I am submitting this comment as the founder of the Connie Taliaferro Initiative for Long-Term Care Reform and as the daughter and advocate of a former Virginia nursing-facility resident.

I support providing VDH and the Office of Licensure and Certification with sufficient resources to conduct timely and effective nursing-facility inspections. However, I do not support charging facilities $29 for every licensed bed while continuing to inspect resident care through a limited sample.

The proposed fee is based on the facility’s entire licensed capacity, including potentially unoccupied beds. Yet the inspection process does not include a detailed resident-level review of every occupied bed. Virginia should not use a comprehensive per-bed fee to fund an outdated sample-based inspection system without demonstrating a clear relationship between the amount charged and the oversight provided.

If Virginia charges a per-bed inspection fee, every occupied bed should receive an appropriate resident-level review. This does not require inspectors to perform the same task repeatedly without purpose. It means using direct observation, medical and care-plan records, staffing assignments, medication and treatment records, call-light data, infection-prevention information, incident reports, and resident or representative input to evaluate the care connected to every occupied bed.

A limited resident sample may fail to identify problems affecting residents who were not selected. Residents with dementia, communication impairments, limited family involvement, or an inability to advocate for themselves may be especially likely to remain unseen. Oversight should not depend on whether a vulnerable resident happened to be included in an inspection sample.

If VDH determines that reviewing every occupied bed is not feasible, it should explain why facilities are being charged for every licensed bed and consider a different fee methodology tied to actual occupancy, inspection workload, or the number of residents reviewed. Facilities should not be assessed based on full licensed capacity without a corresponding level of oversight or a documented cost justification.

The addition of eight Medical Facility Inspector positions does not, by itself, establish that Virginia has sufficient inspection capacity. VDH should publish a staffing and workload analysis identifying:

• Current authorized and filled inspector positions;

• Inspector vacancies and turnover;

• The number of facilities and licensed beds assigned per inspector;

• The current complaint and inspection backlog;

• The number of inspectors required to complete inspections timely and comprehensively;

• The expected backlog reduction resulting from the additional positions; and

• The additional capacity created through the new licensing fees.

Fee revenue should supplement—not replace—existing General Fund support for nursing-facility oversight. Otherwise, facilities may pay substantially higher fees without Virginia creating any meaningful additional inspection capacity.

VDH should also publish an annual nursing-facility inspection fund report showing:

• Nursing-home fee revenue collected;

• How the revenue was spent;

• The number of inspectors funded;

• Filled and vacant inspector positions;

• Inspection and complaint-investigation completion times;

• The size and age of any remaining backlog; and

• Whether inspection timeliness and resident oversight improved after implementation of the fees.

If the program fails to meet established inspection targets, VDH should be required to explain the causes and publish a corrective action plan.

Virginia’s inspection system should be modernized through electronic health records, staffing and assignment data, call-light response reports, medication records, incident data, resident interviews, and structured family feedback. Technology should allow oversight to expand beyond a small resident sample and identify facility-wide patterns.

The issue is not simply whether $29 per bed is affordable. The issue is whether the Commonwealth can demonstrate that the fee produces oversight corresponding to the number of beds charged and the number of residents whose health, safety, and dignity depend on effective inspections.

I respectfully request that VDH revise the permanent regulation and inspection methodology to establish per-bed accountability, modernize resident-level review, protect existing public funding, justify the staffing level, and require transparent performance reporting.

Michelle Taliaferro
Founder
Connie Taliaferro Initiative for Long-Term Care Reform
connietaliaferroinitiative@outlook.com