Black and low-income Virginians are disproportionately affected by nursing home understaffing
For nearly two decades, Virginia’s General Assembly has failed to land on a legislative solution for understaffing in nursing homes. Setting requirements for facilities could be one of the most effective ways of addressing the problem, according to a new report presented to lawmakers this week.
The move would set legislators against the nursing home industry, which has long lobbied against minimum staffing standards. But analysts for the state’s Joint Commission on Health Care found that Virginia ranks below the national average when it comes to adequately provide care.
Nationwide, 31 percent of nursing homes have a one- or two-star staffing rating — the lowest of possible scores — from the U.S. Centers for Medicare & Medicaid Services. The ratings are based on the expected number of direct hours needed to care for patients living in the facility, who often have different levels of acuity.
“Virginia has more facilities with low staffing ratings than other states,” said Kyu Kang, an analyst for the commission, at a meeting on Tuesday. Statewide, 43 percent of nursing homes have a one- or two-star score. It’s an issue of patient care, and also of inequity, according to the report. Facilities with inadequate staffing are more likely to receive lower scores on quality and health inspection assessments. And understaffing is worst in nursing homes with high proportions of low-income and Black residents, who are disproportionately likely to be enrolled in Medicaid.
“There’s significant overlap in the populations we’re studying,” Kang said. “Facilities with a greater percentage of Medicaid residents also serve a greater percentage of Black residents.”
Solving the problem through policy, though, has frequently been a challenge in the General Assembly. Laws to set minimum staffing requirements have been introduced every year for nearly two decades with growing bipartisan support, including from Del. Vivian Watts, D-Fairfax, and Sen. Jennifer Kiggans, R-Virginia Beach, a geriatric nurse practitioner.
So far, nothing has passed. There’s broad acknowledgment among advocates, legislators and the industry that the state’s Medicaid reimbursement rates for nursing homes — the single largest source of payments for most facilities — don’t cover the true cost of care. Because of Virginia’s more stringent requirements for approving admission to nursing homes through Medicaid, residents often require more assistance with daily living than in other states. And the commission’s most recent report found that a growing number of residents have behavioral health needs that aren’t factored into reimbursement rates.
The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.
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