RICHMOND, Va. — A proposed change in the law that would give the state more powers to hold nursing homes accountable for poor performance cleared an early hurdle at the General Assembly, but not without much debate and opposition from an industry group and nursing home operators.
A House of Delegates subcommittee took up two bills Tuesday aimed at improving the Virginia Department of Health's (VDH) oversight of nursing homes, an issue CBS 6 has been reporting on for several months as the understaffed agency has struggled to fulfill its regulatory obligations to inspect and investigate facilities.
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One piece of legislation would make way for VDH to impose new sanctions on nursing homes for lower-level violations. Those sanctions include requiring staff training at a facility, putting a facility's license on probation, or levying a fine against a facility. Supporters of the bill see it as a way to prevent minor noncompliance issues from growing into major deficiencies that could threaten the safety and well being of residents.
"The bill that is before you, I think, will significantly, really, literally, save lives," Joani Latimer told lawmakers.
Latimer is Virginia's Long-Term Care Ombudsman. Her office acts as a resource to help settle disputes between families and their loved ones' nursing homes. While she is not a part of VDH, her office works with the agency when complaints arise to the level of requiring regulatory action.
Speaking during public comment Tuesday, Latimer called out concerning trends of inadequate care across the commonwealth. In fact, she said half of the state's facilities are rated by the federal government as "below average" or "much below average" under the Centers for Medicare and Medicaid Services (CMS) scoring system.
“We have a lot of facilities, too many, frankly, that are providing substandard care. Those have been persistent patterns for years. Too many of our residents and our families suffer as a result," Latimer said.
Public records obtained by CBS 6 showed that VDH, the state agency responsible for overseeing nursing homes, is also "observing an overall decline in the care being provided to residents."
As CBS 6 has described in previous investigative reports, declining conditions come at a time when VDH is failing to inspect nursing homes, which are required at least every 15 months per federal standards. Accordingly, as of January 2025, Virginia ranked the second worst state in the country for overdue inspections. 73% of the state's facilities were overdue for inspection, according to CMS data, while the national average was 20%.
Watch: As nursing home care worsens, why is Virginia struggling to hold facilities accountable?
The agency has also struggled to respond to a skyrocketing increase in nursing home complaints while grappling with nearly a 50% vacancy rate of inspectors. As CBS 6 previously reported, many Virginians have submitted complaints to the agency yet waited months on end for VDH to begin investigations.
To address these ongoing concerns, VDH and lawmakers worked together to propose the two legislative solutions and, in part, cited CBS 6's reporting for sparking urgency surrounding the problems.
“The reporting helped amplify this issue and highlight so much of what everyday people were already reporting to VDH, and now, as representatives of those voices, we are taking the action that they are asking us to take," said Democratic Senator Lashrecse Aird. “I think people are a bit exhausted with feeling like they're navigating a system that is a bit cryptic, and as you have stated, has been unresponsive largely."
Aird is sponsoring the senate version of the bill that would grant VDH more enforcement options, and Republican Delegate Otto Wachsmann is carrying the house version of the bill. Both bodies must pass legislation in the same form in order for it to be sent to the governor to become law.
"I think families have felt like their concerns have gone unheard, and as a commonwealth, we have an obligation to equip our agencies to act as good stewards of both enforcement and the law, and so that's why it's now time for us to change the law. It has been what it has been, and that hasn't worked," Aird said.
In a subcommittee meeting Tuesday, Wachsmann referenced nursing facilities that were repeatedly cited with more than ten violations in a single inspection, yet the facilities would never make improvements.
While CMS, at the federal level, can impose sanctions similar to the ones that VDH wants, Wachsmann said it's important for VDH to have those same abilities when CMS declines to take action.
"If they don't actually do any sanctions for those lower-level citations, then the state will have something else in their toolbox so they can penalize these nursing homes to get the right things done. What we're trying to do is impact the low-level non-patient safety issues that aren't being impacted right now at the state level, so we can prevent those later patient situations that are going on," Wachsmann said.
VDH Commissioner Dr. Karen Shelton expressed support for the bill and said it would expand the state's historically limited and draconian enforcement options. Currently, she said VDH can only penalize facilities with extreme options like pausing admissions and shutting them down.
“Having all these tools together really provides us the ability to be able to address things at hand, things that aren't being solved already. We're seeing an increase in complaints. We've had an increase in our workload. We need more inspectors for that, and we need to have more tools to be able to regulate the nursing home industry," Shelton said.
Meanwhile, the nursing home industry lobbying group Virginia Healthcare Association (VHCA) opposed Wachsmann's version of the bill, saying VDH already isn't doing its job to complete routine inspections.
VCHA's lawyer Scott Johnson said the timely completion of standard recertification surveys, which require a more in-depth review and analysis of a facility than a complaint investigation, would help improve quality of care.
Two VHCA members, who are nursing home operators, also spoke out against the bill during public comment Tuesday.
“It is my strong personal and professional belief that this bill is redundant and frankly, unnecessary," said Ashley Jackson with Saber Healthcare Group. "I understand, in theory, the bill. However, the goal of quality improvement should be done through the onus on the system that we currently have in place."
Jackson said four of the facilities she oversees have not been inspected in over two years. Another three facilities haven't been inspected in a year, she said.
Wendy Walters, who works with Commonwealth Care of Roanoke and is a member of the VCHA Board of Directors, expressed worries that future money penalties may not be appropriate for the severity level of the cited deficiencies.
"I would argue that this proposed legislation really does not add substantially to existing and effective options, but what it does is send a message that nursing facilities are bad places," Walters said.
She added she was concerned about possible unintended consequences that may drive people away from the profession and create more regulatory burdens for caregivers who are already struggling.
"I've seen firsthand how excessive regulation impact staff morale, recruitment, retention and overall career satisfaction. Regulation is, of course, necessary, yet we must consider the burden this places on caregivers, particularly when safeguards are already in place to address these issues," Walters said.
After much discussion, lawmakers in the house subcommittee voted unanimously to advance the bill to a full committee and indicated they were not done discussing the legislation. Later that same afternoon, a senate committee also voted to advance a companion bill forward.
The other legislation that VDH is pushing, and is also patroned by Delegate Wachsmann, would fund more health inspector positions by increasing licensing fees for nursing homes and hospitals. That bill advanced a house subcommittee on Tuesday as well and was not met with much opposition or debate.
Right now, those fees are set at $1.50 per bed and capped at $500 per facility. While VDH would typically collect $150 in licensing fees annually from a facility with 100 beds, Shelton said other states, on average, would collect around $5,000 for the same-sized facility.
Shelton said the fees are "currently stuck in the Code of Virginia since 1979" and "are very low in nature and don't even cumulatively pay for one inspector."
Kim Beazley, who leads VDH's licensing office, told lawmakers Tuesday that she estimates VDH could fund seven additional inspectors by raising licensing fees. That's still not enough to fill all the current vacancies but would be a good start, she said.
When asked by Delegate Patrick Hope whether Governor Glenn Youngkin proposed a budget increase to allot more money for inspectors, Beazley said no.
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