Category Archives: Health Care

Virginia’s Best Nursing Facilities

Posted on June 14, 2023 by | 14 comments

by James C. Sherlock

This is part 4 of a series on nursing homes in Virginia. Part 1 here Part 2 here, Part 3 here.

Medicare.gov curates and publishes a system of nursing home assessments that is outstanding in both design and execution.

As discussed in earlier parts of this series, Virginia has far more bad nursing facilities than it should, but the Commonwealth also has more than its share of outstanding ones.

Fifty-two of 289 are rated five stars by CMS. Only 10% of the nation’s nursing homes achieve that rating. Eighteen percent of Virginia’s.

We’ll look at those best-of-breed facilities. Continue reading →

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Posted in Health Care

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Virginia Nursing Home Regulations and Inspections – A Strategic Improvement Recommendation

Posted on June 13, 2023 by | 2 comments

By James C. Sherlock

Those who read this blog know that Virginia has far more than its share of bad nursing homes. They just do not know what can or should be done about it.

This third in a current series on Virginia nursing homes will take on a problem that is self-inflicted – the state’s nursing home regulatory structure.

Virginia’s nursing home regulations, upon which Virginia licensing inspections are based, are promulgated by the Board of Health.  They are at best redundant to federal requirements.

At worst they are different than federal standards, with no discernible gain in nursing home quality.  Operators follow the federal rules anyway, because they are almost inevitably stricter than those of the state.

Virginia can improve its nursing home regulations by conforming them precisely to federal regulations.  State law already requires them to be in “substantial conformity.”

This change, if accompanied by the combining of federal and state inspections which it would enable, would make everybody happy.  It would also go a long way towards fixing the staffing problems at Virginia’s inspection agency by reducing significantly their required efforts.

Continue reading →

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Posted in Federal, Government Oversight, Health Care, Long Term Care and Nursing Homes, Public safety & health

A Supplement to James Sherlock’s Post

Posted on June 12, 2023 by | 13 comments

by Dick Hall-Sizemore

James Sherlock has done yeoman’s work on this blog with his pointing out the failure of state government to adequately regulate the nursing homes in the Commonwealth. I commend him for his perseverance on this issue.

In doing some research on the budget issues related to this topic, I encountered enough additional information to warrant a separate article, rather than a comment. Therefore, this article should be regarded as a supplement to the recent articles posted by Jim. It also provides me the opportunity to acknowledge that I unfairly criticized the House Republican majority in a comment to one of his earlier posts. Continue reading →

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Posted in Correction, General Assembly, Health Care

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No New Law or Regulation is Needed for VDH to Sanction Bad Nursing Homes

Posted on June 12, 2023 by | 6 comments

By James C. Sherlock

This is Part 2 of this series.  Part 1 is here.

I will offer here a deeper sense of Virginia’s bad nursing homes.  And of the historic lack of adequate regulation by the state.

Start with the fact that even the worst of them are still open.

Centers for Medicare & Medicaid Services (CMS) conduct and update at least quarterly a system of nursing home (and other facilities) assessments that is worthy of your trust.  I am cautious with all things government, but it has earned mine.

Nationally, 20% of nursing homes are rated one star overall by CMS.  In Virginia, 34% of nursing homes have that rating.

Don’t be mollified by the official designation of such facilities as “well below average.”  Many are places persons as vulnerable as nursing home residents should not be permitted to reside.

We are disgraced by having let that happen.   Virginians, through our state government, need to assure it does not continue.

Continue reading →

6 Comments

Posted in Consumer protection, ethics, General Assembly, Health Care, Long Term Care and Nursing Homes

Scandal in Plain Sight – Virginia’s Failed Regulation of Law-Avoiding Nursing Home Owners

Posted on June 10, 2023 by | 28 comments

by James C. Sherlock

One of the most important and heart-wrenching decisions families make for their elderly loved ones is whether they are able to keep them in their homes as they get older and sicker.

Sometimes that is not feasible for a long list of reasons in each case.

More than 30,000 Virginians live in nursing homes.

Both the federal government and Virginia regulate them.  The Virginia Department of Health, for both the Commonwealth and the federal government, inspects.

