Virginia Health Department Improves Nursing Home Inspection Backlog, Reforms Sanction Criteria for Facilities

Stories of neglect in care or unsanitary living situations have plagued several of Virginia’s nursing home facilities in recent years, and data back up a lapse in oversight by state agencies.

With reform efforts underway, the Virginia Department of Health officials said they aim to adopt sanction criteria by the end of the year to rein in bad actors and get troubled facilities back on track.

As of July, 58% of Virginia’s nursing homes were overdue for inspections, and 68 of Virginia’s 289 nursing homes were found to have serious deficiencies, according to ProPublica. Several of the state’s flagged facilities with numerous deficiencies also had high staffing turnover rates.

The issue has been salient among various healthcare spaces, including VDH.

In recent years, the state health department has grappled with staffing turnover — some of which stemmed from COVID-19-era retirements and burnout — along with management and financial issues that the agency has worked to overcome.

But problems within VDH also meant problems within nursing homes have not always received swift remedies or reprimand.

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A series of WTVR investigations over the past year revealed deficiencies in nursing homes ranging from failure to report violence between residents, lack of attention to residents’ health conditions like incontinence, or misuse of medications.

Office of Licensure and Certification Director April Dovel, who stepped into her role late last year, has spent the bulk of this year making adjustments to get nursing home oversight operating smoothly.

To start, VDH has worked on hiring more inspectors and getting them trained for the job.

Industry representatives like the Virginia Health Care Association have supported state laws to boost oversight efforts and adjust once-stagnant licensing fees.

“They agreed to an increase in licensing fees so that we can increase our staffing,” Dovel said. “They want us to come out and complete these surveys.”

Bulked-up staffing doesn’t translate to the agency immediately dispatching inspectors around the state in droves, Dovel said.

The federally required training has typically taken a year to complete, but Dovel’s team has pared the training process down to six months by providing trainees on-the-job experience in team outings for re-certification processes.

Seasoned staff handles investigations into filed complaints.

To date, she said, all new staff who have taken their certification tests within six months have passed.

In addressing backlogged inspections, she said her team has triaged the situation by focusing investigators on facilities that racked up multiple allegations.

More recently, VDH is fielding public comment on a proposed sanction mechanism Dovel said she hopes will be in effect by the end of the year.

Key provisions include that if a facility has had the same or similar violation on two consecutive inspections, the same violation three times within 18 months and repeated failures in correcting deficiencies, that entity could lose its license.

Sanctions would fall into three levels. The first step would be restriction on new admissions. Level two would entail a prohibition on new admissions and reaching level three would revoke or suspend a facility’s license.

If a nursing home is marked for closure, Dovel explained that her team regularly meets with officials in the Department of Medical Assistance Services and the Department of Aging and Rehabilitative Services to brainstorm how residents may be relocated to other nursing homes.

Public comment runs on the state’s regulatory town hall website until Sep. 9. People are already chiming in.

“Thank you for tightening (regulations), decreasing backlogs and increasing inspectors,” wrote an anonymous commenter who said they lived in a rural area of the state.

The person described nursing homes with broken heating or air conditioning, residents with unchanged bandages and the presence of pests and cleanliness issues in facilities.

Rural areas leave families little choice of where to house their aging loved ones, the commenter wrote, adding that meaningful enforcement can help ensure facilities fix issues.

“Please don’t give up, just push harder and keep asking for more help,” the person wrote. “Those are people living in these places, and they don’t deserve what they are getting.”

by Charlotte Rene Woods, Virginia Mercury

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