Virginia Ranks 41st Nationally in Nursing Home Ratings

by Carol J. Bova

Medicare offers a “Nursing Home Compare” website. It uses a one- to five-star rating system for four categories: Overall Rating, Health Inspections, Staffing,  and Quality Measures. There is a category called Special Focus Facility for a nursing home with a persistent poor quality of care, subject to more frequent inspections and escalating fines. New nursing homes are unrated until more information is available. The website reports also include facility details, ownership, inspections, deficiencies, and fines.

The list below combines the percentage of special focus, one and two star (below average and much below average) nursing homes in one column, three, four and five star (average, above average and much above average) nursing homes in the second, and the percentage of new unrated facilities in the third for the 50 states and the District of Columbia.

Sorted by overall rating, from best to worst, Virginia ranks 41st in the country with 41.8% of its nursing homes below average. Only Missouri, New Mexico, North Carolina, Mississippi, West Virginia, Kentucky, Oklahoma, Georgia, Texas and Louisiana had more below average facilities than Virginia.

Correction: The “new unrated” percentage for Louisiana is 0.7%, not 8.3%.


The pandemic’s one possible positive outcome is bringing the condition of our nursing homes to the attention of the citizens of the Commonwealth and creating a demand for improvement.

Carol J. Bova is a writer in Mathews County and on the staff of Chesapeake Style magazine.

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5 responses to “Virginia Ranks 41st Nationally in Nursing Home Ratings

  1. This is excellent information. Are there credible analyses explaining why those states with excellent ratings are able to or do achieve this while states like Virginia can not?

    • Quality is traceable to a combination of Medicaid payment rates and staffing of nurses. Nurse staffing is directly proportional to the quality of care. Appropriate nurse staffing is ensured by quality inspections.
      The business model for nursing homes is that they lose money on Medicaid payments for long term care and make enough profit on Medicare payments for skilled nursing services, typically post-operative, to cover Medicaid losses and make each home profitable. The homes have to pay their staff, their biggest expense, and make enough money to stay in business.
      Medicaid payments are breathtakingly low in Texas and Louisiana and Medicare doesn’t make up the difference. The inspectors there cite the staff shortages, and report them to CMS. So there is a very high rate of churn in nursing home ownership changes and closures in those states.
      Virginia’s Medicaid payment rates for nursing homes in various regions of Virginia puts the state in about the middle of the states in that statistic. Thus the explanation for the low staffing rankings is at the door of the VDH inspection program that very rarely cites nursing homes for staffing discrepancies, even when the payroll statistics show those shortages. That in turn allows some owners, instead of paying enough nurses, to take a higher profit than they otherwise would.

    • Top 10 states and campaign contribution limits by corporations:

      ND – Prohibited
      HI – $6,000 statewide, $4,000 senate, $2,000 house
      ID – $5,000 statewide, $1,000 senate, $1,000 house
      NJ – $2,600 any candidate
      AL – Unlimited
      MN – Prohibited
      WY – Prohibited
      CO – Prohibited
      ME – $1,675 statewide, $400 senate, $400 house

      Somehow Alabama manages to run a decent nursing home program despite their pocket stuffing campaign contribution laws.

      Meanwhile, in Virginia, Nursing Homes donated $9,559,185 since 1996 placing that sub-category of Health Care in 5th place among Health Care donor types. However, for 2020 – 2021 Nursing Homes have risen to #2 on the Health CAre list.

      In Virginia you get the governance you are willing to pay for.

      • Despite many posts in BR (and a lot of good info) – it is still not clear to me why the Feds don’t bring the hammer down on nursing homes that fall below standards.

        I know the state also has a role but at any point in the process, the Feds – who are the ones who keep the data and assign the ratings – they also have the power to pull funding and/or shut down the homes that are not meeting standards – especially for infection control.

        So my question is – if the Feds don’t do it – then why is it on the State to do it – especially if they report back to the Feds?

  2. Good article Carol!

    So here is what I don’t understand. If Virginia has sub-standard nursing homes – and it does and the Feds Medicare and Medicaid can (and do) close down nursing homes that fall below acceptable levels – why aren’t they doing just that?

    Do we know which nursing homes in which states have been closed?

    Have they closed nursing homes in Virginia?

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