Utilities: Addresses, Long Term Care, "Star" Ratings, Costs, Savings & Debt, & General Assembly Resources

Utilities

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Nursing, Assisted Living, IDD Facilities & License Lookup

Directory of Virginia Long Term Care Facilities published by the Office of Licensure and Certification of the Virginia Department of Health, with listings by facility type and Licensure (nursing facilities; hospital long term care units; approved / licensed by the Virginia Department of Behavioral Health and Developmental Services; and Intermediate Care Facilities for the Mentally Retarded (ICF/MR)).

Another Directory of Virginia Long Term Care Services and Facilities.

Search for Virginia Assisted Living Facilities published by the Virginia Department of Social Services, which reminds the reader that in Virginia, “assisted living facilities (ALFs) are non-medical residential settings that provide or coordinate personal and health care services, 24-hour supervision, and assistance for the care of four or more adults who are aged, infirm or disabled. This care may be provided in one or more locations. Non-residential adult facilities are listed under Adult Day Care. Assisted living facilities are not nursing homes. A nursing home is a facility in which the primary function is the provision, on a continuing basis, of nursing services and health-related services for the treatment and inpatient care of two or more non-related individuals. Nursing homes are regulated by the Virginia Department of Health (VDH).”

Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/IID) licensed by the Virginia Department of Behavioral Health and Intellectual Disabilities: Link (defective as of 3-17-2024), Link (works as of 3-18-204), and Medicaid approved IDD facilities & providers (works as of 3-18-2024, you will need Name, Provider Type, Language or Location and to use the drop down box for the service required). Shawn’s note: this is a part of an ongoing project of several volunteer lawyers at the Special Needs Alliance, to which the reader is referred for more information.

U.S. News and World Reports Rankings of Virginia Nursing Homes and Assisted Living Facilities

Senior Housing Net: Local & National Area Facilities (Fee)

Care Scout (Fee)

Specialized Care for Brain Injured Residents (Free)

Medicare Nursing Home Finding and Rating Aids

Medicare: Inspection Reports (Free)

Medicare: Updated (9/2020) Inspection Reports (Free)

Medicaid reimbursement rates (published 8-25-

2022).

What Medicare’s “Star” Ratings Really Mean

CMS assigns star ratings in four categories. The stars range from 1 star (much below average) to 5 stars (much above average). The stars include an overall rating star and separate health inspection, staffing, and quality measures stars.

It is not uncommon for facilities to score below (2 star) or much below (1 star) average on staffing and health inspection compliance and yet earn an above average (4 star) and much above average (5 star, highest) quality measure score.

That is important because Medicare states that the “Quality Measures” star “assigns the star rating based on data from a select set of clinical data measures. More stars means better quality of care.”

How can that be?

Grades are given on a “curve.” One in five nursing homes must receive a single star rating, and more than two in three must receive and are evenly assigned lower grades regardless of the actual quality of care delivered.

As Medicare explains in its Technical User’s Guide for the Five-Star Quality Rating System (July, 2020), it considers the health inspection rating as “the most important dimension in determining the overall rating” it assigns.

In weighing the the overall rating, CMS weighs this “most important dimension” on the relative performance of facilities in the state, and ” bases its Five-Star quality ratings in the health inspection domain on the relative performance of facilities as follows regardless of quality of care itself:

• The top 10 percent (with the lowest health inspection weighted scores) in each state receive a health inspection rating of five stars.

• The middle 70 percent of facilities receive a rating of two, three, or four stars, with an equal number (approximately 23.33 percent) in each rating category.

Design for Nursing Home Compare Five-Star Quality Rating System:

Technical Users’ Guide July 2020

Kaiser notes:

“To help control for variation among states that results from differences in state practices, such as state licensing requirements, the star ratings for State Health Inspections are based on the ranked performance of facilities within a state. That is to say, the star ratings are curved, wherein 5-star ratings are reserved for the 10 percent of nursing homes that received the highest score on the State Health Inspection measure, and 1-star ratings are reserved for the 20 percent of nursing homes that scored the lowest. The remaining 70 percent of nursing homes are evenly assigned 2, 3, and 4 stars. In every state, therefore, 20 percent of nursing homes receive a rating of 1 star.“

Kaiser Family Foundation, Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State (2015).

The National Institute of Health published a 2017 study concluding that ” [a]lthough Nursing Home Compare captures some aspects of patient safety, we found the relationship to be weak and somewhat inconsistent, leaving consumers who care about patient safety with little guidance.” Does Nursing Home Compare Reflect Patient Safety In Nursing Homes?

