Report: Virginia is allowing 'ill-prepared' home care businesses to operate with 'weak' oversight

RICHMOND, Va. — Virginia is allowing "ill-prepared" home care businesses to operate and providing weak oversight of them, according to a new report from the state legislature's research arm, the Joint Legislative Audit and Review Commission (JLARC).

Marcia Tetterton, who runs a trade association for home care and hospice providers in Virginia, said JLARC's findings align with her concerns about the state of the industry.

"We've been watching this for about ten years, and we've seen a huge growth in the number of licensed home care providers in the state, and it's become very obvious to us that many of them are not prepared to manage and operate a home care organization," Tetterton said.

Data shows the number of home care organizations seeking licenses has skyrocketed in recent years, and Tetterton suspects many more are operating without a license.

When asked what she believes is driving the boom, Tetterton said "they see it as a business opportunity" amid a growing aging population.

But at the same time, JLARC found the Virginia Department of Health's Office of Licensure and Certification (OLC) is not denying licenses to any of those applicants, even when their applications are of "poor quality" and when they fail on-site inspections.

Instead, OLC gives them "extensive" assistance, including when they show no improvement and do not understand the gravity of the work they are taking on.

"I’ve gone to some initial inspections where they did not meet one single benchmark," one inspector interviewed for JLARC's report said. "We’ve gone through a plan of correction for two months now with that one provider. They don’t have a good grasp on what is needed.”

Tetterton said these shortfalls could leave vulnerable patients in the hands of untrained and unqualified staff.

"For example, someone could turn up an oxygen tank, and it could lead to a catastrophic event for a person that's on oxygen, or there could be a fall that could occur, and they end up with a broken hip," Tetterton said.

Once these organizations do enter the market, JLARC found OLC's continued oversight is minimal.

90% of them are overdue for biennial inspection. Some haven't been inspected in a decade.

When OLC does get around to an inspection, JLARC said inspectors typically don't visit homes or speak with clients, which the report called a "major shortcoming."

"Without them, OLC inspectors have no firsthand information on the quality, appropriateness, or timeliness of the services HCO staff deliver. Inspectors instead review documentation that presents an insufficient picture of service delivery and HCO/client interactions," the report said.

Researchers outlined multiple challenges facing OLC, including substantial staffing vacancies, a lack of explicit guidance in the law on when to deny licenses, and lacking enforcement options.

OLC staff interviewed by JLARC reported their inspections hardly lead to meaningful results due to the inability to impose consequences when problems are found.

"What is the point of my job?" a staff member interviewed for the report said.

Sen. Mark Obenshain (R-Harrisonburg) appeared troubled by the findings after receiving the report during a meeting earlier this week.

“I’m afraid that without putting teeth in the enforcement, we are leaving people at the mercy of unscrupulous or unqualified home care organizations," Obenshain said.

Tetterton said she believes failures in oversight could not only lead to a decline in quality of care but also create opportunities for financial misconduct.

"I do believe though that a lack of oversight can lead to fraud and abuse," Tetterton said.

In a statement, VDH Commissioner Dr. Cameron Webb said he agreed with JLARC's findings and said the agency is working to update the licensing process, restore timely inspections, strengthen accountability, and build operating capacity.

"Seniors and their loved ones place tremendous trust in VDH to ensure that the organizations caring for them at home are qualified, accountable and following state laws and regulations. VDH will earn that trust through timely inspections, consistent accountability and sustained improvements that ensure access to high quality care and help protect the safety, dignity and well-being of Virginians," Webb said in the statement.

RELATED: As nursing home care worsens, why is Virginia struggling to hold facilities accountable?

OLC is the same office that oversees nursing homes and hospitals, and as CBS 6 has previously reported, it has failed to meet its responsibilities regulating those industries as well in recent years.

Those problems were already highlighted in a 2024 JLARC study, which examined departmentwide staffing and financial problems within VDH.

Tetterton said the General Assembly must act soon to address JLARC's findings. She's, in part, calling for a moratorium on approving home care licenses until OLC can get caught up on its workload.

"If not, we're going to see a very similar scenario to what you know we've seen in the nursing facility markets, and we don't want that to happen to home care. We don't want consumers to lose trust in the services we deliver," Tetterton said.