Virginia ranks 42nd in the nation for total nursing home staffing and 50th in certified nursing assistant staffing, according to a report presented to lawmakers last week. The state ranks 38th for staffing of registered nurses, who have the most significant impact on the quality of care in nursing homes.
The findings raise questions about whether Virginia needs more defined staffing standards in order to improve overall quality in the state’s long-term care facilities.
The Joint Commission on Health Care — a legislative body that studies Virginia’s health system and recommends policy changes to the General Assembly — proposed a minimum nursing home staffing standard last week and outlined policy options for implementing them.
LeadingAge Virginia, which advocates for nonprofit senior services, supports establishing staffing standards but says the state must also invest in the workforce pipeline, said Dana Parsons, the organization’s vice president and legislative counsel, in a phone interview Tuesday.
The commission proposed an initial deadline of 2029 for facilities to meet the standards. Parsons said nursing homes could improve staffing within that timeframe.
“We believe that the staffing standard needs to be imposed to ensure that residents receive quality care but that the standard alone is not enough,” Parsons said. “The commonwealth needs to make an investment to sustain a strong nursing home workforce pipeline.”
Virginia’s state code does not currently set specific nursing home staffing requirements. Instead, state guidance says facilities must have enough staff to care for their residents, said analyst Jen Piver-Renna, who presented the commission’s findings to lawmakers last week.
The commission also found that staffing levels were lowest at for-profit nursing homes and significantly lower at facilities that accept both Medicare and Medicaid. More than 75% of Virginia nursing homes operate as for-profit entities.
The study was a result of legislation passed in early 2026, sponsored by Del. Rodney Willett, D-Henrico. Initially, HB 605 attempted to re-establish nursing home staffing standards, which were enacted in 2023 and then repealed in favor of federal standards. But then courts ruled that the federal standard exceeded its statutory authority and repealed the final rule.
When HB 605 was introduced, it outlined staffing requirements but was changed to direct the commission to study the nursing home workforce. Piver-Renna included three policy options for lawmakers to consider in 2027.
Certain nursing categories spend less time with residents
About 27,000 people live in Virginia nursing homes across the state, where many residents need ongoing supervision and help with everyday activities such as bathing, dressing and moving around.
Usually, nursing homes support people who cannot safely live in less intensive care settings due to chronic health conditions and limited physical mobility, Piver-Renna said.
Virginia nursing home staff provide an average of 3.7 hours of nursing care per resident each day, compared with 3.87 hours nationally, according to the commission report.
The workforce includes several types of nursing staff. Registered nurses oversee clinical care, administer treatments and medications, and supervise lower-level nursing. Licensed practical nurses provide hands-on care, monitor residents’ health and administer certain medications. Certified nursing assistants help residents with daily activities, personal hygiene and comfort.
The study found that Virginia’s staffing levels varied by clinician type, with LPNs spending more time with residents than the national average: about one hour per resident daily, compared with 0.86 hours nationally. Virginia is eighth in the nation for LPN staffing in nursing homes, but those staffers had the least amount of impact on nursing home quality ratings, Piver-Renna said.
Registered nurses, who have the most significant impact on quality of care, spend an average of 0.67 hours per nursing home resident per day in Virginia, compared to 0.68 hours nationally. Virginia ranks 38th in the nation for registered nurse staffing.
Certified nursing assistants spend about 2.1 hours per resident daily in Virginia, compared with 2.33 hours nationally. This discrepancy is enough to place Virginia in 50th place in the nation for CNA staffing. CNAs play an important role in maintaining residents’ ability to function independently.
Improving the CNA workforce and creating clearer career advancement opportunities will be critical, Parsons said.
LeadingAge is developing programs to train CNAs for more advanced roles, giving them opportunities to pursue additional training and advance to LPNs and eventually RNs.
“It’s about creating a career ladder, but also changing the perception of working in long-term care,” Parsons said. “I think sometimes people don’t realize the bonds and relationships you can create.”
Southwest Virginia reflects statewide staffing challenges
At least 24 Virginia nursing homes within 100 miles of Roanoke fall below both state and national averages for staffing, according to the federal Center for Medicare and Medicaid Services’ Care Compare tool. Including facilities in neighboring North Carolina and West Virginia brings that number to 45.
Nursing homes in Southwest Virginia tend to serve more residents each day than the typical facility nationwide. Some facilities in the region serve up to about 160 residents per day compared to the statewide average of 99.5. Nationally, nursing homes serve an average of 86 residents per day.
Registered nurses at some facilities spend as little as 11 minutes per resident daily — well below Virginia’s average of 41 minutes, according to Care Compare.
While some facilities report above average staffing levels for licensed practical nurses, those numbers do not necessarily make up for lower staffing among RNs and CNAs, who provide different types of care.
These staffing gaps could become more pressing as Virginia’s population ages, according to the commission’s report. Demand for long-term care services is expected to increase by more than 25% by 2036, putting greater pressure on nursing homes to recruit and retain enough workers to care for residents.
Proposed staffing requirements
The commission presented a package of policy options at the Senate committee meeting that could help address staffing issues.
First, the commission recommends re-establishing staffing standards. Beginning in 2029, the commission suggests that the total nurse staffing should increase to 3.09 hours per resident per day. That would increase to 3.32 hours beginning 2031.
Increased staffing would increase costs of care for Medicaid members by $24.7 million, with $12.3 million in general fund dollars. These changes would likely affect 79 nursing homes. Increased staffing would also cause an increase in costs of care for Medicaid members by $12.7 million, according to the commission.
The written public comment period closes at 5 p.m. Nov. 2. Comments can be emailed to jchcpubliccomments@jchc.virginia.gov or mailed to 411 E. Franklin Street, Suite 505, Richmond, VA 23219.
