RICHMOND, Va. — Virginia's top health official said the state is now taking a more aggressive approach to holding nursing homes accountable, as the number of complaints about conditions and care in facilities continues to skyrocket.
"We know that there's a lot of concern about many of our nursing homes in Virginia," State Health Commissioner Dr. Karen Shelton told a group of lawmakers Wednesday. "Sadly, too many of our nursing homes in Virginia have low ratings."
Shelton leads the Virginia Department of Health (VDH), the agency responsible for licensing nursing facilities and ensuring they comply with the care and safety standards established in state and federal regulations.
For the past year, CBS 6 has been giving a voice to family members of residents troubled by their loved ones' experiences in facilities across Central Virginia, sharing remarks including:
- “I regret putting my mother in a facility.”
- “They were doing just bare minimum care.”
- “Everyday was a new horror."
Shelton said VDH is ramping up its enforcement efforts partly due to the heightened awareness, saying, “I think it's certainly been helpful to kind of have a spotlight on it. We know that certainly our legislators are very concerned. We know that they get complaints and concerns all the time, but when we focus our spotlight on some of the problems at hand, it raises everyone's awareness."
She presented data to the Joint Commission on Health Care showing 45% of the state's nursing facilities have a 1- or 2-star quality rating (out of 5 stars) from Medicare. That means these facilities are below average or much below average. Shelton said Virginia ranks 38th in the country when it comes to the overall quality of care of nursing homes.
So far in 2025, VDH has received 944 nursing home complaints, already surpassing last year's total of 939. Most of the complaints have to do with quality of care, neglect, and cleanliness, Shelton said.
She added regulators have been increasingly citing facilities with more immediate jeopardy violations, the most serious type of violation in which the risk of harm, injury, or death to a resident has been identified. And in recent reports submitted to federal regulators, VDH said it was observing an "overall decline in care being provided to residents."
WATCH: Virginia's top nursing home advocate sees 'troubling trend' in industry
As to what exactly is causing the rise in dissatisfaction with care, Shelton said it's hard to say, but she pointed to the lingering effects of the pandemic on the health care industry.
“As we look at a combination of events, we can't pinpoint exactly why Virginia is here, but we know that we've identified some problems that we have and are working towards some solutions that we can take in order to get to a better place," she said.
As CBS 6 reported in previous investigations, VDH has faced its own challenges in providing adequate oversight of the industry. As of Wednesday, Virginia still has the second highest percentage of facilities overdue for routine inspection in the U.S., according to federal data.
Shelton said her agency has been making progress in reducing the average amount of time in between routine inspections, but it is still not meeting the federal requirement of inspecting a facility once every 16 months.
Currently, the licensing office is facing a 42% vacancy rate of inspectors. To address the staffing shortage, VDH is offering hiring incentives and has brought on contractors to help work through a backlog of complaint investigations and inspections. As VDH catches up on inspections, Shelton said Medicare quality ratings may change to more accurately reflect a facility's most recent performance record.
An area where she said she could use some help from the legislature, she told lawmakers, is ownership transparency.
“We’ve also noted that there's been a noticeable increase in the number in changes of ownership in nursing homes over the past few years," she said. "Unfortunately, we have relatively little information on these. Having more comprehensive information and detailed ownership information could help us with a variety of factors as we review the licensure process."
Right now, she said VDH does not have statutory authority to review an applicant's regulatory compliance history, the quality ratings of facilities they may already own, financial stability, or any past criminal history or lawsuits when determining whether to grant the applicant a license.
Research released by the federal government shows Virginia had one of the highest rates in the country for the percentage of nursing homes that went through a change in ownership between 2016-2021. It cited reports suggesting facilities acquired by private equity companies experienced "increased emergency room visits, hospitalizations, and costs among long-stay residents." Another federal study stated inadequate ownership data can lead to "limited oversight efforts and accountability of poor performing operators."
Figuring out exactly who is running Virginia's nursing homes can be difficult, as many licensing records list individual LLCs as the owner of a facility. It's a concern some lawmakers have already expressed to CBS 6.
“Something that I've seen in my law practice is you'll have these nursing homes that are owned by lots of different shell companies, and when you finally get through all the various shell companies and LLCs, you'll find out it's somebody in a different state, and it's a very small group of people who ultimately the profits are flowing through to," Republican Sen. Glen Sturtevant said in a previous interview.
Shelton said she was grateful that the General Assembly just passed legislation that gives VDH more state-level nursing home enforcement options, like putting a license on probation and requiring training. According to Governor Youngkin's Health Secretary Janet Kelly, the new law means VDH "finally has better tools to hold bad actors accountable."
But Shelton said there's more work to be done. When asked whether VDH was getting more aggressive in accountability efforts, Shelton said, "Yes, we are."
"As we have rebuilt our infrastructure throughout our agency and then begin to tackle each of the problems as they come through, we have had a special focus on our nursing homes," she said. "And we have been working collaboratively with Secretary Kelly in her office and multiple partners on what can we do? Think creatively, think outside the box. What more can we do to make sure that we are improving nursing home care in Virginia?"
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