am sure that the Governors of Virginia all take recommendations from the Virginia Health Care Association (VHCA), the nursing home lobby, on the appointments to that reserved seat.

It would be unusual if they did not.

But was there no vetting at all in this case? Either by VHCA, the Governor’s office, the Health Commissioner for the Governor or by the General Assembly?

What about now? Should Green remain on the Board as the nursing home representative with the data we have about Trio?

The Board of Health. The Board of Health’s mission statement:

The State Board of Health exists to provide leadership in planning and policy development for the Commonwealth and the Virginia Department of Health to implement a coordinated, prevention-oriented program that promotes and protects the health of all Virginians.

In addition, the Board serves as the primary advocate and representative of the citizens of the Commonwealth in achieving optimal health.

Among its responsibilities are:

  • Makes, adopts, promulgates and enforces regulations, and provides for reasonable variances and exemptions therefrom, to carry out its responsibilities or those of the Commissioner or the Department (§32.1-12);
  • Makes emergency orders and regulations for the purpose of suppressing nuisances dangerous to the public health and communicable, contagious and infectious diseases and other dangers to the public life and health (§32.1-13). [Note: I noted at the time that this responsibility of VBOH was never raised during COVID];
  • May formulate a program of environmental health services, laboratory services and preventive, curative and restorative medical care services, including home and clinic health services to be provided by the Department of Health on a regional, district or local basis (§32.1-11A);
  • Suggests legislative action deemed necessary for the better protection of life and public health (§32.1-15).

Bottom line – VBOH. Look again at the 15 members of the Virginia Board of Health. Those things listed above are only some of what the VBOH does or is supposed to do.

We need a better team.

Ask Ralph Northam if he would not have appreciated help from a more qualified VBOH during COVID.

We need to fix the system, starting with a revision to the Virginia law that sets the membership.

Consider making members of a standing advisory panel the following current statutory members of the Board:

  • the “representative of the hospital industry;”
  • the “representative of the nursing home industry;”
  • and the two “consumers.”

Then consider adding more physicians, nurses and non-profit health foundation leaders to the voting membership of the VBOH itself.

Any future VBOH needs to be demonstrably more up to its mission and responsibilities than the current one.