Eight policy solutions to improve Virginia’s nursing homes


Nicole Pasia


In an effort to address staffing shortages and improve quality of care at Virginia’s nursing homes, legislators deliberated over eight potential policy solutions presented at the Joint Commission on Health Care (JCHC) meeting this week. These included increasing reimbursement rates for nursing home staff, establishing acuity-based work hour requirements, and quality evaluations.


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As one of the JCHC’s 2021 study topics, staff conducted research and spoke with community stakeholders to identify the top problems nursing homes face, as well as solutions they would like the legislature to implement. 

JCHC staff 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 population ages. Currently about 200,000 Virginians require some form of LTSS, either in community or long-term care settings. About 22% of the state population in 2019 was over 60, and by 2030 will increase to 24%, or an additional 300,000 people, according to staff.

Kyu Kang, a JCHC associate health policy analyst, presented four main challenges facing most nursing homes, which coordinate with the proposed policy solutions: 

  • Virginia nursing homes struggle with retaining staff
  • Low staffing leads to more low-quality care
  • The general health care workforce shortage contributes to inadequate staffing
  • Other strategies to incentivize quality care and staffing

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

  1. Direct Virginia Medicaid (DMAS) to increase reimbursement rates for nursing homes, specifically those with more Medicaid residents
  2. Require a baseline number of hours of direct patient care in a day: 3.25 hours per resident, including an RN providing 0.4 hours per resident
  3. Require nursing homes to provide acuity-based hours of direct patient care
  4. Direct DMAS to develop a nursing home provider assessment 
  5. Funding for the Long-Term Facility Nursing Scholarship for CNAs, LPNs, and RNs 
  6. Direct DMAS to establish a quality improvement program on building nursing home capacity
  7. Provide DMAS with funds to conduct an evaluation of its Value-based Purchasing Program for nursing home staff
  8. Direct DMAS to enhance reimbursement when caring for residents with behavioral health diagnoses

Commission members commended the policy solutions from JCHC staff, including Sen. Jen Kiggans (R – Virginia Beach), who previously worked as a nurse practitioner at a long-term care setting in Virginia Beach. Kiggans said the question of increasing nurses in long-term care settings has been an ongoing conversation: 

“While we’re addressing the pay, culture, and the leadership, how do we incentivize nurses to go into geriatrics? Last summer’s discussion was about involving high school students, or our veterans, [and] other health professions … I don’t believe there’s enough exposure [to nursing homes] in those people that truly find a passion. With that type of location, I think, some type of exposure to it 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 commended the Commission’s efforts to address staff shortages. Keith Hare, VHCA-VCAL president and CEO, said: 

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

Meaningful investments in the Medicaid program can help address key staffing challenges and ensure 24/7 access to care for many seniors. 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 Oct. 21 to [email protected]. There is also an opportunity to provide public comment at the JCHC nursing facilities workgroup meeting on Oct. 22 at 10 a.m. EST.