In a 2019 study citing the above, the authors stated that “‘[o]ne consistent message from the many studies that have examined nursing home quality is that our quality measures do not always measure what matters. In this issue of BMJ Quality & Safety, Xu and colleagues [footnote omitted] provide more evidence of the weak and unpredictable relationship between nursing home quality measures and an important patient outcome that does matter—hospitalisation. … the authors find that the 23 metrics they examine showed neither strong nor consistent associations with risk of hospitalisation in a population of Medicaid residents—neither the overall rate of hospitalisation nor potentially preventable hospitalisations.'” Quality measurement and nursing homes: measuring what matters. “

More details and specific data for all nursing homes in the U.S.:

Medicare Quality Measures specific manual.
Medicare Overall Five-Star Quality Rating System: Technical Users’ Guide (July, 2020)
Kaiser Family Foundation, Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State (2015). The study publishes tables that correlate the Medicare star system for each state’s data.
CMS, Special Focus Facilities program. The SFF is a joint effort by the federal and state governments to monitor and assist a minority of facilities, while noting that “[m]ost nursing homes have some deficiencies, with the average being 6-7 deficiencies per inspection.” For nursing homes with persistent issues, the program helps. It’s is good to see that Virginia appears to have very few participants.
All Medicare datasets for the compare program.
Medicare Provider Information (with links to current CVS data file). General information on currently active nursing homes, including number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System. Data are presented as one row per nursing home.

Virginia Department of Health Nursing Home Surveys

“State law requires that all nursing facilities obtain a license to operate in Virginia. There are more than 279 nursing facilities containing 31,927 beds located throughout Virginia. All but fifteen nursing facilities are certified for federal reimbursement under Medicare and Medicaid. Nursing facilities are inspected every 2 years under state Licensure and on an average of every 12 months under Medicare/Medicaid certification.”

Virginia publishes all the results of inspections here.

These links are for all nursing facilities, hospital long-term care units, state mental health facilities federally certified by the Virginia Office of Licensure of the Virginia Department of Health (OLC/VDH), and intermediate care facilities for persons with intellectual disabilities federally certified by OLC/VDH. Each link contains survey reports and location information for the facility.

Assisted Living Facilities

Virginia Department of Social Services Inspection Reports of Assisted Living Facilities (official compliance reports and inspection reports by the DSS)

Assisted Living Facilities.Org (Private Finder Utility for ALF)

Nursing Home Abuse Links

Rx Help

Helping Patients a clearinghouse for various private patient assistance programs for which persons who cannot qualify for Medicaid (or other insurance programs) may qualify. The site claims to be free, completely confidential, and easy to use.

Needy Meds a clearinghouse for information about private pharmaceutical patient assistance programs that make no cost prescription medications available to eligible participants. Many of the programs are based upon patient income in relation to the federal poverty level income standards, available here.

Virginia Health Professions Announcements and Link to License Lookup

Maintained by the Virginia Department of Health Professions, this link provides specific Licensure information for the following general listing of professions and their individual licensing sites in Virginia and elsewhere:

Audiology & Speech-Language Pathology	Nursing
Counseling	Optometry
Dentistry	Pharmacy
Funeral Directors & Embalmers	Physical Therapy
Health Professions	Psychology
Long-Term Care Administrators	Social Work
Medicine	Veterinary Medicine

Health Care & Economic Statistics

United States Hospital Costs and Related Health Data

Hospital Costs per day (2019 publication)

Longitudinal mapping of adjusted hospital costs per day (with historical costs and other health metrics), The Henry H. Kaiser Family Foundation

Medicare Provider Utilization and Payment Data

Data from CMS for the cost of procedures by hospital and by state, commencing 2011, tabulating utilization and payments for procedures, services, and prescription drugs for Medicare beneficiaries. by specific inpatient and outpatient hospitals, physicians, and other suppliers. These data include information for the 100 most common inpatient services, 30 common outpatient services, all physician and other supplier procedures and services, and Part D prescriptions.

Home Equity Conversion Mortgages (HUD’s “HECM” Reverse Mortgage Program) Information

	Search Current Virginia HECM Lenders

	How HECM reverse mortgages work Important Information for Home Equity Conversion Mortgage (HECM) holders and their spouses Inheriting a Home Secured by an FHA-insured Home Equity Conversion Mortgage Questions about Reverse Mortgages Shawn’s Reverse Mortgage Outline (2014)
	HECM HANDBOOK (4235.1 Home Equity Conversion Mortgages) HECM Reverse Mortgage Loan Servicing Manual A HECM Reverse Mortgage Calculator array. The calculator approximates a reverse mortgage given any of the three HECM options including a new home purchase. Please note: no endorsement or warranty of the calculator provider or accuracy of the results of the calculator is expressed or implied by Majette.net. Please see the General Disclaimer.

