Time May Be Running Out For Nursing Home Reforms, Del. Watts Warns

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     If Virginia does not enact minimum staffing standards for nursing homes during the next year, the chances for such reforms are likely to slip away for the foreseeable future, Del. Vivian Watts warned Tuesday.
     Speaking on a video conference call with AARP Virginia advocacy staff, volunteers and some constituents, Watts (D-Annandale) said she was “shocked” that the General Assembly didn’t pass a nursing home staffing bill during the most recent session given the fact that nearly 4,000 state residents had died in long-term care facilities as a result of the COVID-19 pandemic.
    “If we don’t do it in the next year, that spotlight will move away,” she said. “It’s just essential that we put this in place now, as other states have.”
     Watts said the death rate in Virginia nursing homes is about 30 percent higher than in most other states and can be attributed, in part, to inadequate staffing levels.
     Bipartisan efforts to enact minimum staffing ratios for nursing homes died when bills by Watts and Sen. Jennifer Kiggans, a Republican from Virginia Beach, were scuttled in both houses earlier this year.  Instead, the General Assembly instructed the Joint Commission on Health Care to study staffing standards in nursing homes and report by Dec. 1.
     Watts said she has met with staffers on the commission and was encouraged by their commitment to prioritizing the issue.
    “It will be a very serious study,” said Watts, who also indicated she plans to continue being involved in the commission’s activities as it moves forward with making recommendations.
    If reelected this fall, Watts said she plans to introduce a nursing home staffing standards bill, probably in December, for consideration by the General Assembly next year. Watts has introduced similar legislation every session since 2002, but the alarming death rates at long-term care facilities this year has heightened public awareness of the issue.
     Federal studies have shown that nursing home residents need at least 4.1 hours of direct care – such as help in bathing, dressing, toileting and eating—within a 24 hour period. Virginia does not set any staffing ratio standards for long-term care facilities.
    “I regard that as a basic minimum, I don’t regard it as a gold standard,” Watts said.
     The nursing home industry in Virginia has recognized the need for more staff in long-term care facilities, but has blamed the shortage on a lack of trained personnel and low wages. It has opposed bills that would set specific staffing ratios.
      The cost of boosting staffing ratios in nursing homes has been the primary impediment to providing better care. Watts noted that over the past decade, Virginia has ranked around 48^th among the states in Medicaid spending on nursing home residents.  Approximately 20,000 of the state’s roughly 32,000 long-term care residents are on Medicaid.
    Phasing in higher staffing standards over six years would cost the state about $40 million in Medicaid funding, which would be matched by the federal government.
     To pay for that, Watts, who chairs the House Finance Committee, has proposed a new estate tax that would be limited to those individuals with estates of over $12 million, or couples with estates of over $25 million.  Business and farm assets would be excluded from the estates.
      Watts said the tax would fall on about 20 state residents a year, but would provide improved care to about 20,000 nursing home residents.
      Watts said she has already had to counter claims that the proposal is a “death tax” that would impact a large swath of the population
    Earlier this year, the General Assembly approved a $49 million boost in funding for nursing homes. Watts said she supported that increase, but would not support further increases unless they are tied to staffing standards for long-term care facilities.
    Watts urged advocacy organizations such as AARP Virginia to get involved in efforts to enact staffing standards in long-term care facilities. She also noted that women’s organizations should become more involved in the efforts because women far outnumber men in nursing homes.