RICHMOND, Va. — A final report from the Nursing Home Oversight and Accountability Advisory Board was delivered to former Gov. Glenn Youngkin by his health secretary on the day before his last full day in office. The report did not contain revelatory information that has not already been publicly presented, but it did give new insights into how some external stakeholders responded to the board's work.
The report is a culmination of the initiatives that Governor Youngkin directed as part of an executive order issued in August, which included the establishment of the board, made up of advocates, providers, experts and government officials.
“I can tell you it was a privilege and it's an honor to be on the board where you're invited to be a part of making the change," said Joanna Heiskill, a consumer advocate on the board.
Heiskill said she looked back fondly on the committee's efforts in just a short amount of time but added the report, which outlines recommendations to improve quality in nursing homes, did not fully capture all members' feedback.
“We have a final report, and it's really not the final report," Heiskill said. “I think that there are things that effectively have been left out. I feel like it has been rushed.”
The final recommendations did not differ much from what members initially proposed during its last full board meeting in November. Here's what they include:
- Strengthening the ownership vetting process and expanding powers for the state to prevent owners with a poor track record from purchasing facilities
- Enhancing financial reporting requirements to respond to private equity's involvement in the industry
- Broadening programs that can help grow workforce capacity
- Ensuring hospitals provide nursing home quality data when discharging patients
- Fully funding the long-term care ombudsman program
The report also highlighted the Virginia Department of Health's Office of Licensure and Certification's (OLC) efforts to hire more inspectors. However, facilities are not yet seeing more timely inspections, also known as surveys, because of it.
“We appreciate and recognize that people have been hired, but from the providers, at least from my perspective as a provider in the commonwealth, we haven't seen any changes yet," said Mandy Gannon, a regional administrator with GreenTree Healthcare and member of the board. "We haven't seen the surveys getting back on track, and of course, we need that. We all need that. We need accountability on both sides, from the provider side as well as the OLC side."
Gannon said she felt like the board lacked industry representation, which was echoed by Ryan Hoover, another Virginia nursing home administrator who followed the board's meetings. Hoover provided public comment to the board which was included in the board's final report.
“Why they didn't put the biggest nursing home group in the state, Virginia Health Care Association, why they didn't put one of them on the panel kerflummoxes me and seemed to me to be indicative of, ‘We were out for blood. We were out to make good press and not actually to make meaningful change,'" Hoover told CBS 6.
Hoover runs a non-profit, 40-bed facility in Madison County called Mountain View. It's operated by the Mennonite church and only serves end of life patients, nearly all of which are Medicaid members. He said a vast majority of his staff are volunteers and their dedication to caregiving is driven by their faith.
The facility has exceptionally high overall quality ratings and reported staffing levels that are significantly higher than state and national averages. Hoover acknowledges Mountain View's model is very unique, but he believes it could be replicated.
“If we totally took the motivation of profit out of long-term care, and we infused it with— if you could find the people who care about the mission of serving others, it's completely possible," Hoover said. "I would be delighted if private equity was never within a million miles of a nursing home.”
The solutions to improve care, from his perspective, may not involve more regulation because "the bad guys don't intend to change" and "squirrely people are still going to find a way to squirrel around it." He believes timely and "equitable enforcement" of the laws and regulations already on the books would be a more reasonable approach.
Hoover said he'd like to see more collaborative relationships between the providers and regulators and a stronger industrywide emphasis on mission over profit. Overall, he said he "wasn't excited about the outcome of the board."
Other public commenters featured in the board's report pushed for more stringent minimum staffing standards, better pay for nursing staff, and solutions to a lack of communication between facilities and family members.
"The horrific conditions that residents endure in these facilities, particularly those plagued by chronic understaffing, are nothing short of a humanitarian failure. Residents are forced to live in environments where basic human dignity is routinely compromised: neglected hygiene, delayed medical attention, inadequate nutrition, and a pervasive sense of isolation and helplessness," said a commenter with the advocacy group Dignity for the Aged. "These are not isolated incidents but systemic issues in insufficient staffing levels that prioritize cost-cutting over care."
A VCU Health doctor also submitted public comment to advocate for increased oversight of the nursing home medical director role, noting a lack of federal requirements and specialized training beyond licensure.
"There are 288 licensed nursing facilities in Virginia and 124 medical directors, with 5 serving more than 11 facilities and 1 serving 21 facilities," the report states as a summary of the feedback. "Florida and California have passed laws to elevate clinical leadership in nursing homes, where medical directors oversee medical care coordination. Florida’s law restricts the number of facilities to a maximum of 10 facilities and requires monthly visits."
Meanwhile, certified nursing assistant Victoria Jackson, who has worked in nursing homes, followed the Youngkin administration's initiatives and said she was doubtful they'll lead to lasting change.
“It honestly was infuriating to have to sit there in that room and listen to those people act like they had actually done something," Jackson said. She was referencing a press conference Governor Youngkin held last week to celebrate the progress of the implementation of the executive order.
She believes efforts to improve quality in Virginia nursing homes are being held back by unrestricted industry lobbying.
“Political influence is being purchased by lobbyists, by PACs, and by industry associations," Jackson said. "None of it changes until we actually address the root cause, which is these people are being regulated, and they're writing the laws.”
Heiskill said while the board hasn't had enough time to truly make an impact on real life outcomes in long-term care, she said it was valuable to be given a voice and a direct line of communication to the state's top health officials. Gannon relayed a similar sentiment when asked whether she would deem the board's work successful.
Moving forward, both Gannon and Heiskill said they'd like to see the board continue, and they hope Gov Abigail Spanberger's administration puts a focus on improving care for some of Virginia's most vulnerable.
“I would just hope that the new governor will continue to show her commitment to the seniors in Virginia. I would also hope that they will support it through funding and through Medicaid funding," Gannon said.
“It's my hope, since this is a bipartisan issue, that Governor Spanberger would take the time to pay attention to the cries and the pleas from nursing facility residents and their families," Heiskill said.
CBS 6 reached out to a spokesperson for Gov. Spanberger to inquire whether she has or will review the board's report of recommendations and whether she plans to continue with the advisory board. We have not yet heard back.
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