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Profound Registered Nurse Shortages in a Virginia Beach Nursing Home

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By James C. Sherlock

Registered nurses (RNs) both supervise medical treatment and are the primary medical care providers in nursing homes.

Physicians are on call but generally are not present.

One Virginia nursing home is currently advertising:

RN’s Now hiring All Shifts! Pick your shift.

Perhaps not good news for those patients.

Some of the worst nursing homes are just bad places to work.  Others don’t pay their nurses enough.

Some both.

I will describe with Centers for Medicare & Medicaid Services (CMS) information a Virginia Beach nursing home that:

  • is grossly understaffed; and
  • has been cited in its most recent inspection both for abuse of patients and for failure to provide appropriate treatment and care.

Yet it is open and soliciting new residents.

Virginia nursing homes and RNs.  The last Bureau of Labor Statistics report offers results from May of 2022.

Virginia at that point had 69,510 working RN’s, paid an average hourly mean wage of $39.36 and an annual mean wage of $81,860, calculated for 2080 hours.

It is perhaps illustrative of the extent of the national problem with nursing home staffing that staffing is a characteristic rated by CMS for nursing homes but not for hospitals.

Despite that, some Virginia facilities are currently offering RN jobs at well below comparable RN wages last year.

  • One RN job at Heritage Hall in Front Royal is being solicited for $58.9k – $74.6k per year*. That nursing home is currently rated by CMS at one star for staffing. That converts to an hourly wage range of $28.32 to $35.87.
  • The same RN job at the Leesburg Heritage Hall, rated two stars for staffing, is offered for the same $28.32 to $35.87 hourly range.
  • Glenburnie Rehabilitation and Nursing Center in Richmond is offering two RN jobs at $62k – $78.6k per year which converts to $29.81 to$37.79 per hour.  Glenburnie has a one-star CMS rating for staffing.

All job offerings and salary ranges in this story are quoted from Indeed.com yesterday unless otherwise noted.  Maybe they will fill those jobs, maybe not. But doing so does not appear to be a strategic priority.

RN turnover in nursing homes is very high, averaging 56% annually in Virginia and 54% nationally over the past twelve months.  That is also a statistic published only for nursing homes.

For that reason there appears to be an industry-wide nursing home sign-on bonus in Virginia of $5,000 – $7,500, paid out in two increments at 90 days and 6 months of employment.

But hospital sign-on bonuses for RNs here range from $7,500 to $10,000 and above.

A Virginia Beach example. A charge nurse is an RN who is in charge of a ward in a healthcare facility during his or her shift.   They will generally need a minimum of 3-5 years of experience in a clinical setting before they can get hired as a charge nurse.

A charge nurse job at UVa Health System is offered at $39.39 – $64.98 an hour.

Saber Healthcare Group advertises for an RN charge nurse who can “earn up to $40 per hour” at its Colonial Health & Rehab Center LLC (Colonial) in Virginia Beach.

Let’s see how RN staffing has been going at Colonial over the past three months, as reported by CMS:

  • RN hours per resident per day in CMS data represents each facility’s daily average over the last reported three-month quarter as verified with its payroll system.
  • Registered nurse staffing at Colonial over the last quarter was, on weekdays, 13 minutes per resident per day.  Nationally the average figure was 39 minutes.  Both figures are adjusted for patient load and individual patient nursing requirements.
  • But even 13 minutes was far better than on weekends, when the average RN hours per resident per day at Colonial was three minutes per resident per day vs. a national average of 36 minutes.  You read that right.
  • CMS notes that Colonial submitted data that did not meet the criteria required to calculate RN turnover.  We can only imagine.

Inspections and federal sanctions.

The same job advertisement linked above offers as a benefit of Colonial:

Culture of employees creating an IMPACT!

So let’s look at impacts.

Federal fines in the last three years: 4

    • $74,419  07/08/2021
    • $2,293. 01/11/2021
    • $9,750. 12/11/2020
    • $9,750. 09/25/2020

Payment denials by Medicare in the last 3 years: one on 07/08/2021.

Most recent health inspection 07/08/2021. Total number of health citations in that inspection: 17.  Average number health citations in U.S. nursing homes 8.8.

Last complaint inspection, 06/23/2022, resulted in two citations: one for abuse and one for failure to provide appropriate treatment and care.  The level of harm for each was actual.  We note no federal fines after that inspection.

Bottom Line. Colonial Health & Rehab Center is still open and soliciting new patients.

It’s just a few miles from me.  I can even pre-register.

I’ll tell my friends.

