3 daughters fight to improve Virginia’s nursing home industry

RICHMOND, Va. — Three strangers are connected through their own painful experiences with the last days of their loved one’s life.

Joanna Heiskill lost her mother. Tracey Pompey’s father suddenly died. Kelly Edward’s mother passed away at 72 years old.

They all belong to the local group, Justice and Change for Victims of Nursing Facilities. Heiskill created the group after she said she discovered her mother was not given the required oxygen she needed to survive.

“The next phone call I got they were rushing her in an ambulance to the hospital,” she recalled. “I’m disappointed at the way our government has decided to shun the elderly.”

Since the start of 2021, Virginia ranked second in the nation in deaths in nursing homes, according to AARP.

AARP Virginia State Director Jim Dau shared with CBS 6 somber statistics.

One in 10 nursing homes said they didn’t have a week’s worth of protective equipment. One in six nursing homes reported an insufficient number of care workers or nurses on staff.

“Before COVID-19 happened, nursing homes were having tragic problems with infection control and it’s largely a function of their staffing levels,” Dau explained. “We need to be paying attention to this now because largely we haven’t been paying attention to it before.”

For 20 years, Del. Vivian Watts (D-Fairfax) has worked to find a solution to a complex issue. She revealed that Virginia is one of the few states in the nation without minimum staffing requirements in nursing homes.

“It is not satisfying for many to work in a nursing home,” Watts explained. “It’s not what they wanted to do when they wanted to help people.”

Virginia does not support their citizens on Medicaid adequately without staffing standards, Watts argued.

About 20,000 of the Commonwealth’s 30,000 patients living in nursing homes are on Medicaid. In order to qualify for the state to pay your nursing home bills, the patients must be unable to care for themselves on a daily basis - like eating, bathing, and dressing.

“Virginia traditionally has been 48th in the nation - give or take - in the amount per population that we spend on Medicaid and that’s largely because of our nursing home situation,” Watts stated.

In return, the most vulnerable in our population require the most attention.

Derrick Walker, a personal injury attorney at the Richmond-based law firm Allen & Allen, believed the deaths are preventable.

“Far too often we are seeing CNAs [Certified Nursing Assistants] that are taking care of 20 patients on a shift,” Walker said.

Federal law does require Medicaid-certified nursing homes to have a licensed nursing on duty 24-hours a day. Virginia requires homes to staff “in sufficient number to meet the assessed nursing care needs of all residents.”

Both New Jersey and Delaware enacted laws that require a 1:8 patient to staff ratio during the day.

“Some of [the nursing homes] are very good, but they are corporations,” Walker stated. “Their bottom line is to turn a profit and as long as Medicare or regulatory agencies are not requiring a certain number of staff members on the floor at a certain time doesn’t increase the overhead.”

Walker described the workload for nurses and nurse's assistants as “back-breaking.”

Retention and burnout contribute to a lack of staff on duty or available in the job market. A nurse’s assistant could make more money working inside of a restaurant, advocates said.

Watts said the Commonwealth would be required to pay an additional $40 million for Medicaid just to meet the minimum staffing requirements of other states. Those state funds would also be matched by federal funds.

Amy Hewett, a spokesperson for the Virginia Health Care Association and Virginia Center for Assisted Living, acknowledged in a statement that “long term care providers were already facing a workforce shortage prior to COVID, and the pandemic has only exacerbated this crisis.”

COVID-19 cases in a surroudning community was a top factor in outbreaks in nursing homes, Hewett said citing independent academic research.

"We have been calling for help for years for help with our workforce recruitment and retention challenges and the historic Medicaid underfunding of nursing home services, which covers the care for 6 in 10 Virginia nursing home residents," she wrote.

Hewett said VHCA-VCAL supports those efforts to focus on staffing as well as a comprehensive strategy to recruit more staff.

Tracey Pompey shared her father’s story with CBS 6back in 2017. Her father was found vomiting stool and died on the floor of his room.

“Not all facilities are bad. But the ones that are bad, they know they are bad,” she said.

Heiskill also encouraged the state to focus on improving the health education system. VALA agreed.

“In some professions within the senior living industry, Virginia also experiences more strict requirements than other states that result in a barrier to entry for some of the professions for senior living communities. These barriers to entry also contribute to the shortage of staff members within the industry,” Hackler wrote.

Walker, the personal injury attorney, shared important advice when looking for the right location for your loved one to stay.

“I have a very soft spot for these cases,” Walker admitted. “At the heart of all of these nursing home cases there is a promise.”

Plan your visit of a nursing home or an assisted living facility during mealtime, which is often the busiest time for staff.

Use your eyes and ears to determine whether the location is delivering quality care at a busy time when mistakes can be made. Does the food look appetizing, do the patients look well kept and staff is in sufficient numbers, Walker asked. If the facility has enough staff during a busy time, more often they have enough staff during the downtime, as well.

There are resources available on the Virginia Department of Health's website such as ratings and the number of beds available of nursing facilities. Inspection and violation records are also available.

But Heiskill cautioned that those ratings could be skewed especially if the facility recently opened or changed names or owners.

The daughters urge everyone to pay attention because, one day, you may also find yourself in the care of strangers.

"If we can get together, we are all committed," Heiskill said. "We need to make it known and help people to learn that they have to speak up."

Judy Hackler, executive director at the Virginia Assisted Living Association (VALA), recognized that staffing shortages existed before the pandemic began.

In a statement emailed to CBS 6, she said that nursing homes are regulated by the Virginia Department of Health, and assisted living facilities are regulated by the Virginia Department of Social Services.
She argued that mandating staffing ratios is not the answer since not all locations are physically the same and their patients share different needs.

"A senior living community with 50 residents in a single-story building that have very minimal staffing support needs would not need the same number of staff members on a shift as a senior living community with 50 residents in a two-story building where a quarter of the residents need more extensive staffing support for their activities of daily living," Hackler stated.

Arguably, the pandemic hit the facilities the hardest.

“The COVID-19 pandemic significantly increased that need for staff members in senior living, but we unfortunately saw a significant decline due to infection fears, employment restrictions on working multiple locations, and even the increased benefits provided by unemployment services,” Hackler wrote in a statement.

Hackler said that assisted living facilities were also either ignored or left out of financial relief packages requiring the facilities to purchase their own PPE and other tools to combat the virus.

"It is estimated that 56% of assisted living operators in the nation may not be able to sustain operations for another year if financial relief is not provided," she explained.