Twenty Years—and Still No Staffing Standards

Watch the video of the legislative update with Del. Vivian Watts

In Virginia there are no minimum hourly staffing standards for nursing homes.  This fact still shocks many whose loved ones are in such facilities.  No staffing ratio standards?  How can that be? Is there any wonder a nursing home resident may have to wait for hours to have bed linens changed due to insufficient staffing?  Is there any wonder why a patient who cannot reach her breakfast tray may lose the opportunity to eat before it is picked up because there is no one to respond to her call to move the tray closer? The stories that are told are horrifying.  So why isn’t something being done?

For 20 years Delegate Vivian Watts, representing the northern Virginia 39^th House of Delegates district in the Virginia General Assembly, has been beating the drums for nursing home reform, trying to raise awareness of the insufficiency of staffing in facilities.  For 20 years Watts has supported legislation to right the wrong, often the bill’s patron. For 20 years the General Assembly has refused to act.  Two years ago, Watts warned in a legislative forum that “time may be running out for nursing home reforms.”

Then the COVID-19 pandemic hit and where did it hit the hardest?  Nursing homes. A surprise?  Certainly not.  COVID-19 merely amplified an already serious issue—substandard care due to insufficient staffing. So, with the amplification of the problem, many thought change would certainly come.  It still has not.  The General Assembly in its 2022 session once again delayed action.

In a legislative update and conversation with Watts held virtually on April 20, 2022, Natalie Snider, AARP Virginia State Advocacy Director, reported that AARP Virginia in collaboration with the Virginia Poverty Law Center and the State Long-Term Care Ombudsman Program, has assembled a coalition of various stakeholder groups to support nursing home reforms.

“So far, we have worked with Delegate Watts, Delegate (Betsy) Carr, Senator (George) Barker and Senator (Jenn) Kiggans, and the Joint Commission on Healthcare, to find some path toward reform,” said Snider. “But that fight is ongoing.”

Why, after all the deaths in nursing homes during the pandemic—in Virginia the number of deaths was 30% higher than the average in other states—was now not the time for action? 

“Competing interests,” Watts said.  It all boils down to where to put the available money.  She cited the example of public education, a very worthwhile issue to fund.  It impacts people for a lifetime, first as a student, then the parents of students, and so on. 

Experiences with nursing homes involve a much smaller slice of our lives, Watts said.  With the emphasis on aging in place, for many, nursing homes are a last resort of care and so people who need this last resort will only be there for a finite amount of time, perhaps only a few months.  Once the experience with the nursing home is over, though it may have been regarded as providing poor care, people are less inclined to continue the fight for reform because their lives or the lives of their loved ones are no longer impacted by the poor care provided.

Advocates who work on behalf of the long-term care facilities have long blamed the pipeline - the of source of employees - for poor staffing.  Advocates for nursing home residents say lack of transparency about nursing home profits, particularly those facilities owned by for-profit corporations, prevents clear public understanding of where the money goes.  It is clear however that staff of nursing homes are critically underpaid, advocates say. This is reflected in statistics that show many employees may work at two or three different facilities in order to earn a living wage. 

Watts expressed her gratitude to AARP Virginia and the coalition for its support of staffing standards. 

“The nursing home industry [is] fighting really hard to keep these standards at bay,” Snider said. She noted that the House of Delegates Health, Welfare, and Institutions Committee, chaired by Delegate Bobby Orrock, has promised to bring stakeholders together over the next several months to find a solution to nursing home staffing shortages.  The first of these promised meetings was scheduled for April 27. Watts was there making her passionate plea for change.

Stay tuned.

Watch the video of the legislative update with Del. Vivian Watts