RICHMOND, VA — Virginia lawmakers are advancing a slate of legislative measures aimed at strengthening nursing home oversight across the Commonwealth, including proposals to establish minimum staffing requirements, fund workforce training programs, and mandate greater transparency around facility ownership, according to reporting by Skilled Nursing News and WTVR.
The legislative push arrives at a critical juncture for long-term care regulation, as the federal nursing home staffing mandate was repealed effective February 2026, placing the responsibility for setting staffing standards squarely on individual states.
Staffing Standards and Workforce Investment
At the center of the effort is a bill introduced by Del. Rodney Willett (D-Henrico County) that would establish minimum nursing care requirements for certified nursing homes participating in Virginia's Medicaid Nursing Facility Value-Based Purchasing program, as reported by WTVR. The measure would require facilities to provide at least 3.08 acuity-adjusted hours of nursing care per resident per day through 2027, with that threshold rising to 3.25 hours by 2031.
However, the staffing proposal has faced significant resistance. According to WTVR, the original bill — HB 605 — was ultimately stripped of its mandate and reduced to directing the Joint Commission on Health Care to conduct another study on nursing home staffing levels. Joanna Heiskill, a nursing home reform advocate who served on Governor Youngkin's nursing home advisory board, called the outcome "very hurtful," stating that it demonstrated Virginia's government "does not care enough," as quoted by WTVR.
Virginia nursing homes currently average approximately 3 hours and 47 minutes of nurse staffing per resident daily, falling below the national average of 3 hours and 54 minutes, according to WTVR. That places the state's CMS staffing rating at 2.5 out of 5 stars — the eighth lowest in the nation.
To address the workforce pipeline, Sen. Barbara Favola (D-Arlington) introduced budget amendments that would allocate $2 million over two years to provide no-cost certified nurse aide training through the Virginia Community College System, according to Cardinal News. The initiative is modeled after a 2021 Minnesota program that successfully trained approximately 1,000 CNAs. An AARP analysis found that 91% of Virginia nursing homes currently have open CNA positions, underscoring the depth of the staffing crisis.
Ownership Transparency Measures
Separately, state lawmakers introduced bills that would tighten requirements around nursing home ownership disclosures, as reported by Skilled Nursing News. Del. Willett's second bill would require nursing home operators to disclose all direct and indirect owners, provide five-year histories covering financial, regulatory, and criminal matters, and indicate whether facilities appeared on the federal worst-performing list during any ownership transition, according to WTVR. The Virginia Health Care Association has expressed support for the ownership disclosure legislation.
The transparency measures reflect growing national concern about the role of private equity and complex corporate structures in nursing home operations, where layers of holding companies can obscure who ultimately controls a facility and its finances.
Funding for Area Agencies on Aging
The legislature is also considering budget amendments to increase state funding for Virginia's 25 Area Agencies on Aging, which connect older adults and caregivers to long-term care planning and community-based services, according to Skilled Nursing News.
"With looming federal funding cuts, additional state investments would allow AAAs, including several based in Southwest and Southern Virginia, to expand access to home- and community-based services, strengthen caregiver support, enhance preventive health and support workforce development," William Lester, president and CEO at Warm Hearth Village, said in Cardinal News.
Lester, who also serves as a LeadingAge Virginia board member, has argued that not-for-profit nursing homes consistently outperform for-profit facilities on staffing levels and quality metrics, according to Cardinal News. Not-for-profit providers currently represent roughly 10% of Virginia's nearly 300 licensed nursing homes.
The demographic urgency behind these proposals is significant: Virginia is projected to have more than 600,000 residents aged 80 and older by 2040, according to Cardinal News, placing enormous future demand on the state's long-term care infrastructure. Nearly seven in 10 Virginia nursing home residents currently rely on Medicaid to fund their care.
CMS Inspection History
While the Virginia legislation would affect facilities statewide, individual facility records illustrate the wide spectrum of care quality across the Commonwealth. The Virginia Home, a 130-bed non-profit facility in Richmond, holds a top overall CMS rating of 5 out of 5 stars, with a quality measure rating of 5 out of 5 stars and a health inspection rating of 4 out of 5 stars. Its staffing rating stands at 3 out of 5 stars — a figure that mirrors the statewide challenge that lawmakers are attempting to address.
