Eight Policy Solutions to Improve Virginia Nursing Homes – State of Reform


In an effort to address staff shortages and improve the quality of care in nursing homes in Virginia, lawmakers deliberated on eight potential policy solutions presented to the Joint Commission on Health Care (JCHC) Meet this week. These included increasing reimbursement rates for nursing home staff, establishing acuity-based working hour requirements, and quality reviews.

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As one of JCHC’s 2021 study subjects, staff conducted research and interviewed community stakeholders to identify the key issues nursing homes face, as well as solutions that they would like the legislature to implement.

JCHC staff have found that the number of Virginians in need of Long-Term Services and Support (LTSS) is expected to increase over the next decade as the state’s population ages. Currently, approximately 200,000 Virginians require some form of LTSS, whether in community settings or in long-term care. About 22 percent of the state’s population in 2019 was over 60, and by 2030 it will grow to 24 percent, or 300,000 more, according to staff.

Kyu Kang, Associate Health Policy Analyst at JCHC, outlined four main challenges facing most nursing homes, which coordinate with the proposed policy solutions:

  • Virginia nursing homes struggle to retain staff
  • Lack of staff leads to substandard care
  • The general shortage of manpower in the health sector contributes to the understaffing
  • Other strategies to encourage quality of care and staff

An overview of the study’s policy solutions is presented below:

  1. Leading Virginia Medicaid (DMAS) to increase reimbursement rates for nursing homes, especially those with more Medicaid residents
  2. Require a base number of hours of direct patient care per day: 3.25 hours per resident, including an RN providing 0.4 hours per resident
  3. Require honest nurses to provide hours of direct patient care based on acuity
  4. Lead DMAS to develop nursing home provider assessment
  5. Long Term Institution Nursing Scholarship Funding for CNA, LPN and RN
  6. Request DMAS to establish a quality improvement program on nursing home capacity building
  7. Provide funding to DMAS to conduct an evaluation of its value-based procurement program for nursing home staff
  8. Direct DMAS to improve reimbursement in the care of residents with behavioral health diagnoses

Commission members welcomed the political solutions of JCHC staff, including Senator Jen Kiggans (R – Virginia Beach), who previously worked as a nurse practitioner at a long-term care facility in Virginia Beach. Kiggans said the issue of increasing the number of nurses in long-term care facilities was the subject of an ongoing conversation:

“As we look at compensation, culture and leadership, how do we get nurses to get into geriatrics? Last summer’s discussion was about involving high school students, or our veterans, [and] other health professions… I don’t think there is enough exposure [to nursing homes] in those people who really find a passion. With this type of location, I think some type of exposure is something to consider and probably an area for improvement.

The Virginia Health Care Association – Virginia Center for Assisted Living (VHCA-VCAL), which represents nearly 350 nursing homes and long-term care facilities in the Commonwealth, also praised the Commission’s efforts to address health shortages. staff. Keith Hare, President and CEO of VHCA-VCAL, said:

“We appreciate that the Joint Commission on Health Care recognizes the need for a multidimensional approach to the complex issue of staffing and quality of nursing homes. This report represents the continuation of an important conversation about how we provide high quality care to the elderly in Virginia who depend on care at the nursing home level …

Significant investments in the Medicaid program can help address key staffing issues and ensure 24/7 access to care for many older people. It is essential for Virginia to better fund nursing level care covered by the Medicaid program. ”

Members of the public who wish to make a public comment on the proposed policy solutions can submit written comments by October 21 at [email protected]. Public comments can also be provided at the JCHC Nursing Facilities Working Group meeting on October 22 at 10 a.m. EST.


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