How Virginia lawmakers are pushing for changes to the state’s nursing home system

State lacks an elder abuse registry and has no minimum requirement for staffing at nursing homes

Twelve thousand adults are hurt or neglected each year in the state of Virginia and most of them are elderly; however, if you want to know where these incidents are happening, you’re out of luck.

ROANOKE, Va. – Twelve thousand adults are hurt or neglected each year in the state of Virginia and most of them are elderly; however, if you want to know where these incidents are happening, you’re out of luck.

Our 10 News investigation continues as we take concerns to leaders and lawmakers in Virginia to find out what changes need to be made to protect your loved ones.

We asked lawmakers if they think the system we have in Virginia right now is broken.

“Rather than saying it’s broken, I think probably it’s been outgrown and we probably need to do some renovation to it, if not a whole overhaul,” said Del. Chris Head, a Republican who represents the 17th District made up of parts of Botetourt and Roanoke counties, as well as the city of Roanoke.

“It is clear that the system is under a lot of stress and that the COVID pandemic really exacerbated that. It’s clear where the holes are for sure,” said Del. Sam Rasoul, a Democrat who represents the 11th District, which covers part of Roanoke City. “For me we have a lot more work to do.”

The two men agree on one thing, a need for change in Virginia’s nursing home system. And they’re not the only ones.

[Roanoke nursing home being investigated for possible neglect after two police reports were filed, resident had two toes amputated]

“As a field, we’re so far back and we really need to move forward,” said Eden Ruiz-Lopez, the deputy director for the National Center on Elder Abuse.

At least one in 10 older adults in a community setting experienced some form of abuse in the prior year, according to the Center.

“With the growing aging population, we’re concerned that the problem is only going to get worse before it gets better,” said Ruiz-Lopez.

She said knowledge about elder abuse lags about two decades behind child abuse and domestic violence.

That means policies and laws are behind too, according to Lori Smetanka, the Executive Director for National Consumer Voice for Quality Long-term Care.

“There have been a lot of systemic problems in the long-term care industry, in the nursing home industry,” said Smetanka.

That’s led 10 News to bring these issues to lawmakers.

“Seniors are so vulnerable. They really, truly are. The senior adult population still comes from an era that is much more trusting,” said Head who adds he introduced legislation in the General Assembly last year to start an elder abuse registry.

“If someone is being negligent then they need to be held accountable,” said Head. “You have a child abuse registry. You also have a sexual offender registry. The framework should already be there. We need to have an adult abuse registry.”

But Head said his bills failed because of money. The fiscal impact statement cited the costs at more than a million dollars--- including website updates and more staff to handle appeals.

“We need to figure this out now and fund our priorities,” said Rasoul, who has a background in geriatric health care and said more needs to be done. “I think that’s a pretty easy way to have some kind of approach where people understand where this abuse is happening and to ensure that we are helping to protect some of our older Virginians.”

[‘She was in deplorable condition’: Allegations of neglect in a Roanoke nursing home]

But experts said the registry is only one piece of what needs to change ---

“We need to hold the administration accountable, the owners accountable,” said Smetanka. “We need to think about it more big picture. What’s been going on in that facility that led to that neglect? Because you can’t just pin it on the staff. There are administrative and systemic issues like if the staff don’t have the resources and supports they need.”

Smetanka said there’s not a staffing minimum at the federal level that people are held to through Medicare and Medicaid.

“That’s the problem. There’s not a federal minimum. The requirement in nursing homes is just for sufficient staff. That’s a very loose term and it’s hard to define it,” said Smetanka. “If you are a staff person who is in charge of 20 or 25 residents that need to be fed, that need to be bathed, that need to be dressed, that need to be gotten out of bed or turned or changed throughout the day there’s no humanly way possible that they are going to be able to provide all of those services.”

It’s not just the federal level. 10 News has learned Virginia has no minimum requirement for staffing either--- only to meet the assessed needs of all residents.

Smetanka said compare that to Vermont, where there are specific guidelines for staffing--- at three hours per resident day and Arkansas, wihc has staffing ratios for days, evenings and nights.

Smetanka said without more specific requirements, it leaves a lot of room for interpretation.

[What you can do to protect your loved ones living in nursing homes]

“What we know in this industry also is that if it’s not required, they’re not going to do it,” said Smetanka.

“Look, we fund our priorities, to me this is a priority and in Virginia having worked in nursing homes, seeing what happens when we do not have proper staffing, I think we need to make it a priority moving forward,” said Rasoul.

Smetanka said the recommended guideline is a minimum of 4.1 hprd (hours per resident day) staffing standard across the licensed nurses and CNAs, with most of that time being CNAs.

“We’re moving along at such a breakneck speed with the growth of the senior population that we should have gotten in front of this long ago,” said Head.

“As a society we should not accept it and we should do better and we can, we can do better,” said Smetanka.

Virginia is in the middle of a study commissioned by the General Assembly, looking at current laws and what needs to change to help prevent and remedy abuse, neglect, and exploitation of the elderly.

We’re tracking that closely --- and will bring you the results.

[Vital information missing on government websites to research nursing homes]

To see the steps you can take if you have concerns about a loved one, including how to find your local ombudsman’s office click here.

If you want to take a look at reports concerning this facility or any other you can look up reports on the VDH website here.

This is part of an in-depth 10 News investigation. Jenna Zibton is working for you, investigating different angles of what COVID-19 means for families with loved ones in nursing homes. Contact Jenna if you have questions at or on Facebook.

About the Author:

You can see Jenna weekday mornings at the anchor desk on WSLS 10 Today from 5-7 a.m. She also leads our monthly Solutionaries Series, where we highlight the creative thinkers and doers working to make the world a better place.