Notably, The Virginia Home operates as a non-profit corporation, placing it in the category that Lester and other advocates argue delivers superior outcomes. LeadingAge Virginia's non-profit member facilities already average 4.3 hours of nursing care per resident daily, according to WTVR — well above the proposed state minimum of 3.08 hours.
The contrast between high-performing non-profit facilities and the broader statewide staffing picture highlights why advocates contend that minimum standards, rather than voluntary benchmarks, are necessary to protect residents across all types of ownership structures.
Ownership & Operations
The push for ownership transparency in Virginia reflects a broader national trend. As nursing home ownership structures have grown increasingly complex — with management companies, real estate investment trusts, and private equity firms playing larger roles — regulators and families have struggled to identify who bears ultimate responsibility for care quality and staffing decisions.
The proposed disclosure requirements would give state regulators and the public clearer insight into ownership changes, which research has linked to temporary declines in care quality during transition periods. Federal regulations already require some ownership reporting through CMS, but advocates argue that state-level requirements with stronger enforcement mechanisms are essential.
Resources for Families
Families with concerns about care quality in Virginia nursing homes can contact the Virginia Long-Term Care Ombudsman program at 1-800-552-3402. Ombudsman advocates can assist with complaints, provide information about residents' rights, and help navigate the regulatory process.
The national Elder Care Locator hotline is available at 1-800-677-1116 and can connect callers with local aging services and advocacy resources nationwide.
Additional information about long-term care ombudsman programs, including how to file complaints and locate local representatives, is available through the National Consumer Voice for Quality Long-Term Care at ltcombudsman.org.
Families considering a nursing home placement should review facility inspection reports, staffing data, and quality ratings available through the CMS Care Compare tool, which provides detailed performance metrics for every Medicare- and Medicaid-certified facility in the country.
UPDATE — March 18, 2026
**UPDATE (December 4, 2025):** The Centers for Medicare & Medicaid Services officially repealed the Biden-era nursing home staffing rule, effective February 2, 2026, according to the Center for Medicare Advocacy. The repeal eliminates minimum staffing requirements of 3.48 hours per resident day and mandatory 24/7 registered nurse coverage that University of Pennsylvania researchers estimated would have saved approximately 13,000 lives annually, as reported by AARP. While the nursing home industry praised the decision and HHS Secretary Robert F. Kennedy Jr. described the original mandate as "rigid" and "one-size-fits-all," according to Skilled Nursing News, consumer advocates including Senator Ron Wyden condemned the rollback, warning it will make residents "less safe in nursing homes." The enhanced facility assessment process requiring facilities to staff based on resident acuity remains in effect despite the repeal.
UPDATE — March 19, 2026
According to reporting by the Missouri Independent and other state outlets, Missouri Senator Adam Schnelting has introduced Senate Bill 910, which would require long-term care facilities to maintain at least $1 million in liability insurance or reserve accounts, with non-compliance potentially resulting in license revocation. The legislation, which was heard by the Senate General Laws Committee, would elevate elder abuse by a care provider from a Class A misdemeanor to a Class E felony and mandate that the Missouri Department of Health and Senior Services display a standardized icon on its website identifying facilities with substantiated abuse or neglect findings within the past 36 months. The bill emerged from a series of seven elder abuse prevention forums held across Missouri in fall 2025 by Lieutenant Governor David Wasinger and Senator Schnelting as part of their "Protect Our Seniors" tour, gathering community input that directly shaped the legislative package.
UPDATE — March 19, 2026
According to WTVR, the Virginia nursing home staffing bill has been significantly weakened, with its minimum staffing requirements stripped out and replaced with a directive for yet another study by the Joint Commission on Health Care. Delegate Rodney Willett (D-Henrico) cited budget constraints as the primary reason for the change, explaining that implementing the staffing standard would require increased Medicaid reimbursements, though he estimated the annual cost would be significantly less than $20 million. The bill initially proposed a 3.25 acuity-adjusted total nurse staff hours per resident per day minimum, which was later reduced to 3.08, but ultimately transformed into a study directive after passing through a budget committee. Advocates and families expressed frustration with the change, noting that the Joint Commission on Health Care already completed a study on this same issue in 2021.
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