RD464 - Workforce Challenges in Virginia’s Nursing Homes

Executive Summary:

*This report was replaced in its entirety by the Joint  Commission on Health Care on November 12, 2021.


One-fifth of Virginia’s nursing homes are not meeting expected staffing levels, disproportionately impacting low-income residents

All nursing homes in Virginia struggle to recruit and retain staff, and 21 percent of facilities are not providing enough hours of direct care. A shortage of certified nursing assistants (CNAs), who provide a majority of direct patient care, is the biggest challenge for Virginia’s nursing homes. In general, facilities with fewer staff also have a higher concentration of Medicaid recipients and Black residents.

Low staffing increases the risk of low-quality care

More than 60 percent of facilities with low staffing receive poor health inspection ratings, which include criteria such as medication management and resident quality of life. When staffing falls below a minimum threshold, it becomes increasingly difficult for staff to manage the workload and provide quality care, leading to burnout that exacerbates these challenges. Increasing the number of hours of direct care per resident is shown to improve clinical outcomes and resident satisfaction.

Shrinking workforce is a contributing factor to staffing challenges

There are a decreasing number of (LPNs) and CNAs in Virginia. Recruitment can be difficult as nursing home jobs are considered less desirable, compared to other health care settings. Retention is dependent on wages, benefits, training and advancement opportunities, workplace culture, and leadership. The COVID-19 pandemic significantly exacerbated existing workforce challenges.

Residents’ behavioral health needs are not adequately accounted for in reimbursement rates

An increasing number of nursing home residents have behavioral health needs that require additional time and attention from staff. Providing quality care to these residents requires increased staff time, but current Medicaid reimbursement rates do not fully compensate for these needs.