HENRICO COUNTY, Va. — State advisors working to improve Virginia's nursing homes are introducing recommendations to protect vulnerable residents and hold the industry accountable to delivering better care.
The Nursing Home Oversight and Accountability Advisory Board, formed by an executive order issued in August by Governor Glenn Youngkin partly in response to CBS 6's investigative reporting on long-term care issues, met Friday to begin the process of formalizing their proposed solutions.
The body's third meeting kicked off with presentations from three board members, including consumer advocate Joanna Heiskill of the group Justice and Change for Victims of Nursing Facilities. Her advocacy stemmed from neglect she said her mother experienced at a nursing facility several years ago.
Calling it a "crisis," she implored the board to address what she believes is the root cause of declining quality of care: profit seeking. Heiskill said ownership entities acquiring facilities "without limits and restrictions" in Virginia is "not sensible" and "dangerous." The Virginia Department of Health (VDH), which is responsible for licensing operators and approving ownership changes, currently has limited statutory authority to collect information that would give it insight into an owner's history of quality and regulatory compliance, the state health commissioner has said.
“To allow corporations to purchase and operate these homes as profit-driven enterprises is wrong, because what happens is you have profit over quality of health," Heiskill said. "This is how we got here."
Heiskill also encouraged the board to center solutions on the experiences of residents, whom she said oftentimes do not have as prominent of a voice as industry representatives when it comes to lobbying lawmakers for change.
“Think of the lonely person in a bed somewhere that's laying in their waste and that's not getting the bell answered, that's crying like my mother did," Heiskill said. "Corporations lobby for legislation that protects their bottom line and not the lives of the residents that they are entrusted to care for."
Board member Jackson Baynard, Henrico County's Fire Chief, also delivered remarks to the board, particularly highlighting how long-term care facilities drain emergency resources on unnecessary calls for service that he said stem from lack of care and inadequate staffing.
“We’ll get a 911 call for a catheter that’s come out. That is something that can be very easily, with appropriate staffing, fixed within that facility," Baynard said.
Those types of calls bog down hospital operations, prevent crews from responding to other emergencies, and can even cause "transfer trauma" for the patients involved, he said.
Baynard said about 40% of long-term care transfers are preventable and added unnecessary calls are more apparent in facilities with high staff turnover. As it relates to who's making these calls, he said the county "never interacts" with advanced practice providers such as a doctor or nurse practitioner, and "oftentimes not even a [registered nurse.]"
Board member Jonathan Cook, CEO of LifeSpire Virgina which runs not-for-profit senior living communities, told members, as a provider with 30 years of experience, that he was unaware the state ranked so low for quality of care in nursing homes.
“I didn't know until I came here that Virginia ranked 38th in the country. That was eye opening to me. I went home and told my wife, I said, 'wow,' because that's not the experience I see every day. I didn't realize the numbers on the abuse registry. I went back and I told one of my coworkers. I'm like, 'wow.' That's something I was unaware of, so my eyes have been opened by serving on this committee," Cook said.
Amid a somewhat heated discussion about staffing mandates, Cook said he didn't think anyone fully understood how difficult it is for providers to recruit employees.
“I’m in the process of importing [registered nurses] from the Philippines just because we can't find them here. So you can't just arbitrarily say that you're going to hire more people," Cook said.
Cook was responding to comments from board member Sam Kukich, a resident advocate, who was pushing for required staffing ratios and said she believes facilities should not admit more patients than it can appropriately care for with its staffing capabilities.
The Virginia legislature did adopt a law in 2023 that requires facilities to provide at least 3.08 total nurse staff hours per resident per day with numerous exemptions and opportunities for facilities to course-correct before facing penalties when in violation. The statewide staffing mandate was supposed to take effect in July 2025, but implementation and enforcement have been delayed due to a federal staffing mandate that ultimately was overturned.
Kukich's husband, Bob Kukich, who said his mother was in five different Virginia nursing facilities, told the board during a strongly worded public comment that nursing homes were "state-sanctioned torture."
"Virginia nursing homes are not homes. They are human landfills where the elderly are dumped, forgotten and left to rot under the indifferent gaze of a broken system," Kukich said.
Midway through the meeting, the board broke off into three subgroups to come up with preliminary policy recommendations that are due to Governor Youngkin next month. Here's what the board is proposing:
They're pushing for stronger ownership transparency requirements and cost reporting procedures to respond to private equity acquisitions. Various board members have raised concerns about limited information into nursing home chains, their business structures, and the financial relationships between operating entities and affiliates they do business with.
The board suggests VDH should improve its vetting practices during the licensure process and be given powers to stop owners with a poor quality history from purchasing more facilities.
“We've heard a lot throughout the workstream and throughout some of our meetings about really poor performance from a number of facilities that may all be affiliated with one another," said Sara Stowe with the Commonwealth Council on Aging.
The board is also recommending that VDH provide more accurate public-facing information for consumers. The federal government currently publishes data regarding quality ratings, ownership affiliations, and inspection results but VDH Chief Operating Officer Christopher Lindsay said some of that information is "flawed" and that VDH has the opportunity to correct it. VDH is also launching a portal no later than Saturday that will give the public better insights into facility inspection outcomes, complaint data, and disciplinary actions.
Lindsay added other recommendations should include enhancing workforce and training programs and strengthened collaboration between government agencies with oversight responsibilities.
Lastly, the board is pitching family engagement measures such as fully funding the long-term care ombudsman program, launching a residents rights campaign, and regulations that would require hospitals to give patients important quality information about nursing homes before discharging them to a facility.
“It was acknowledged that these hospital systems sometimes have partnerships and contracts with pipelines that feed these patients to these nursing homes, and they think it should be very much fair, square, based on quality, based on first choice, if able," said July Traylor with the state Medicaid agency.
As far as next steps, Health and Human Resources Deputy Secretary Leah Mills said these preliminary recommendations will be compiled into a draft report that the board will provide further feedback on.
The report will then go before the public for a public comment period and then will be delivered to Governor Youngkin by the end of the year.
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