Pandemic deaths fail to shake loose a legislative solution on nursing home staffing

Pandemic deaths fail to shake loose a legislative solution on nursing home staffing
The Virginia State Capitol. (Source: Ned Oliver/Virginia Mercury)

Sam Kukich was initially excited to join a workgroup she thought would focus on improving staffing levels at Virginia nursing homes.

The director of Dignity for the Aged, a Poquoson-based nonprofit, Kukich had become an almost inadvertent advocate for reforming standards of care in the nursing home industry. She and her family had already made headlines across the state when they detailed a nearly five-year-long struggle to find care for her mother-in-law, who lost 65 pounds and suffered dozens of falls at multiple facilities in the Hampton Roads region.

When she started Dignity for the Aged in 2018, largely out of frustration, Kukich started hearing from “all sorts of people” about cases of abuse and neglect in Virginia nursing homes. Many of the cases, she said, were linked to understaffing — certified nursing assistants and other health care workers who were simply too overworked and overwhelmed to properly care for residents.

So Kukich was disappointed last year when a Virginia Senate subcommittee rejected a bill from Sen. Jennifer Kiggans, R-Virginia Beach, that would set minimum staffing ratios for the industry. It was the 16th straight year similar legislation had died, but this time, legislators ordered the state Department of Health to organize a workgroup to “review and make recommendations” on increasing the nursing home workforce in Virginia.

“I told Sen. Kiggans that I would very much like to be on the committee,’” Kukich said. “So I was pleased that they invited me.”

When the bill died again this year, after months of meetings by the workgroup that failed to produce concrete proposals to fix staffing shortages, advocates say, that made it 17 times in a row.

National advocacy groups rank Virginia among the worst in the nation when it comes to staffing levels in nursing facilities (Families for Better Care, a Texas-based watchdog group, has given the state a failing grade for the last two years). And given the scope of Kiggans’ bill, Kukich thought staffing ratios would at least play a major role in the discussion.

By many accounts, that didn’t happen. The workgroup held eight meetings from early July through November, as hundreds of residents were dying in Virginia’s long-term care facilities. But when the workgroup released its final list of 34 recommendations, the top three centered on creating optional service-learning credits for school children who volunteered in long-term care facilities. The fourth suggested changing regulations to allow for more volunteerism overall — volunteers who would need to be trained and overseen by professional staff members.

Lower on the list there were recommendations on creating financial incentives for nursing home workers. Lower still, at 21 and 22, there were proposals to pay facilities higher Medicaid reimbursements if they met specific staff-to-resident ratios — suggested to start at 12-to-1 and increase to 6-to-1 over the next four budget cycles.

Joani Latimer — the state’s long-term care ombudsman, a watchdog over Virginia nursing homes and resident rights — said those types of programs are often called “value-based purchasing” or “pay-for-performance.” Nationwide, they’re gaining traction as a way to give incentives for better care, rather than penalizing facilities for staffing shortcomings they say are often outside their control.

The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.