Financial Data

Net Worth, Debt, and Long Term Care Costs

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	Immediate Annuity Calculator Note: results and methodology are not warranted by the Web Site and are subject to the terms and conditions of our disclaimer. See the Virginia Medicaid Manual and our outline regarding Virginia Medicaid annuity policy.

	Net Worth, Debt, & Long Term Care Costs Who can afford long term care privately? A. What we have. 2022 Household Income and Net Worth: The median household annual income for persons between 65 to 74 is $50,200. For those above 74, it is $43,100. The median household net worth of all Americans is $118,200. The median net worth excluding equity is $41,200 – which means home equity (of $77,000) accounts for 65.14% of total net worth. Excluding the home but including all personal property such as cars, tangibles, and financial investments is $87,000 for households between 65 and 74, and $70,000 for households above 75. Wang, What is the Average Net Worth by Age in America?, September 16, 2022. Linked with permission. Costa, What’s the Median Retirement Savings by Age?, September, 2022. Accessed August 1, 2023. B. What we owe. The typical American household now (2021) carries an average debt of $145,000. The median debt was only $50,971 in 2000. Fay, Demographics of Debt, February, 2022. – Car loans aggregate $1.4 billion dollars (end of 2022) (Fed Reserve, 1-9-2023). The average car payment (in 2022) exceeds $600.00 per month. – More than 10 million Americans over 65 have a mortgage (Lending Tree, January, 2023). In Virginia Beach, more than 21% and in Richmond, Virginia, more than 20%, are indebted on a mortgage, costing more than $1,400 per month. While the debt burden included in Mr. Fay’s article included mortgage debt, it did appear to include the older community’s contingent obligations, including “co-signing” collateral liability of older Americans for the $1.7 trillion debt incurred by their children and grandchildren, more than a third of whom owed more than $100,000.00. Students and parents borrowed about $95.9 billion for student loans in 2020-2021, but the writer is unable see what percentage of that, if any, includes the parents liability upon student default. The big (macro) picture? Americans. About 2/3 of Americans are living paycheck to paycheck, including in that cohort nearly half of those earning more than $100,000 annually. Virginians. As of 1-11-2023, each Virginia citizen’s share of our common debt is $8,939. The debt / Virginia domestic productivity ratio is 12.53%. C. Who’s going to need long term care. Every day until 2030, 10,000 Baby Boomers will turn 65. 70% of them will require long term care in their lifetime. U.S. Census Report (accessed 1-11-2023). HHS Report (accessed 1-11-2023). D. *What Virginians* pay for long term care (2021 figures). Assisted Living Care, Average: $5,250 Nursing Home Care, Average: $8,213. Compare with Medicaid Manual (from 2018, the last amendment, M1450.630 (D), $6,422 except in Northern Virginia, $9,032). E. How long is nursing home and related personal care needed, and what will it cost? The most recent official survey may be this “urgent need” ASP-TRACIE report to HHS. The June 2017 report states that “[i]t is not uncommon for someone to receive care at home for several months or longer, followed by a two and a half year stay in an assisted living facility, with almost 60% then requiring a nursing home stay of somewhere between nine months and a little over two years. All combined, this is a total of approximately 4-5 years of long-term care. In this scenario, the total cost of care could easily exceed $300,000, depending on the cost of care in your region.” The HHS refers to 2017 dollars. Adjusted for ordinary inflation through April, 2022, the last date for which annual inflation figures are available, in 2022 dollars the cost would be between $358,000 and $362,000.00. F. Conclusion*. Before adjusting for ordinary* inflation, the median Virginia household could pay for nursing home care for one householder for less than 5 months from the householder’s net worth if the householder devoted all of the net worth to nursing home care and not to payment of other debt. If the house is sold, all of the net worth in the median would be exhausted in less than 15 months. Secured (mortgage) debt will be paid from the proceeds, so for the 20% of average seniors (in Va. Beach and Richmond, at least), there will be much less. It is no wonder that there is a crisis situation throughout the acute care (hospital) spectrum. “Boarders” in acute care emergency rooms are a crisis that has spread so that patients simply refuse discharges to nursing homes or assisted living facilities: “At peak times which occur up to 5 days per week we have more patients boarding than we have staffed beds. High numbers have included last week when our 22 bed emergency department had 35 boarders and an additional 20 patients in the waiting room…In addition, we have patients who unfortunately have died in our waiting room while awaiting treatment. These deaths were entirely due to boarding. Our boarding numbers have unfortunately skyrocketed in the wake of Covid as a consequence of increasing surgical volumes and decreasing inpatient nurse staffing.” 40 Professional Associations to President Biden (November, 2022) ___________________________________________________________________ Key statistics about income, savings, and overall financial well-being, *75 Must-Know Statistics About Race, Income, and Wealth, Morningstar (Benz, Jun 8, 2020). The Wealth of Households: 2017* (published 2020, United States Census). While excluding persons living in nursing and similar congregate care facilities, the work notes that home equity and retirement accounts composed the majority of household wealth (61.7 percent), with the value of the median home ($118,000). The median net worth of persons over 65 (including the home) is reported between $141,800 (single man) and $128,700 (single woman). Compare and consider the details in the context of long term care costs from the Federal Reserve Bulletin, Changes in U.S. Family Finances from 2016 to 2019: Evidence from the Survey of Consumer Finances (September, 2020) and the Genworth Monthly Median Costs: National (2019): [T]he median net housing value—defined as the home’s value minus any debts secured by the home -… [in 2019 was] $120,000. Financial assets (transaction accounts, certificates of deposit, savings bonds, other bonds, stocks, pooled investment funds, retirement accounts, cash value life insurance, and other managed assets) … had a median value of $25,700 in 2019. Income and Poverty, United States Census (2019) How Wealthy Am I, Compared With the Rest of the World? In January, 2020, the median net worth per household in the United states was $97,300. The median / (mean) average for householders aged 65-74 was $224,100 ($1,066,000), and for 75+, $264,800 ($1,067,000). “What’s your net worth, and how do you compare to others?,” Dayana Yochim, Market Watch, January 23, 2020. United States Debt Clock What we owe beyond what we are collecting as a nation, real time. As of October, 2020, we owe more than 120% of our GDP; in 1980, we owed about 35%. About the Debt Clock. Virginia Debt Clock. Where do our taxes go? The Virginia Auditor’s page.

