RICHMOND, Va. — A group established by the governor to figure out how to make Virginia's nursing homes better came together as one body for the first time on Monday.
The inaugural meeting came as industry representatives sharply criticized the state government for a "broken oversight system."
Joanna Heiskill said her mother would be proud to see change in action.
“I feel like my mom would be very excited about the events happening right now," she said. “It’s been a long time coming.”
Heiskill's mother died in 2019 in a Richmond nursing home after experiences that she said were horrific and launched her into years of advocacy. She helped found "Justice and Change for Victims of Nursing Facilities," a network of family members of current and past residents who push for stronger protections for a vulnerable population.
So when Heiskill arrived for her first meeting as an advisor to Virginia's top leaders on issues involving long-term care, she wore her mother's earring to feel her presence.
“I put this on today because this was hers. She loved this. I just felt like, 'You know mommy, let's go to the table and let me be your voice,'" Heiskill said.
The Nursing Home Oversight and Accountability Advisory Board, which was created under Governor Glenn Youngkin's executive order, held its first meeting on Monday.
Watch: Governor, top health officials take action following CBS 6 investigations into nursing home oversight
The board consists of various experts, advocates, and state officials selected by Health and Human Resources Secretary Janet Kelly who will make policy recommendations to the governor and health commissioner on how to improve quality of care in nursing homes.
The group's work comes at a pivotal time as Secretary Kelly said the state's nursing homes are "currently performing well below the national average," and the Virginia Department of Health (VDH) has received a record number of consumer complaints.
It's expected that more than 1,800 complaints, which typically allege poor care and conditions in facilities, will be filed by the end of the year — which would more than double last year's total.
When asked what's driving the concerning increase, Kelly said, “I think partly because there's something to be complained about, and that's something that the nursing home industry needs to address. But I also think that for the first time, people actually believe that something is going to get done, and they believe that their voice is going to be heard.”
The State Long-term Care Ombudsman Joani Latimer, whose office helps settle disputes between residents and facilities, presented what she believed was the "perfect storm" of factors leading to declining quality of care in the wake of the pandemic.
She cited a workforce crisis, lacking enforcement, industry pushback against regulation, "constant churning" of nursing home ownership, and "troubling" trends of private equity and real estate investment trust acquisitions.
Latimer pointed to federal data showing the average overall quality rating among for-profit facilities is 2.55 stars (out of five) and 4.1 stars for non-profit facilities. Additionally, she said staffing levels tend to be better in non-profit facilities.
“There's a significant difference in for-profit facilities versus not-for-profit facilities," she said.
Latimer said proposed solutions should include strengthening regulatory tools and other protections such as Adult Protective Services and the ombudsman's office, increasing transparency through collecting better ownership and financial data, ensuring Medicaid incentive payments reward the right operators, and addressing workforce challenges including workplace culture.
She and VDH officials also reported recent instances of facility leadership instructing their staff not to cooperate with state inspectors and ombudsmen. In an August inspection report of a Virginia Beach facility, VDH inspectors said staff reported the administrator threatened them with losing their jobs if they spoke to inspectors.
“It’s very aggressive stuff that we have not seen in the past, and it's very chilling," Latimer said.
Board member Jim Sherlock, who writes about nursing home issues for Bacon's Rebellion, said he believes the main problem lies within the structure of ownership companies that conduct related-party real estate transactions, limiting financial resources for direct care. Of note, Medicare and Medicaid funding generally make up the majority of a facility's income.
“Medicare and Medicaid money is paid out in rent. It's paid up in fees to these shell companies, and there's not enough money left for the patients to be taken care of," Sherlock said. "You need forensic accountants to look at where your money is going."
For some ownership companies, he claimed understaffing is a "feature, not a bug."
Licensed nursing home administrator Mandy Gannon disagreed with that assertion and warned the board not to paint all providers with a broad brush.