We should be able to expect patients to receive at least basic standards of care. A high percentage in Virginia have not .

In a five-star system, the Centers for Medicare and Medicaid Services (CMS) rates 98 of Virginia’s 289 nursing homes at one star – defined as much below average. More than a third.

Nationwide, only the worst 20 percent receive a one-star rating.

The last time I reported, in October of 2021, those figures were 54 one-star facilities out of 288. Nineteen percent.  So some of our nursing homes have gotten precipitously worse.

The ratings are backward-looking a couple of years, so the measured declines discussed here did not start recently.   By definition of the way that Medicare compiles records and assigns scores, some have been bad for a long time.

People have suffered and died from the lack of proper care and effective oversight. Continue reading →

28 Comments

Posted in Change Management, Consumer protection, Courts and law, Efficiency in government, General Assembly, Governance, Government Oversight, Health Care, Law enforcement, Long Term Care and Nursing Homes, Medicaid, Money in politics, Open Government

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Sentara Does a Very Good Thing

Posted on May 28, 2023 by | 5 comments

Courtesy Sentara

by James C. Sherlock

Sentara brass will not believe that I wrote that headline. We have a history.

But right is right.

A Sentara mobile care unit will start June 1 to provide primary care service two days a week in two separate locations in Petersburg.

The people of Petersburg desperately need it. That city is rated the Commonwealth’s least healthy jurisdiction.

Without good primary care, a health system never has a chance.

The partners in providing the mobile unit are Sentara, Potomac Health Foundation and Sentara Northern Virginia Medical Center Auxiliary.

Congratulations to all of them. Continue reading →

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Posted in Charity and philanthropy, Health Care, Medicaid

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Leapfrog Group Safety Scores for Virginia Hospitals

Posted on May 16, 2023 by | Leave a comment

by James C. Sherlock

The latest Leapfrog Group safety grades are out for 72 of Virginia’s hospitals.

The Leapfrog Hospital surveys are the next-best source to the ratings based on broader data offered by  Medicare Compare. Leapfrog Group data accuracy measures are explained here.

The grades represent cumulative scores of hospital safety, quality, and efficiency measures assessed by an organization founded to improve patient safety.

We’ll examine the just-posted scores for Virginia hospitals. Continue reading →

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Posted in Health Care

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Virginia Lacks Regulations for the Safe, Scientific and Effective Diagnosis and Treatment of Transgender Youth

Posted on May 14, 2023 by | 75 comments

UVa Children’s Hospital Courtesy UVa

by James C. Sherlock

To get this out of the way, I personally support qualified diagnosis and psychological treatment for gender dysphoria in children and adolescents.

I oppose puberty suppression, cross-gender hormonal treatments and transgender surgical procedures in minors.

That said, transgender individuals, like everyone, deserve skilled, safe and standards-based medical care.

Virginia laws and regulations protect people from all sorts of things, but somehow they do not protect transgender persons from bad medical treatment. It seems axiomatic to regulate transgender medical practice to the most up-to-date and widely accepted professional standards.

But that is not the case in Virginia. It is not that the standards are out of date; they apparently do not exist.

I searched the regulations of the Department of Health for the term “transgender” and it came up “no results found.” But VDH protects us from bad shellfish.

The Department of Behavioral Health and Developmental Health has lots of regulations, but a search for the term “dysphoria” comes up empty. Continue reading →

75 Comments

Posted in Children and families, Culture wars, Ethics, General Assembly, Health Care, LGBQT, Parental Rights, Psychology, Virginia Law

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Glen Allen Va’s “Do No Harm” Doing a Great Deal of Good

Posted on May 12, 2023 by | 26 comments

by James C. Sherlock

Do you assume that Virginia’s medical schools are strict meritocracies, taking only the most well prepared and accomplished applicants?

And that their efforts are then focused entirely on creating the most skilled physicians possible?

If so, you are mistaken.

The Medical College Admission Test (MCAT), written by the American Medical Association (AMA), a proudly progressive organization, measures everything they know to measure.

The AMA knows MCAT is by far the best predictor of success in medical school and brags about it. The MCAT itself was redesigned in 2015 to include sections that required test-takers to have an understanding of the social and behavioral sciences.

