RICHMOND, Va. — Governor Glenn Youngkin has signed bills into law aimed at improving care in Virginia's nursing homes by strengthening the state's abilities to oversee facilities and crack down on poor performers.
In a statement to CBS 6, the Commonwealth's Secretary of Health and Human Resources Janet Kelly said because of the legislation, the Virginia Department of Health "finally has better tools to hold bad actors accountable" and indicated facilities that don't provide high-quality care should be "sanctioned or shut down."
Virginia's level of oversight of the industry was at the center of CBS 6 investigative reports, which highlighted the voices of family members who said it took VDH many months to investigate complaints they submitted about troubling care and conditions. And according to federal data, Virginia has the third-highest rate of facilities overdue for inspections at 68%.
"I would like to see them fund the Department of Health to the degree that the inspectors will be able to do their job in a timely manner," said Joanna Heiskill, an advocate for nursing home residents. "I'm talking about a big boost in support."
Heiskill is part of the group Justice and Change for Victims of Nursing Facilities and has long pushed for state authorities to do more to hold nursing homes accountable, in honor of her mother who she said suffered in a facility.
“Every day, somebody is either dying, being abused or neglected, and unfortunately, Virginia has to catch up," Heiskill said.
As regulators have generally observed a worsening quality of care in nursing homes and as CBS 6 has been highlighting those issues, lawmakers, including Republican Delegate Otto Wachsmann and Democratic Senator Lashresce Aird, sponsored legislation that VDH had proposed to bring solutions to the table.
“Because of the investigative work that you have been involved in, there have been so many headlines simply increasing awareness of some of the challenges that Virginia's nursing facilities have been experiencing. With the work of the Virginia Department of Health and those who have nursing homes here in Virginia, we worked together in collaboration to determine, how do we keep the balance of having safe care and loving nursing facilities while also making sure that when there are instances where a facility could be performing better, that the commissioner here in Virginia is empowered to take action in real time," Aird told CBS 6.
To that end, there were two bills introduced in the 2025 General Assembly session.
The first will increase licensing fees, which haven't changed since 1979, so that VDH can hire seven additional inspectors. The legislation passed without much debate and with the support of the Virginia Health Care Association, the lobbying group that represents the interests of the industry.
Currently, the department faces a shortage of inspectors while handling an increasing workload.
"During COVID, more people complained, and that meant that the few inspectors VDH had to inspect nursing homes, which were already overwhelmed and were starting to not keep up, they couldn't do their inspections every two years because they were hit with all the complaints that were coming in," Wachsmann said. "The bottom line was they just needed more inspectors."
“Do you think that seven is enough?” reporter Tyler Layne asked.
“We’ll see. It’s better than what it has been," Wachsmann said.
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The other bill was more contested and ultimately passed with modifications. It aims to expand the enforcement actions VDH can take when it identifies a pattern of lower-level violations of care standards during state inspections, something VDH has previously not been able to do.
“The purpose I feel of that program is when you get to low-level violations, you give sanctions so they fix them before they get to the areas that are creating patient harm," Wachsmann said.
Under the current structure, VDH relies on the federal regulatory agency, the Centers for Medicare and Medicaid Services (CMS), to impose penalties in response to inspection findings. While CMS utilizes enforcement actions such as fines and denial of Medicare and Medicaid payments for severe violations that jeopardize the safety and wellbeing of residents, it does not typically penalize facilities for citations that do not result in actual harm. The new legislation aims to address the gap where CMS doesn't take action.
When the new law takes effect, VDH will have the authority to require training at a facility, put a license on probation, and impose monetary penalties. Facilities will be given an opportunity to take appropriate corrective actions before VDH imposes sanctions.
"And then, if you're just egregious, you have been warned, you have been trained, maybe you need to be fined. And in the worst-case scenario, if the fines aren't enough, maybe they need to cease to operate and/or be allowed to bring in new patients," Aird said.
But the final version of the bill was softened from what was initially proposed. The VHCA pushed for changes to the bill and said it felt VDH already had "extensive regulatory authority to oversee nursing homes and resident quality of care" due to its partnership with CMS which uses "a robust system of citations and federal civil monetary penalties (CMPs) when nursing homes are found in non-compliance" with Medicare and Medicaid standards.
In the reworked bill, the implementation of the new sanctions was delayed, some of the more aggressive provisions like the ability for VDH to refuse to renew a license in response to inspection findings were removed, a condition was added that VDH must have completed a timely inspection within a two-year cycle, and the cap on fines was reduced greatly from $100,000 to $10,000.
“I think the charges for not following the rules will certainly get [nursing homes'] attention. Can we keep moving that or driving it to where it even squeezes them a little bit more? Absolutely," said Vickie Runk, an owner of assisted living facilities and the member of the Virginia Board of Health representing the nursing home industry.
While Runk acknowledged the finalized legislation could be stronger, she still considered it a positive step forward and would like for inspectors to focus their efforts on care-related issues as opposed to documentation issues.
"I think that we have to give everybody a chance to get on board, and then once we've given them far warning and they know what the repercussions are going to be, then I think we hold them accountable, and I think that's exactly what this bill does. It gives us a starting point. Is it where we want to be? No, but at least we're headed in the right direction," Runk said.
For Heiskill, she expressed disappointment in what she felt was a weakened bill and believes there's much more work to be done to improve the quality of care across Virginia.
“You're not doing enough. That's not enough. It's watered down to the degree that you're just saying, 'We're going to give you something, just something,' but how effective is it going to be?” Heiskill said. "We understand that we do have lobbyists, and we have big money, and in this case, those who don't have that are suffering, but we won't go away."
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Meanwhile, both sponsors of the bill felt the compromises were fair.
"For maybe people on the consumer advocacy side that feel some of the changes may have watered down the bill a little bit, how would you respond to that?" Layne asked Aird.
"I actually think when you go from not having any ability for the state to respond at all to now giving them full power to respond in real time and to even lower-level sanctions, not just the most egregious, I think that that is significant progress," Aird said.
"There's got to be give and take. I'm not a nursing home administrator, so when I put the bill in, I didn't know everything about nursing homes. We talk a lot about lobbyists. A lot of people think lobbyists are bad. I don't look at it that way. That industry has lobbyists that were able to relay to us some things that that we missed the point on in the bill, and we needed to come to a compromise," Wachsmann said.
VDH indicated it intends to use its new powers in an effort to protect one of the state's most vulnerable populations.
"Virginians in nursing homes deserve high-quality care that gives them dignity and respect. Nursing home operators who do not provide high levels of care need to be sanctioned or shut down. We are grateful for the many nursing home operators who provide good care to Virginians," Secretary Kelly said.
The laws regarding licensing fees and state-level sanctions will take effect on July 1. Before VDH can begin enforcing the sanctions, the Board of Health must promulgate regulations, which could take nine to twelve months.
Share your nursing home stories with the CBS 6 Investigative Team: Email Melissa Hipolit and Tyler Layne
CBS 6 is committed to sharing community voices on this important topic. Email your thoughts to the CBS 6 Newsroom.
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