Business View Magazine - August 2023

116 BUSINESS VIEW MAGAZINE VOLUME 10, ISSUE 8 payments for those nursing facilities that met or exceeded performance and/or improvement thresholds in six key areas, including two staffing metrics, and measures related to hospitalizations, emergency department visits, pressure ulcers, and urinary tract infections. Legislators then decided to use the VBP Program in setting a minimum staffing requirement of 3.08 total nursing hours per resident day. By first incentivizing increased staffing through VBP, Virginia bucked the trend of imposing a staffing standard based only on punitive measures, recognizing that inadequate Medicaid funding has significantly contributed to the staffing levels everyone wants to improve. VHCA-VCAL supported the standard because it aligned with the staffing metric in the VBP Program and is tied to Medicaid funding going forward. As staffing is the largest component of nursing facility care, the costs of higher staffing must be built into the Medicaid rates. The legislation included exceptions to sanctions if a facility is facing established circumstances affecting the ability to hire staff or has demonstrated a concerted effort to recruit and retain direct care staff. This is in contrast to an expected federal mandate for staffing minimums that is unlikely to account for existing staffing shortages or that states like Virginia may have designed unique approaches that provide a greater chance of successful outcomes. For the VBP Program and the staffing standard to ultimately be successful, Virginia needs to sustain the funding needed and find ways to grow the nursing workforce, which was devastated during the pandemic. Recovery of the Long Term Care Workforce Is Ongoing Staffing in Virginia’s nursing homes and residential-care facilities plummeted in the pandemic when over 11,600 workers were lost over two years. The latest data shows facilities are still down by almost 4,500