Long Term Care Insurance

Program offered to federal government workers by Long-Term Care Partners

Virginia Medicaid Partnership LTC Policy Provisions, see Medicaid Manual M1460.160.

Genworth Long Term Care Cost Survey

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Date Calculator finds times between dates, age from date of birth, etc. Useful in precisely fixing dates of expiring powers of attorneys and terms in limited guardianship and conservatorship orders.

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Elder Abuse Utilities

Virginia General Assembly Links

Virginia Case File System – Enter the name for suspected abuser (“John A. Smith”) and see all Virginia Cases.

Law regarding financial abuse by agent:

Civil provisions for proof: Agent’s duty to provide information; persons entitled to information. Co-agent’s liability for failure to protect principal. APS and banks authority.
Criminal liability for misuse of power of attorney.The 2022 statute is applicable when the agent makes an “illegal, unauthorized, or fraudulent use, or deprivation of use, of the property of a vulnerable adult with the intention of benefiting someone other than the person giving the power, and the person giving the power of attorney is a “vulnerable adult.”A “vulnerable adult is a person at least 18 years of age who is impaired by reason of mental illness, intellectual or developmental disability, physical illness or disability, or other causes, including age, to the extent the adult lacks sufficient understanding or capacity to make, communicate, or carry out reasonable decisions concerning his well-being or has one or more limitations that substantially impair the adult’s ability to independently provide for his daily needs or safeguard his person, property, or legal interests.An agent violating the statute is guilty of a misdemeanor. This offense is in addition to any other criminal offense, often those grouped in the criminal law as fraud or embezzlement and fraudulent conversions and prosecuted depending upon the value of the assets which the agent has converted to his own use.
Cases.Chittum v. Commonwealth, No. 0783-20-3, (Va. Ct. App. Jan. 25, 2022) (criminal) (before effective date of Va. Code Sec. 18.2-178.2)(defendant guilty of grand larceny after she transferred $163,600 belonging to her mother, held in a joint checking account, to herself despite defendant’s argument that that she lacked the necessary intent to commit grand larceny because (1) she had joint ownership in the account and her mother had granted her power of attorney, and (2) she made the transfer with her mother’s consent and at her behest).Phillips v. Rohrbaugh, 300 Va. 289 (2021) (civil) (long discussion of agent’s duty to account to third parties other than the person giving the power of attorney and the use of Va. Code Sec. 64.2-1612(H) to limit the agent’s duty to provide information to third parties).

Sessions. The Virginia LIS page gives current and former session information. Searchable data bases allow us to research everything reported in every session going back to 1994.

Session Summaries. One of the best ways to keep track of the bills, these great summaries are from the Division of Legislative Services, the legislative branch agency created statutorily by the General Assembly for nonpartisan legal and general research services to members of the General Assembly and its standing committees in the House of Delegates and Senate of Virginia. These summaries have formed the basis of the writer’s recent law changes since 2020, and they have been a research Godsend.

May 15, 2023, at 3:45 PM EDST

Utilities

Health Care & Economic Statistics

Net Worth, Debt, & Long Term Care Costs