by James C. Sherlock

Effective May 1 of this year, Karen Shelton M.D. became Virginia’s Health Commissioner. Dr. Shelton is now the licensor and regulator of Virginia’s nursing homes.

By law, state-licensed nursing homes must comply with federal and state laws and standards. By regulation, the Health Commissioner “may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care.”

It is time.

I hope that she will pose a challenge to her Office of Licensure and Certification (OLC), of which I am a public admirer, that goes something like this.

Too many Virginia nursing homes are measured objectively by CMS (the Centers for Medicare/Medicaid Services) to be dangerous to the health and welfare of their patients through a combination of:

• inspections that we ourselves conduct;
• staffing measures linked to payroll data; and
• medical quality measures from federal records.

Many have been that way for a very long time.

Current staffing far below CMS requirements seems to indicate that too many have no apparent path to improvement.

Come and see me in a couple of weeks with a list of the absolute worst of them.

And tell me why I should not shut them down to let the rest know that there are minimum standards beneath which they will not be permitted to operate in Virginia.

And one more thing.

Please let me know if there are organizations or individuals, current or recent, whose facilities have appeared regularly enough with the lowest staffing rating to indicate that understaffing may constitute a business model rather than a local exigency.

That too will not be tolerated.

We will take on those challenges here as if they are our own.

This article will identify the absolute worst of the facilities, using government records. The next will look at understaffing trends among owners.

Authorities of the Commissioner. See Virginia Administrative Code Title 12. Health » Agency 5. Department of Health » Chapter 371. Regulations for the Licensure of Nursing Facilities » Part I. » 12VAC5-371-90. Administrative sanctions.

A. Nothing in this part shall prohibit the department from exercising its responsibility and authority to enforce the regulation, including proceeding directly to imposition of administrative sanctions, when the quality of care or the quality of life has been severely compromised.

B. The commissioner may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care. Such sanctions include:

1. Restricting or prohibiting new admissions to any nursing facility;

2. Petitioning the court to impose a civil penalty or to appoint a receiver, or both; or

3. Revoking or suspending the license of a nursing facility.

C. The following reasons may be considered by the department for the imposition of administrative sanctions or the imposition of civil penalties:

1. Failure to demonstrate or maintain compliance with applicable standards or for violations of the provisions of the Code of Virginia;

The worst.

OLC’s list might vary from the one that I have assembled from CMS data because they may have information not yet published. But I offer below for further assessment each nursing home with the lowest possible current CMS rating in all of the four major rating categories.

They literally can’t have performed worse — across the board.

That list, downloaded June 18th, includes the following facilities with long-term ownership:

• Elizabeth Adam Crump Health And Rehab in Glen Allen — ownership since Dec. 2016: GL Virginia Holdings LLC (Atlanta)
• Woodmont Center in Fredericksburg — current ownership since May 2011 Genesis Va Holdings LLC, a Pa. Company. Parent is Genesis Healthcare Inc. stock symbol GENN) — Stock price went from $2.29 on June 1, 2018, to $0.0018 today.

It also includes the following facilities acquired since COVID, but long enough ago that the current owners own the ratings.

• Blue Ridge Rehabilitation and Nursing in Harrisonburg — ownership since Jan. 2022: Meyer Weisz
• Emporia Rehabilitation And Healthcare Center –– current ownership since Mar. 2022: Tzvi Alter
• Lynchburg Health & Rehabilitation Center — current ownership since May 2021: Lynchburg Holdings I LLC
• Rural Retreat Care Center — current ownership since September 2021: Ryan Ostrow 50% and Ruta Concetto 50%

Finally, take Canterbury Rehabilitation & Health Care Center in Richmond. Current ownership since December 2019. Readers may remember Canterbury as the epicenter of the COVID epidemic in Virginia — 51 deaths by May 7, 2020.

They will be disappointed to find that three years later Canterbury is still a terrible nursing home under the same ownership, Genesis Healthcare, since 2011. It has earned current one-star ratings overall, in inspections and in staffing.

Staffing. We must consider the distinct possibility that “much below average” staffing in those facilities is due to the fact that virtually no nurse who does not already work there wants to do so. It would be understandable.

If so, the chances of improving that metric are slim.

National comparisons. CMS compiles data on everything.

One such statistic is health deficiencies per inspection cycle. In CMS records from May 2023, deficiencies in the last three inspection cycles were:

• national: 8.5 per inspection.
• In Virginia: 11.5.

But somehow Virginia also trails national averages in number and amount of fines — by a lot.

• Average number of fines per nursing facility over the past three-year period: national 2.4; Virginia 1.7.
• Average fine amounts in same period: national $35,933; Virginia $20,332.

Virginia Consumer Protection Act.

The commonwealth has defined fraudulent acts or practices committed by a supplier in connection with a consumer transaction in Code of Virginia § 59.1-200.

A glance at the websites of the worst nursing homes at least raises questions about misrepresentations.

The Attorney General is empowered to investigate. He or any Commonwealth’s Attorney can sue to compel compliance.

Medicaid Fraud. Two dedicated units of the Attorney General’s Medicaid Fraud Control Unit (MFCU) investigate allegations of abuse or neglect of elderly and incapacitated adults receiving Medicaid benefits in the Commonwealth.

Individual citations for abuse and long-term patterns of neglect should prove of interest.

Nursing Home Administrators. A license is required to practice as a Nursing Home Administrator in the state of Virginia. Virginia has a Board of Long Term Care Administrators that grants administrator licenses and hears complaints about licensees that can result in termination of a license.

Bottom line. Virginia has 289 nursing homes rated by CMS and inspected by the Virginia Department of Health.

• Six have records that literally cannot be worse. Their very vulnerable patients by multiple government measurements have been subject to neglect, poor medical treatment and sometimes physical abuse over long periods of time.
• The seventh had 51 of its patients die in the early days of COVID without measurably improving its performance three years later.

How, under any serious regulatory regime, are these seven facilities still open?

The excuse that the patients will have to be moved does not wash. The patients can be moved. Indeed they must be moved for their safety and health.

The above list was developed from published data, but OLC has more information than I ever will. The owners and managers of facilities on any OLC list of the worst facilities must be sanctioned within the limits of the law.

Next, I will report here on the owners and managers whose facilities have one-star staffing ratings. Perhaps we can find some managers or owners linked to more than situational understaffing and try to imagine why.

If so, we’ll offer that information for the consideration of the public, the Commissioner, the Board of Long term Care Administrators and the Attorney General’s investigators.