With two new laws enacted by the General Assembly and a strong executive order from the governor, Virginia seems, however belatedly, on track to strengthen state oversight of the nursing homes where thousands of Virginians spend their last day — or years.
The actions follow appalling news reports about unsanitary and inadequate facilities, abuse and neglect of elderly patients, and the state’s failure to inspect nursing homes in a timely way.
Federal data this year revealed that 68% of nursing homes in Virginia were overdue for routine inspections. The national average is 17%. Not surprisingly, while timely inspections have been decreasing, complaints about nursing homes have risen. By the end of July, the Virginia Department of Health (VDH) had received nearly 1,000 complaints about problems at nursing homes — more than the total for 2024.
By July, the state had investigated 285 complaints. By August, more than 1,000 were on the waiting list.
It’s not hard to see why the record is so dismal. Last year, the state’s Joint Legislative Audit and Review Commission reported serious staffing shortages and overdue inspections at the VDH Office of Licensure and Certification. In August, the VDH’s office responsible for inspections had a 42% vacancy rate.
There are nearly 300 licensed nursing homes across Virginia, with beds for more than 33,000 patients. Without regular inspections and enforcement of standards, no one really knows whether nursing homes are taking proper care of the vulnerable people who are their residents.
This lack of oversight is troublesome, of course, for the patients, at a time in their lives when they particularly need reliable care, sympathy and consideration.
Then there are the families who decide, for a variety of reasons, that their elderly or infirm loved one should be in a nursing home. When they try to find a home that will meet their needs, the choice can be anguishing, especially if little reliable information is available. Is the facility safe, clean and well maintained? Does it take good care of its residents, physically and emotionally? Are patients treated with respect and kindness?
Who knows? Without timely, professional inspections, the answer to that question can be, essentially, “Nobody.”
Virginia is now working to fill those voids. One of the new laws passed earlier this year gives the state health commissioner authority to impose penalties on nursing homes for violations, including probation and fines of as much as $500 per day for each violation. The other new law established the Hospital and Nursing Home Licensure and Inspection Program, with license fees to help pay for inspections and oversight.
Then Gov. Glenn Youngkin signed an executive order directing the Department of Health to add staff and new technology designed to increase oversight. More transparency — knowing what is happening at nursing homes — should lead to improved safety and better care, while making it easier for the public to have accurate information about the facilities. The increased staff should make it possible to get back on schedule for regular inspections.
To make all this work, the health department must actively recruit inspectors and provide adequate salaries for them. The VDH is working to modernize licensing and inspections and to create a public portal for access to inspection results.
A new Nursing Home Oversight and Accountability Advisory Board composed of health care providers, advocates, geriatricians, legal experts and others is starting efforts to help with oversight, transparency and new ideas.
The condition of nursing homes in Virginia, made worse by the lack of adequate information, had reached a crisis stage, endangering vulnerable patients and leaving families feeling helpless.
There is much to be done, but the new laws, procedures and efforts stand a good chance of making a difference. The new approaches need our support, and also our watchful eyes. More oversight should mean increased transparency. If care is to improve, and confidence in that care is to grow, anyone who has or might eventually have an interest in nursing homes should continue to pay attention.