Virginia sets clearer triggers for nursing home sanctions
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The Virginia Department of Health is setting clearer guidelines for when serious or repeated problems at nursing homes should prompt state sanctions.
Why it matters: Multiple Richmond-area nursing homes have faced serious — and at times, deadly — deficiencies involving staffing, neglect and resident safety, as families and advocates urge the state to do more.
The big picture: VDH licenses privately operated facilities and conducts federal inspections for the Centers for Medicare & Medicaid Services.
- And it already has the power to restrict admissions, suspend or revoke licenses, and pursue other sanctions against Virginia's nearly 300 nursing homes.
- But April Dovel, who began leading VDH's nursing home oversight office in November, told Axios regulators lacked a consistent framework for deciding when to use state enforcement powers rather than rely on the federal process.
- Now, Dovel said, when facilities repeatedly fail to correct systemic problems, "we're going to take action against your license, or restrict new admissions."
The latest: VDH guidance released Monday, with public comment open through Sept. 9, lays out triggers for considering state sanctions.
- They include the same or similar violation on two consecutive inspections, the same violation three times within 18 months, and repeated failures to correct deficiencies.
- Multiple deficiencies in areas like quality of care can also prompt review, though enforcement decisions will remain case-specific.
Why now: Dovel said VDH's oversight operation became "very reactionary, putting out fires" after pandemic-era staffing losses as complaints rose, inspections accumulated and inspector vacancies hit 40%.
- Then news coverage put a spotlight on the issues, she told Axios, helping build General Assembly support for more oversight resources "to prevent these things from occurring again."
- That means more staff to find problems, and more capacity to create guidance for what to do about them.
Stunning stat: As of July, 58% of Virginia nursing homes hadn't received a standard inspection in at least two years, the nation's second-highest percentage, per ProPublica.
Zoom in: Of the 30 most recent serious deficiencies reported statewide this year through July, 10 were at Richmond-area nursing homes, ProPublica said.
- At Shalom Gardens in Henrico, inspectors found that a resident who hadn't been assigned a nurse was later found dead and didn't receive the required CPR.
- At Canterbury in Henrico, inspectors found that the facility failed to protect residents from another resident with known aggressive behavior. One person was hospitalized.
- At Wonder City in Hopewell, inspectors documented a chronic nursing shortage and an instance of a 17-hour gap between meals.
Canterbury administrator Veronica Haskins told Axios the facility disputes the findings and has formally challenged its two citations for immediate jeopardy, the most serious deficiency level.
- Shalom Gardens and Wonder City didn't respond to Axios' request for comment.
What to watch: Dovel said success should mean fewer overdue inspections, more consistent enforcement and more inspectors.
- VDH aims to complete about 18 routine inspections per month, cut the inspection backlog to fewer than 90 by January, and add seven inspector positions, bringing the total to 46.
What they're saying: For Dovel, whose experiences with grandparents in Virginia facilities drew her to regulatory work, the mission is personal.
- "As long as I am in this seat, I am going to do everything that I possibly can to make sure that this work gets done," she said.