In the range of 29,000 Virginia seniors are residents of one of our 291 certified nursing homes, so, about 100 per, would be the average head count there.
The Virginia Department of Health currently uses five overworked teams of certification inspectors to try to keep tabs on how our nursing homes are doing, but because we haven’t prioritized basic inspections in forever, 58 percent, according to a ProPublica study, were overdue for getting a routine look-over from the state, and that same ProPublica study found that 68 of our nursing homes – 23.4 percent, so, just about one in four – were found to have serious deficiencies.
Yikes, indeed.
The good news coming: the General Assembly, earlier this year, approved funding to hire eight complaint investigators, which will allow the certification teams that had responsibility for both – certifications and complaints – can focus on reducing the recertification backlog.
In theory, reduce the recertification backlog – state law requires that nursing homes go through the recertification process every 15.9 months – and that should reduce the number of complaints.
It’s a good working theory that they have there.
Now, we just need to get it from theory to practice.
Dumb politics
As I was researching this topic, I stumbled upon a federal report highlighted by Bedsore.Law, a website for nursing home attorneys, that tells us VDH “returned more than $2.4 million in unspent federal funds between 2021 and 2023.”
The money, per the reporting, from the Centers for Medicare & Medicaid Services, “was specifically meant to support nursing home surveyors, investigators, and regulatory staff.”
“Federal officials emphasized that states may use these funds to bolster inspection capacity,” the item from Bedsore.Law went on, before quoting an elder care regulation expert, Toby Edelman, saying that failing to use available funds “is really troubling” and puts vulnerable residents at risk.
“If the surveyors don’t come in, facilities decline in the quality of care they’re providing,” Edelman said.
Starting over
We talked last week with April Dovel, who was hired last fall to head up the Office of Licensure and Certification at VDH, to get insight into how things are going to address the recertification backlog.
Patience seems to be the name of the game. Dovel said she would ultimately like to have two certification teams in each of the state’s six regions, but in the here and now, the eight new complaint investigators, and the three new complaint intake analysts, hired under new funding from CMS, are what she has to work with, in terms of increasing capacity.
Hearing Dovel explain the recertification process helps us understand why there’d be a backlog, given the limited resources that have been available at OLC – frustratingly, out of simple lack of direction during the Northam and Youngkin years.
Dovel said the initial survey takes four days on the ground – i.e. with the recertification team at the facility – to complete, at the start of a process that gives the team 10 business days to report back to the facility with its findings, then has the facility under a 10-day deadline to submit a plan of correction for review.
Throw in a course of revisits, and you can see where things can get bogged down.
“So, yeah, so it could take, I mean, start to finish, we’re talking about weeks of processing and back and forth, between the plan of correction and so on and so forth,” Dovel told us.
And this, mind you, is on a single recertification, of one of the 291 nursing-home operations statewide.
Dovel has five teams doing this work in the field and back in the office at any given point in time; her goal is to have 12, and I think you can see why.
This is important!
In the here and now, the goal internally at OCL is to have less than 90 facilities that are outside of the standard recertification window by January, and to reach zero by the end of 2027.
Going forward, OCL has a budget request in for additional inspectors, which, come on, state legislators, this needs to be a funding priority.
This is me saying this, not Ms. Dovel – I don’t want to get her in trouble with the pols here – but somebody needs to be looking out for our parents and grandparents.
Politicians don’t like the hired staff telling them what to do.
If they’d asked me, I’d tell them, if you’d been doing their jobs on this, we wouldn’t be where we are.
This literally is a matter of life and death that we’re talking about here.
Give OCL what it needs, OK?
Because the folks there put their heart and soul into what they do.
“Our mission is incredibly important to not only us, and we take it very personally, but as you mentioned, we’re all getting older by the day, right, and we want to make sure that that the individuals that we love and care about, should they need nursing home care, that they’re getting good quality care,” Dovel told me.
“While the onus is always on the provider to be expected to do that, we do have an instrumental role to play, to make sure that they’re meeting regulatory requirements. Our work is important, and having the funding to be able to do that is equally as important,” Dovel said.
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Chris Graham