The current MCAT sections breakdown is as follows:

  • Section 1 – Biological and Biochemical Foundations of Living Systems (BBLS);
  • Section 2 – Chemical and Physical Foundations of Biological Systems (CPBS);
  • Section 3 – Psychological, Social, and Biological Foundations of Behavior (PSBB);
  • Section 4 – Critical Analysis and Reasoning Skills (CARS).

Remember that women and minorities who take the MCAT are not so “disadvantaged” that they do not feel ready to apply to medical school.

The AMA hoped the change would produce more women and “underrepresented” (as opposed to Asian-American) minorities with high MCAT scores.

Fair enough.

Yet the rest of the woke medical leadership refuses to accept the results of AMA’s MCAT because that test still does not yield the “correct” candidates. Continue reading →

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Posted in Culture wars, Democracy and Western Civilization, Demographics, Education (higher ed), Health Care, Individual liberties, Marxism, Not-for-profits, Politics, Race and race relations

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Primary Care for Underserved Virginians

Posted on May 9, 2023 by | Leave a comment

by James C. Sherlock

It is an old story for Virginia: shortages of primary care providers in inner cities and rural areas.

Perhaps the best article I have ever seen on the unique value of primary care and payment reforms to reflect its value was published in 2021 in the Harvard Business Review.

I recommend it wholeheartedly. Especially to Virginia Medicaid.

But if all of the excellent recommendations in that article were adopted, they would not by themselves put primary care physicians where they are needed most.

Solving primary care shortages in Virginia should be a bipartisan issue because it affects Democratic and Republican strongholds roughly equally. But it has never in my experience gotten enough traction in Richmond.

The problem is centered around the fact that government insurance alone does not reimburse primary care physicians or nurse practitioners sufficiently to support a practice.

Whether single practitioner or groups, including hospital-owned groups, they currently need some minimum percentage of privately insured patients to pay the bills.

Otherwise, to serve the poor, they generally have to work for the government, which itself cannot fill the jobs it already has in underserved locations.

What to do?

First, care enough about the problem to address it. Then, think outside the current box. Continue reading →

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Posted in Children and families, General Assembly, Health Care, Poverty & income gap

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Critical Staff Vacancies at Central State Hospital

Posted on April 29, 2023 by | 10 comments

By James C. Sherlock

This space has offered the opinion previously that it is unwise to build a new Central State Hospital (CSH) on the site of the old one.

A follow-up FOIA request to the Virginia Department of Behavioral Health and Developmental Services has yielded current “jobs filled” data to compare to “jobs vacant” data reported earlier to enable us to examine significant personnel shortfalls by percentages.

They make a discouraging point about the current status and the future prospects of CHS in Dinwiddie County.

Continue reading →

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Posted in Efficiency in government, General Assembly, Health Care, Labor & workforce

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School Closures Resulted In Spike In Suicide Attempts Among Kids

Posted on April 27, 2023 by | 13 comments

by Kerry Dougherty

How is it that those of us without fancy degrees from prestigious universities or medical training intuitively KNEW that the Covid-19 lockdowns and school closures would have a profoundly negative effect upon kids?

I watched one of my nieces, who graduated from high school in 2021, spend her junior year at home, isolated from her friends and extended family. A future physician and excellent student, she sat alone, doing class work off of a computer screen. On top of that, her entire social structure was dismantled. There were no sleepovers or parties, no sports, dances or proms. When schools finally reopened she was seated more than 6 feet away from the nearest other student at lunch and if they dared speak to each other, a teacher would scream, “NO talking!”

All for a virus that barely affected kids, as we all knew from the earliest weeks of the pandemic.

I worried about her and her friends. Turns out, she’s OK. Some of her classmates? Not so much.

Last week, UVA Today published a study showing a sharp increase in the number of attempted suicides by children ages 10 to 19 from 2020 on.

The rate of suspected suicide attempts by poisoning among children and adolescents ages 10 to 19 reported to U.S. poison centers increased 30% during 2021 – the COVID-19 pandemic’s first full year – compared with 2019, a new UVA Health study found.

