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.

I fully recognize the potential downsides. I could write a book about them. But so be it.

Unionization is the only correction I see right now for Virginia’s most dangerous facilities. If the unions organize the chains of Virginia’s worst actors, I hope they are meaner than snakes in contract talks and enforcement.

Unlike the government, unions don’t offer waivers to management.

State Inspections. I have written more than once about the state inspection problem. I cited the reference data and the extraordinarily forthright FOIA responses of the Director of the Office of Licensure and Certification (OLC), Kimberly Beasley. They show that the Virginia Department of Health (VDH) does not have nearly enough inspectors to check on nursing homes regularly and is unlikely to be able to recruit and train the staff they need.

Last I checked, there were vacancies for eight nurse inspectors in the section that inspects nursing homes. Given the salaries offered, the lack of a bonus — $10,000 is a common bonus for a new hire RN in Richmond — and the working conditions, specifically all of the weekly travel, the offers are simply not competitive for the Richmond area.

That is but one of the factors that demonstrates that the General Assembly for a very long time has purposely underfunded VDH facility inspectors. According to Director Beazley, even if the OLC was at authorized end strength, it would not have enough personnel to be able to do the job.

The understaffing and non-competitive salaries, of course, result in the retention problem.

It is a death spiral orchestrated by elected officials.

State enforcement. That has been matched by a clear lack of interest in nursing homes by Virginia’s governors, General Assembly and Department of Health.

To wit:

  • Virginia’s Health Commissioners could have denied licenses based on OLC’s own inspection results. They have never done so.
  • Not one has even been forced to stop accepting new patients, another sanction available to the Commonwealth under federal law, until staff ratios meet federal standards. Virginia, of course, has no staffing standards.

If there is an exception to or an explanation for those issues, I have never found or heard it. It would likely take only one such action to encourage the rest to fix their problems.

State standards. Virginia’s nursing home standards, to the limited degree they exist, are worse than useless. They are redundant at best and contradictory at worst to the federal nursing home standards. They never exceed those standards and often do not meet them.

One of the easiest and most productive things that VDH could do would be to adopt federal standards by reference to its regulations and submit legislation next year to do the same thing with Virginia laws.

That way the OLC could at least apply the same standards to state licensure and certification and to the federal inspections that VDH conducts for CMS. So could the nursing home owners.

The villains among Virginia nursing home chains. From my article on October 4 of last year:

If you are looking for villains, look no farther than a few select chains. The numbers below are the number of one-star nursing homes of the listed chains in Virginia vs. the total nursing homes of that chain in Virginia:

  • Consulate – nine of 21
  • Saber – Nine of 32
  • Accordius – six of 18
  • Trio – four of nine
  • ProMedica – three of six
  • Communicare – three of five

Why would a chain have so many bad facilities? Is it because understaffing is perhaps the easiest way to raise profits?

As for the non-profits on this list, they will have to explain their own corporate issues.

It would be interesting to know if the Health Commissioner has ever considered denying additional licenses to those chains.

A few suggestions for these companies:

  • If you want to be in the nursing home business, do it right or find another investment. Peoples’ lives are at stake.
  • If you put nursing homes in the middle of nowhere, please don’t cite difficulties in recruiting staff as your excuse.
  • For the rest, get better managers and pay your people what it takes to attract and retain them. You can see from the data that others in the same business in Virginia manage to do it and thrive.

What to do?

Under those conditions, the only viable answer appears to be unionization of the work forces of the chains that so callously understaff their facilities.

To quote a new Health Affairs article:

Since the COVID-19 pandemic began, nursing home residents have accounted for one of every six deaths in the United States. Nursing home workers have also been at risk, with more than one million workers testing positive since April 2020.

That article makes the point that labor unions play an important role in improving workplace safety for nursing home workers and their residents.

The authors determined that nursing home labor unions were associated with 10.8% lower resident COVID-19 mortality rates and 6.8% lower worker COVID-19 infection rates. Absent the government-directed COVID patient death scandals in unionized nursing homes in New York and New Jersey, the differences would have been even greater in favor of the unionized facilities.

My father’s family were coal miners in a company town in Western Pennsylvania. I know enough about how they lived and died to make me a supporter of blue collar unions for the specific and closely related reasons of worker safety and training.

For those reasons and for the safety of their patients I encourage Virginia nursing home employees to unionize. For those who oppose unionization, please offer your viable alternative.

And yes, the costs to Medicaid for long-term care will go up.

Pay them.

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8 responses to “Unionize Virginia’s Worst Nursing Home Chains”

  1. vicnicholls Avatar

    Excellent article as always Capt.

  2. DJRippert Avatar

    Interesting that a “right leaning” author finds value in unionizing. Seems right to me.

    1. James C. Sherlock Avatar
      James C. Sherlock

      When the government fails in its duty to regulate and discipline healthcare facilities in support of public safety as Virginia’s government has done, unions are the only recourse to enforce minimum standards on companies that do not care about their employees or their patients.

      1. Stephen Haner Avatar
        Stephen Haner

        I can see unions advocating for better pay and working conditions, and perhaps resulting in more applicants for the jobs and workforce stability. I remain in doubt that patient safety and care would be their top priority, and one of the worst downsides is how they protect folks who should be fired.

        1. James C. Sherlock Avatar
          James C. Sherlock

          Two replies:
          1. As I wrote, there are potential downsides, but patient safety and care would be improved by the very increased workforce and workforce stability you acknowledge. Unless and until the government fulfills its responsibilities, there is no other viable plan to accomplish those things.
          2. The professional nurses are licensed by the state, so if a nurse proves incompetent or will not do her job then the state can take licensure action regardless of any union contract.

  3. Cathy Robb Avatar
    Cathy Robb

    My mother is a resident in one of these corporately-owned, chain nursing homes. It’s fraught with all the issues you’ve covered in your articles. However, if the laborers were to unionize, what happens when they go on strike? The residents who need 24 hour, skilled nursing (such as my mother who is a quadriplegic) could be left bedridden with no care. I fear patient care will be the last priority in a unionized work force.

    1. Zeddicus Avatar

      Other way around.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Your fears are generally unfounded. As I wrote, unionized nursing homes had a better patient safety record during COVID than non-union homes.

      Nothing is a sure thing, but you should at least be comforted that a union workforce in a nursing home should, all other things being equal, be more stable, better staffed and better trained than a non-union one.

      As important, these are not government jobs.

      The government is exploited by its unions because the government negotiators have no skin in the game.

      Owners of nursing homes, in contrast, if they are competent can be expected to demand better performance for higher pay in order to justify the added expense.

      UPS, for example, is unionized. Its margins are higher and it is more valued (P/E) by investors than non-union FEDEX.

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