 

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4 responses to “Profound Registered Nurse Shortages in a Virginia Beach Nursing Home”

  1. James A. Bacon Avatar
    James A. Bacon

    My family had a recent experience with a rehabilitative nursing home facility in North Carolina where a relative convalesced for three or four months. That facility was short-staffed and unresponsive to our relative’s medical situation. We got her out of there as soon as we could. As dissatisfied as we were, we recognize that labor shortages are endemic in the industry.

    It strikes me that some facilities might be able to pay better than others because their revenue base is different. There are three major gradations: private pay, Medicare, and Medicaid, with Medicaid paying the least. If a particular nursing home serves a primarily Medicaid population, it generates less revenue per patient and, therefore, cannot afford to pay as much. I would like to know about the patient mix of the one-star facilities that you’ve highlighted. Do their populations tend to be on Medicaid? If so, that may say a lot. Perhaps the problem resides with Medicaid reimbursement rates rather than the facility management. Patient mix is a big factor in hospital economics; it likely is the same with nursing homes.

    1. James C. Sherlock Avatar
      James C. Sherlock

      There are 31 nursing homes within 25 miles of my house in Virginia Beach. Most are understaffed.

      The registered nurse turnover in nursing homes tends to be high in this area, partly because of aggressive hiring here by Sentara and Chesapeake Regional Medical Center. But every other nursing home in this area deals with it much better than Colonial.

      The question you asked is whether understaffing is driven by underpayments. I will answer by contrasting three local nursing homes.

      Medicare primarily among the government payers and private insurances pay for skilled nursing, which requires hands-on nursing by RNs for people coming out of the hospital for in-bed recuperation and physical therapy. Those payments can last for up to 100 days. The payments are profitable, sometimes very profitable, for any well-run skilled nursing facility.

      Medicaid is the primary payer for longer term for people who need nursing but not of that intensity. LPNs provide the primary nursing services under the supervision of RNs. Those tend to be break-even transactions.

      Colonial takes Medicare and Medicaid.

      There is another nursing home that is also a few miles away, Seaside the Health Center at Atlantic Shores. It accepts Medicare but not Medicaid.

      Otherwise, it is exactly the same business type as Colonial. It is a for-profit LLC. It is not part of a continuing care community.

      It is awarded 4-stars across the board by CMS: overall, health inspections, staffing and quality measures.

      RN staffing at Seaside in the past quarter has been 52 minutes per resident per day on weekdays, 33% higher than the national average and 21 minutes per day on weekends, just below the national average.

      But telling a different story, Saber’s Kempsville Health & Rehab Center, also in Virginia Beach, has a four-star staffing rating, though its RN staffing during the week did not approach that of Seaside.

      One feature of Saber’s Kempsville facility is that it has low nursing turnover, which speaks to the quality of its management and drives 4-star staffing.

      But unfortunately its inspections have not been nearly as good as Seaside’s, which speaks to the quality of the nursing. It rates 2-stars overall and 2-stars for inspections.

      So the lesson is, if you need post-surgical nursing and rehab down here, go to a facility that does not offer long-term nursing care.

      So Medicaid is one of the culprits, but not the only one. Management counts.

  2. Thomas Dixon Avatar
    Thomas Dixon

    These expositions are much needed and eye opening to a lot of people. I would like to add that we must not put all of our dependence on CMS, JACHO, or any other government funded entity to be the fair and ethical judges of our caretaking institutions.
    As one who has experienced them firsthand, I know that they, themselves are a bloviated bureaucracy down to the minutia of (for one of many examples) advising staff not to use the word “encourage” when writing notes on patients. Because that after all would take away their free will.

  3. walter smith Avatar
    walter smith

    Medicare/Medicaid is a huge wrench in pricing.
    As is employer insurance which mostly makes the consumer not pay attention to the cost.
    Insurance company billing codes and procedural control – more market disturbance.
    The poor population…always a problem…maybe those charitably oriented organization we should have kept.
    And let’s not forget part of the problem – shhh…Covid “vax” mandate. Even prior though, there was a movement to require vaxing for all employees. Supposedly, this would improve patient outcomes. UVA, prior to July 1, 2019, hired non-vaxed employees (they had to get a religious or medical exemption for legally required shots and could refuse non-legally required shots). I think the real reason for the change was to allow an easier way to get rid of pesky Christians and get more employees willing to do what they are told. Anyway, the Covid vax did drive many people out to the extent they were not fired. UVA will say it only denied a handful of religious exemption requests which is…true and not true. The denied some and effectively denied many more by asking for more info…at the school founded by the author of the Va Religious Liberty Statute. A DISGRACE!

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