Attempted suicides continue to climb.
Continue reading →

13 Comments

Posted in Blogs and blog administration, Children and families, Education (K-12), Health Care, Individual liberties, Mental illness and substance abuse, Psychology, Schools and Public Recreation, Uncategorized

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No More Deliveries Here

Posted on April 26, 2023 by | 17 comments

Sentara Halifax Regional Hospital, South Boston

by Dick Hall-Sizemore

Pregnant women in Halifax County will soon be faced with an unwelcome dilemma. Sentara Halifax Regional Hospital (SHRH) in South Boston has announced that, beginning in May, it will begin phasing out its labor and delivery services. Those patients expected to deliver before August 4 will continue to be served. Those obstetric patients expected to deliver after August 4 will be “contacted and supported in their transition to other regional obstetrics providers.”

Sentara framed the decision to close the labor and delivery services at SHRH in financial terms. The service is unprofitable. The county’s population is getting older and fewer babies are being born. There has been a 33% decrease in the number of deliveries from 2018 to 2022.

The most likely alternatives that will be available are hospitals in Danville, Lynchburg, South Hill, and North Carolina. Depending on where one lives in Halifax County (it is the fourth largest county by area in the state), getting to a hospital for delivery could entail a drive of 45 minutes to more than an hour. Of course, there could always be a trip to the emergency room at SHRH. Continue reading →

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Posted in Health Care

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Washington State Appears Set to Legalize No Notification of Parents for Youth Gender Transition

Posted on April 20, 2023 by | 53 comments

Washington State Senator Mark Lilas (D), sponsor of Senate Bill 5599 Supporting youth and young adults seeking protected health care services.

by James C. Sherlock

In another flashing sign of the apocalypse, Democrats in the Washington State legislature want the state to become a destination for runaway youth seeking gender transition as minors.

They proudly point to a newly passed law as their party’s response to other states passing laws to prohibit transgender medical services to youth under the age of 18.

Virginia progressives, envious, are temporarily disarmed from changing Virginia law.

There will be work to do when they get back full control in Richmond.

I have every confidence in their capability to catch up.

Washington State is poised to legalize non-notification of parents of “youth seeking protected health services” if the kid runs away from home.  The law creates a new “compelling reason” to not notify parents of the location of a runaway child.

The existing “compelling reason” in Washington law is an allegation of child abuse.

The new law added as a “compelling reason” that the child is seeking gender transition.  If a child has runaway for that reason, no parental knowledge of the child’s intent to transition genders, much less parental abuse, even needs to be alleged.

The bill passed on party line votes.

Instead of notifying parents, the youth shelters and temporary foster homes will notify the state Department of Children, Youth and Families (DCYF).

It gets worse.

Wait until you read about Washington State’s Medicaid “services” to these kids.

Continue reading →

53 Comments

Posted in Children and families, Culture wars, Health Care

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The More Things Remain the Same

Posted on April 10, 2023 by | 10 comments

by Joe Fitzgerald

Stop me if you’ve heard this one. The Hopewell chemical plant where Kepone was born and raised has been cited 66 times over the past eight years for releasing toxic chemicals into the air and into the James River.

The Richmond Times-Dispatch tells the story better than I do. What makes this latest stream of toxins so poignant is the release this week of the book Poison Powder: The Kepone Disaster in Virginia and its Legacy, by University of Akron history professor Gregory Wilson. (From the University of Georgia Press, or from Amazon.)

Wilson’s work is an excellent history that brings alive what so many of us remember from back then. People we knew, including my brother Tom, worked and suffered at the Kepone plant in Hopewell in the mid-1970s. The James River, the cradle of American settlement, was closed to fishing. People who couldn’t spell “ppm” could tell you how many parts per million of Kepone were in their blood.

Tom died last summer, age 67, of what some medical sites call a rare type of kidney tumor that had also attached itself to his stomach and bowel and maybe a couple of organs I’ve forgotten. Kepone? Nobody will ever know for sure. But Wilson’s book makes sure everybody who wants to will know what happened in Hopewell almost 50 years ago.
Continue reading →

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Posted in Business and Economy, Consumer protection, Environment, Ethics, Health Care, Manufacturing, Public safety & health, Science & Technology, Uncategorized, Water-waste water

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