‘Sickest of the sick’

But it’s not so simple in Virginia, nursing-home industry leaders argue, pointing to a host of complex reasons why Virginia has always been thrifty in its funding of home care.

“Because we’re a stingy state and our program is already so lean, by default that means that we only take care of the sickest of the sick,” said Hobart Harvey, vice president of the Virginia Health Care Association, which represents nursing facilities.

Cheryl Jones looks over the medications of her client Barbara Worthy.

Federal dollars for Medicaid are portioned out to states according to per-capita income: The poorer a state’s residents, the more money the federal government gives it for Medicaid.

Virginia, the ninth-wealthiest state in the country, ranks 47th for Medicaid spending. West Virginia ranks 49th in per-capita income and 10th in the nation for Medicaid spending.

In Virginia, criteria for nursing-home admittance are more stringent, meaning that a person entering a nursing home on Medicaid typically requires more health care assistance than those in most other states, Harvey said. Virginia’s nursing homes likewise suffer from the same underfunding of Medicaid, reporting a $10 loss per Medicaid patient every day.

“You would be hard-pressed to walk through any nursing home in Virginia and find one or two people that you’d believe could be cared for at home,” asserted Roanoke civic leader Heywood Fralin, whose Medical Facilities of America owns facilities in Virginia and North Carolina.