When Susan Fanning broke her ankle, she could no longer use the bathroom on her own. At her Chesapeake nursing home, she recalled waiting more than three hours in a wet incontinence brief for someone to change it.
Other times, she said, medication she expected at 9 p.m. did not arrive until around midnight.
Fanning has lived at Chesapeake Health and Rehabilitation Center for about a year. She said the employees in her unit and the facility’s physical therapists are great. But her concern is whether enough people are available to provide care.
“There's no loyalty here, so people come and go, come and go all the time,” Fanning said. “People are late coming in, and they have people that they're supposed to cover have already gone home, so there's nobody in that position for a while.”
WHRO reached out to Chesapeake Health and Rehabilitation Center for comment. Calls seeking a response were not returned.
Virginia’s long-term care ombudsman said Fanning’s account echoes what her office hears most: residents aren’t getting the basic care they need.
Those concerns come as the state works through overdue nursing home inspections and proposes clearer guidelines for responding to repeated violations.
A WHRO analysis of the July 2026 Centers for Medicare & Medicaid Services health citations file found 101 Virginia nursing homes had at least one citation for abuse, neglect or exploitation during their most recent inspection cycle.
Across three inspection cycles that range from every nine to 15 months, 179 out of roughly 290 Virginia nursing homes had citations in this category. Of those, 71, or about 40%, were cited in at least two cycles.
Nine of Virginia Beach’s 14 federally certified nursing homes received citations in the category during the most recent inspection cycle, the most of any city or town listed in the data.
Among them, Virginia Beach Healthcare and Rehab Center received six citations, the highest in the area.
But Joani Latimer, Virginia’s state long-term care ombudsman, said the data is likely underselling the issues.
“My instinct is to say that it probably does not fully reflect the picture,” Latimer said. “We do see many cases where residents and their families are reluctant to report abuse, particularly if there’s a sense of possible retaliation.”
When basic care falls short
Latimer said the basic unmet needs can mean a resident does not get help eating, drinking or staying clean.
It can also mean staff are not following a care plan or providing enough supervision.
Without enough trained and supported caregivers at these facilities, Latimer said, even employees committed to their residents can become overwhelmed.
“You’re really planting seeds for neglect and abuse,” she said.
Fanning, who previously worked as a hospital dietitian, recalled five occasions when no meal was brought to her. She also said meals are now served with small plastic utensils that can be difficult to use.
“The food that we're getting is inaccurate. It's not enough food to help people heal,” she said. “They overcook everything, so all the nutrients are gone anyway.”
Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association, a nonprofit representing nursing homes and assisted living providers, said nursing homes are caring for residents with increasingly complex medical needs while struggling to recruit nurses and nursing assistants.
The association operates 97% of Virginia’s Medicaid nursing home beds, Hewett said.
She said Medicaid payments fall short of the cost of care, leaving facilities under financial pressure. Some facilities limit or pause admissions when they do not have enough staff to safely care for additional residents.
“Nearly every facility would say that they would love to have more nurse aides, more RNs, and it’s just hard to find them because the workforce is limited,” Hewett said.
Inspectors are stretched thin
The Virginia Department of Health is facing staffing shortages of its own as it works through overdue nursing home inspections.
April Dovel, director of the Virginia Department of Health’s Office of Licensure and Certification, said about 42% of nursing homes had been inspected within the last 16 months window at the time of her interview, leaving more than half overdue.
She called the backlog "truly unacceptable.”
Latimer, the ombudsman, said Virginia has been trying to catch up since the pandemic disrupted inspections and kept surveyors out of facilities.
Staffing gaps continue to limit the agency’s ability to catch up. Dovel said several experienced surveyors retired from the Tidewater team in early August, while two positions remained vacant in Northern Virginia.
Complaints are also increasing, she said. The same teams responsible for routine inspections must investigate those complaints, return to check whether facilities have corrected problems and handle enforcement work.
“It’s the recertification team that has to do everything,” Dovel said.
Those delays matter because routine inspections examine a facility’s overall operations, beyond the specific concerns raised in a complaint, Latimer said.
Her office has seen care decline and complaints rise during periods when inspectors were not visiting regularly. But she cautioned that it is difficult to separate the effects of inspection delays from other factors affecting care.
VDH is currently using outside surveyors from contractor HMS to complete inspections, including in Tidewater, Dovel said.
The agency also plans to recruit seven investigators statewide over the next year to focus on complaints, freeing other surveyors to spend more time on routine inspections.
Dovel said the department aims to bring the number of facilities with overdue inspections below 90 by January 2027 and completely eliminate the backlog by December 2027.
What happens when violations return
WHRO’s review of three inspection cycles found 71 Virginia nursing homes with abuse-, neglect- or exploitation-related citations in at least two cycles.
A repeated citation, however, does not necessarily mean a nursing home failed to correct the same problem, said Hewett with the Virginia Health Care Association.
She said inspectors could cite the same federal regulation in different years for entirely different incidents involving different residents or staff.
But Latimer, the ombudsman, said repeated serious problems raise a different question: why the regulatory process is not producing lasting change.
After inspectors identify a deficiency, nursing homes are generally required to develop a plan explaining how they will correct it.
“There are facilities that tend to have persistent, ongoing, numerous citations,” she said.
Regulators, she said, have to determine why those problems are not being resolved.
Virginia health officials said they are changing how they track those patterns.
Dovel said inspectors have historically cited deficiencies under federal nursing home regulations but have not consistently recorded corresponding violations under Virginia’s licensing rules.
That distinction matters because federal and state enforcement operate on separate tracks. Federal citations can threaten a nursing home’s Medicare and Medicaid certification. State violations can ultimately affect the facility’s Virginia license.
Dovel said VDH recently added state nursing home regulations to the federal survey system it uses. Going forward, when inspectors identify a federal deficiency that also violates a state rule, the agency expects them to record both.
She said the change is intended to give the state a clearer record when problems become systemic or continue despite repeated inspections.
At the same time, VDH has proposed new sanctions guidance spelling out when repeated noncompliance should be considered for state action.
The proposal includes triggers such as the same violation appearing during consecutive inspections, complaint investigations or follow-up visits, as well as when a violation appears at least three times within 18 months.
“We want to make sure that we're paying really close attention to that,” Dovel said. “Whether that would be having a recommendation to restrict new admissions or prohibit new admissions, or potentially petitioning a court for civil monetary penalty, and absolute worst case scenario, potentially suspending or revocation of a license.”
Dovel said the focus is on facilities where inspectors return and find that deficient practices have not been corrected.
“It’s never the goal to shut a provider down,” Dovel said. “The goal is to ensure that they’re meeting the threshold of the regulation.”
Hewett said the industry association is reviewing the proposed state sanctions guidance, following a public comment period that ended this week.
For residents such as Susan Fanning, however, the measure of whether oversight is working is more immediate.
Fanning said most of the concerns she raised through a local ombudsman were eventually addressed, but staffing remains a problem.
Moving somewhere else is not an easy alternative. Fanning said Medicaid pays for her nursing home care. She cannot afford assisted living, and her son’s home would need modifications before she could live there.
“I have no choice,” she said.
