RICHMOND, Va. -- State agencies responsible for overseeing nursing homes are struggling to keep up with inspection requirements, according to federal data and reports, and Virginia has experienced some of the most significant shortcomings.
Long-term care facilities that participate in Medicare and Medicaid programs, which represent all but a handful of Virginia's roughly 300 nursing homes, must meet federal health and safety requirements. To hold nursing homes accountable to those standards, the Centers for Medicare and Medicaid Services (CMS) asks state agencies to complete inspections, certify facilities, and investigate complaints. In the commonwealth, the Virginia Department of Health (VDH) is that agency.
CMS requires states to inspect nursing homes at least every fifteen months, but as of August 2024, 66% of Virginia providers were overdue for inspection. That's significantly above the 22.7% national average and the fourth-highest percentage of uninspected facilities in the country.
CBS 6 reported Virginia's oversight concerns after Steve Lambert questioned why it took the state eight months to investigate complaints he submitted about the conditions of his brother's nursing home.
In December of last year, Lambert said he visited the Westport Rehabilitation and Nursing Center to find his brother laying face-down with his gown not covering him, his adult diaper exposed, and what appeared to be somebody else's dead skin covering the bed.
Lambert said Winfred could not move himself due to muscle loss and could not speak up for himself due to an intellectual disability.
“No one should have to live and be treated and cared for under those conditions, particularly if they can't advocate for themselves, which was the situation with my brother. [VDH has] a regulatory responsibility to provide the proper oversight of facilities like that," Lambert said.
After CBS 6 questioned the delays, VDH initiated Lambert's complaint investigation in August 2024. The results are still pending, and Westport did not provide a response to CBS 6 regarding Lambert's allegations.
CBS 6 confirmed through a public records request that VDH is facing a 40% vacancy rate of long-term care medical facility inspectors.
However, inspection delays and staffing challenges are not new or unique to Virginia. Some state agencies across the country are grappling with similar issues, as documented in a 2023 report titled "Uninspected and Neglected" from the U.S. Senate Committee on Aging.
The consequences of a lack of oversight from these agencies, according to experts who provided feedback for the report, are putting vulnerable residents at risk.
WATCH: Virginia man 'disheartened' it took the state 8 months to investigate 'horrifying' nursing home conditions
"When recertifications are delayed months or years beyond the statutory timelines, it means that nursing homes are not subject to the comprehensive inspections best suited to uphold care quality and protect resident safety. Declining regularity of recertification surveys has led to a growing number of complaints being filed, which States have had trouble responding to in a timely manner, leaving residents in potentially dangerous situations," the report noted.
Another expert noted there was a "direct connection" between poor nursing home conditions and the insufficient enforcement capacity of state agencies.
State agencies cited "severe understaffing" as a result of high turnover, low salaries for inspectors, demanding workload, and intense training requirements among other factors. The staffing conditions have led to delays in inspections.
Stagnant funding has also contributed to the compounding issues, according to the report.
A CMS spokesperson said annual funding for survey and certification work has not increased in over nine years, despite a "sharp increase" in the volume of nursing home complaints. In the current year, CMS expects state agencies to collectively perform over 90,000 nursing home complaint investigations, a 13% increase from 2022.
The Senate report showed calls for increased funding were bipartisan. Administrations under both President Trump and President Biden have requested more funding for oversight efforts, but lawmakers did not meet those requests.
"Despite the repeated and escalating warnings, Congress failed to provide funding that CMS Administrators in Democratic and Republican administrations said was needed to meet statutorily required timelines for overseeing nursing homes and other health care providers," the report stated.
Warnings from states about their limited capacity also dated back many years.
Reportedly, Virginia "repeatedly told CMS about struggles hiring staff" including a 2019 email in which the state cited a 31% turnover rate among staff and a 248% increase in overtime to meet inspection deadlines.
Virginia's vacancy rate of inspectors increased from 5% in 2002 to 31% in 2022. Additionally, Virginia had one of the highest ratios of nursing homes to inspectors at 6.4:1.
The report ultimately called on Congress and states to invest in "robust nursing home oversight."
According to a CMS spokesperson, President Biden's proposed budget calls for $492 million for oversight efforts, an increase of $85 million or 21% from 2023. It also proposes to shift funds for nursing home inspections from a discretionary appropriation to a mandatory appropriation.
"Adopting this proposal would finally guarantee sufficient funding to promote the health and safety of the nation’s nursing home residents," a CMS spokesperson said.
CMS noted that despite limited resources, its latest performance evaluation of state agencies found an overall improvement in oversight activities.
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