RICHMOND, Va. — As the Virginia Department of Health (VDH) races to fill dozens of vacancies within its office responsible for overseeing nursing homes, the agency reports it has received a record number of applications from hundreds of interested candidates.
VDH's Chief Operating Officer Christopher Lindsay presented that data to lawmakers last week during a Joint Subcommittee on Health and Human Resources Oversight meeting.
Lindsay kicked off his remarks by thanking the medical facility inspectors working in the Office of Licensure and Certification (OLC), whom he described as investigators on the "front lines" in nursing homes to ensure facilities are "providing safe and high-quality care."
But too often, he said, they're seeing "the worst of the worst."
"This has been a very public time for these teams. There's been an incredible amount of attention paid to their work, not only here in Richmond, but across Virginia, and I want to thank our friends in the media for giving a voice to so many of our citizens that are demanding better," Lindsay said in his opening remarks.
One of the office's top priorities, Lindsay said, is filling 23 vacant long-term care inspector jobs out of 49 total positions authorized.
The goal is to get the number of vacancies down to zero by the end of the year, as directed by Governor Glenn Youngkin's recent executive order which he introduced partly in response to CBS 6's investigative reporting into delayed inspections and complaint investigations due to years of understaffing within OLC even as regulators observed declining quality of care.
With aggressive recruitment efforts underway, Lindsay said VDH has received more than 550 total applications across all postings. More than 300 of those applications are for medical facility inspector jobs; however a majority of applicants do not have the required qualifications.
“That is a lot of applications in a short amount of time... Why couldn’t we have done this years ago?” reporter Tyler Layne asked Lindsay following the meeting.
“I think the thing to concentrate right now is, several months ago, we said we need to look at a leadership focus, we need to look at a recruitment focus, and we need to put an incredible amount of attention on not only filling vacancies, but filling vacancies with the right type of clinical leaders," Lindsay responded.
Strengthening the inspection force comes at a crucial time as consumer complaints, which typically allege poor care and conditions in facilities, are skyrocketing.
Lindsay expects 1,849 complaints to be filed in 2025 which would more than double last year's total of 730. The complaints are also growing more serious in nature, meaning the allegations reflect a resident's health or safety being put in jeopardy and require immediate investigation.
As to what exactly is driving the increase, Lindsay said that's still being researched, but Senator Mark Obenshain (R-Harrisonburg) has a theory.
“These trends are deeply disturbing but not terribly surprising," Obenshain said during the meeting. “We are seeing significant consolidation in the industry. Large national operators, private equity firms, are assuming ownership of more and more facilities and consolidations increasingly removing management from day-to-day operations of these facilities, which create some problems in my opinion.”
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, and CMS has said it's "increasingly concerned" with the quality of care at facilities, especially those owned by private equity companies and investment firms.
“Do you feel like VDH has kind of partly allowed some of these problems to persist by approving people to come in and buy up a ton of nursing homes and not really operating them with the standards of care necessary?” Layne asked Lindsay.
“I think VDH has operated within the regulatory environment that allows this to occur, and we're taking a hard look across the board at what regulatory steps we need to take to put a tighter stance on these types of issues," Lindsay said.
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Lindsay told lawmakers VDH is also working to develop new procedures to utilize its existing powers to suspend or revoke nursing homes' licenses as well as restrict new admissions. It is also initiating the regulatory process to implement additional enforcement actions such as placing licenses on probation, requiring staff training, and levying fines against facilities.
These additional enforcement options will become available thanks to legislation passed during this past General Assembly session. However, Sen. Obenshain said he wants to revisit that legislation in the upcoming session to make the sanctions more aggressive.
Lawmakers softened the language of the original bill to dramatically lower the maximum fine VDH can impose on facilities for regulatory violations. Industry representatives had cited concerns that facilities are already subject to significant sanctions at the federal level.
"These facilities treat these sanctions as cost of doing business. They're not substantial enough," Obenshain said.
Health and Human Resources Secretary Janet Kelly told CBS 6 in a previous interview that the Youngkin administration, which originally proposed the legislation, also wanted stronger enforcement.
"The legislation that we had had a lot of teeth in it, and I think the General Assembly took some of those teeth out, so I would like to see them strengthen that bill," Kelly said.
While Lindsay expressed great optimism about the future of OLC, at least one legislator, Del. Mark Sickles (D-Arlington), wasn't so sold.
“To hear testimony like this is really frustrating to me, because these are not new problems. These problems have been existing. Even in your own testimony, the complaints have gone up over a year’s time over there, and now in August, we're doing things about it," Sickles said.
On Monday, the newly established Nursing Home Oversight and Accountability Advisory Board will hold its first meeting. The board is another initiative stemming from Youngkin's executive order.
The group will discuss solutions to improve quality of care and present policy recommendations to the state health commissioner and governor.
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