Three weeks ago, Autumn Care of Mechanicsville raised wages at the Hanover County nursing home to make it easier to hire nurses and certified nursing assistants in an industry that can’t recruit enough of them.
The nursing home says it will meet the new minimum staffing requirement that Virginia will put in place on July 1 to boost the quality of long-term care after the COVID-19 pandemic, which hit nursing homes and assistant living facilities hardest. The new staffing standards are lower than pending federal requirements, but nursing homes say they face a stiff challenge to find enough qualified employees to fill current job vacancies.
“It you don’t have the nursing staff, you can’t achieve quality care,” said Karen Stanfield, a former nurse who has served as vice president of operations at Saber Healthcare for more than 16 years, including the pandemic.
The Ohio-based company owns 33 nursing homes in Virginia, including Autumn Care and Tyler’s Retreat at Iron Bridge in Chester.
“We’re not exactly short-staffed, but we’re not staffed at what I want to be staffed at to make sure care is consistent,” Stanfield said.
Finding the money to hire and keep those employees would be harder under Gov. Glenn Youngkin’s budget amendment that would cut proposed state funding by $10 million for nursing home staff. The cut also would remove $11.6 million in matching funds from the federal government under the Medicaid program for elderly, disabled and impoverished Virginians.
The combined cut would be doubled again because the new reimbursement rate would remain in place for two years, until the state revises all of its provider reimbursement rates under Medicaid. The total cost would be $43.3 million.
“It addresses money which goes directly toward that direct care,” Stanfield said. “It goes only to hire nursing staff.”
Broader effort
Youngkin proposed the cut as part of a broader effort to identify $300 million in savings to deposit in the state’s revenue reserve fund as a hedge against potential revenue losses because of cuts President Donald Trump and ally Elon Musk are making in the federal workforce and spending that are crucial to Virginia’s economy. The Republican governor supports Trump’s cost-cutting initiative, but said he is preparing for potential revenue losses that members of the General Assembly fear.
“Everyone around the table will need to take a little less than what they want, but still, there is a substantial increase in so many areas,” the governor said when he announced 205 amendments and eight line-item vetoes to the budget that the General Assembly adopted on Feb. 22.
That does not reassure Virginia’s nursing home owners.
Amy Hewett, a spokesperson for the Virginia Health Care Association, said, “We’re very concerned about the budget amendment and working to get it overturned.”
“This isn’t overall (provider) rates,” Hewett said. “It’s direct care staff.”
Del. Mark Sickles, D-Fairfax, a member of the House Appropriations Committee and chair of the House health care committee, said the proposed cut in nursing home rates is not likely to survive when the assembly reconvenes on Wednesday to consider the governor’s proposed vetoes and amendments to legislation, including the budget bill.
It takes a simple majority to vote down a budget amendment — unlike the two-thirds vote it takes to override a governor’s veto of legislation.
Sickles is dismayed by the cuts that Youngkin proposed to assembly spending on Medicaid and other human services. Those cuts including reducing by half $8.7 million the legislature included for community services boards to coordinate support services for intellectually disabled people on the state’s priority waiting list, one of the governor’s own initiatives.
Youngkin cuts proposed new school funding to boost state’s reserve
“We have the money, we can afford to do it,” he said. “Poor people need health care, too.”
Sickles acknowledged the concern that House Democrats have expressed about the potential damage to Virginia’s budget from the ongoing Trump and Musk cost-cutting, which they expect they will have to address in special session later this year.
“If we all know that (revenue losses are coming), then we need to look at that billion-dollar tax cut in this budget,” he said. Sickles referred to a one-time rebate to taxpayers that the General Assembly proposed and approved for delivery in mid-October.
The timing of the proposed cut in nursing home rates doesn’t help, with the state finally set to establish minimum staffing standards for nursing homes.
“We’re trying to balance the carrot and the stick,” Sickles said. “We realize prices are high everywhere. It’s costly to take care of our most vulnerable citizens.”
Del. Otto Wachsmann, R-Sussex, an independent pharmacist in Stony Creek, is concerned about the quality of care in nursing homes in his district and their ability to hire nurses and aides. He sponsored legislation Youngkin already signed into law this year that would increase the fees nursing homes pay to the state to hire more health inspectors to ensure the quality of care and impose sanctions for violations of nursing home standards.
Wachsmann said nursing homes in his rural district already pay more to hire certified nursing assistants to drive from urban areas every day for work.
He also cited the case of a nursing home owner in a more populated part of the district whose business plan turned upside down after federal regulators reclassified the area as rural, reducing its rates to the provider by more than $1 million a year.
“I find this is happening a lot,” Wachsmann said. “People are underpaid.”
Saber Healthcare is paying about $25 an hour for certified nursing assistants at Autumn Care of Mechanicsville, Stanfield said. Registered nurses are earning about $45 an hour.
But it’s still not enough to hire and keep staff, she said, especially in the Hampton Roads area, much less meet a pending federal minimum staffing requirement that is higher than the one the state is about to implement.
“I’m not against it,” Stanfield said. “The more staff we have, the better off we are, but where am I going to find the bodies?”