“There are hundreds and hundreds, thousands, of caregivers in facilities across the Commonwealth providing excellent, compassionate care to our elderly and so I think we just need to be cautious about that," Gannon said.
Administrator turnover was another topic of discussion during the meeting, as members pointed out that leadership instability can lead to staff turnover and affect the quality of work.
Board member Jackson Baynard, Henrico County Fire Chief, said one facility in the county made 518 calls for service within one year. 145 of them, he said, were "most likely unnecessary transports" which can cause "transfer trauma" for the subject and place a burden on the EMS system.
Baynard attributed the unnecessary calls to "poor directives" on when to call 911 by administrators "who are only there for maybe six months before there's turnover."
Gannon said there's a need for more leadership programs to encourage future administrators, and Todd Barnes with Department of Veteran Services said the pathway to obtaining a long-term care administrator license should be "quicker and shorter."
Just a few hours before the meeting, the Virginia Health Care Association (VHCA), which represents the industry, released a press statement criticizing VDH for its "broken oversight system."
VHCA President Keith Hare said Governor Youngkin's executive order falls short of addressing nursing homes' immediate needs as VDH is failing to complete inspections, follow-up visits, and address corrective action plans in a timely manner.
“There are timelines associated with those, and those are many, many times being missed. And when that happens, that puts residents and patients at risk," Hare said.
Most times when VDH completes an inspection, it does so on behalf of the Centers for Medicare and Medicaid Services (CMS), which has a strict deadline for facilities to come back into compliance after being cited with violations of care and safety standards.
If a facility remains noncompliant for 180 days, it risks losing its Medicare and Medicaid certification, which is an extreme "last resort" enforcement action. But Hare said nursing homes must rely on the understaffed VDH inspection office to provide facilities with reports detailing any violations found, approve the facility's plans to correct such violations, and perform follow-up inspections to ensure facilities cleared their violations.
"[VDH is] not even coming close to the timeline that they need to do that, and that's what the Centers for Medicare and Medicaid services are reacting to when they will send letters that possibly could decertify a facility when the facility has not done anything to deserve that. That's very, very dangerous, because we never want to be in a situation where a facility is decertified and residents have to be moved. That is the worst-case scenario," Hare said.
The VHCA's statement comes a month after CMS terminated Princess Anne Health and Rehabilitation Center's provider agreement. The facility was cited with violations, some of them severe in nature, during inspections performed in February, June, and August. Hare said the VHCA's statements were not specific to Princess Anne or any one provider's situation.
Watch: Virginia nursing home at risk of shutting down after 'extremely rare' federal action
Secretary Kelly pushed back against the VHCA's claims.
“That statement sounds to me like a lot of finger pointing from the industry to the state when they really need to be the ones to take ownership and accountability for their work. We have so many complaints, and those take priority over inspections and surveys. So if the complaints would go down, meaning their work was better, then we could be more timely on the inspections and the surveys," Kelly told CBS 6.
During the meeting, VDH Chief Operating Officer Christopher Lindsay gave an update on the agency's efforts to recruit inspectors amid a race to fill vacancies by the end of the year. Lindsay presented the same data, showing a record number of applications for those positions, to a General Assembly subcommittee last week, which CBS 6 previously covered.
While Hare said filling inspector vacancies is a step in the right direction, and should've happened years ago, he said it could still take up to a year before new inspectors can become fully trained.
For advocates, like the loved ones of resident whom CBS 6 interviewed nearly a year ago, they feel optimistic that much needed change is on the way.
Watch: As nursing home care worsens, why is Virginia struggling to hold facilities accountable?
While last year they felt the government was disappointing and nonresponsive to their concerns — they now say they feel truly heard.
“I pray that the next governor coming in makes this as just as much of a priority," Heiskill said.
The board is expected to meet again in October. Secretary Kelly said the goal will be to reach strong consensus among members on a number of recommendations and then submit those reports to the governor and health commissioner.
CBS 6 is committed to sharing community voices on this important topic. Email your thoughts to the CBS 6 Newsroom.
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