State Health Commissioner Response:
We agree with the report’s central finding: the current system needs substantial improvement.
That improvement needs to be significant, and it needs to be urgent. The report’s recommendations align with our own assessment and with work already underway. But agreement about the problems, or even the solutions, isn’t nearly enough.
What matters most is what we do next. For Virginians who depend on care in their own homes, the quality of that care is essential to their health, safety, dignity, and well-being. These problems didn’t develop overnight. They’ve been building for a long time, and they haven’t been addressed effectively.
As Commissioner, I intend to change that trajectory. Governor Spanberger asked me to strengthen how this agency operates, and home care oversight is a clear place where that must happen. From the earliest days of this administration, improving our licensure and inspection programs has been a leadership priority. We’ve already applied a more disciplined approach to nursing home oversight, making steady progress on that inspection backlog. We’re bringing that same approach to home care organizations through four strategic priorities.
First, restoring timely oversight. Inspections must happen when they’re supposed to, with the flexibility to respond quickly to urgent health and safety concerns. We’re establishing clearer inspection expectations, stronger supervisory review, and greater accountability for results. We’re validating our overdue inspection inventory and assessing staff capacity to establish monthly production targets and a projected timeline for clearing the backlog. And we’re moving toward a regional approach to better align inspectors with provider demand and strengthen supervision. Our goal is to make timely, meaningful oversight the expectation, not the exception.
Second, modernizing initial licensure. The report identifies substantial delays in initial licensure, and we agree the process needs to change. Today, inspectors divide their time between initial inspections, routine oversight, complaints, and administrative responsibilities. We’re working to separate application review and applicant communication from field inspections, allowing inspectors to focus on inspections. We’re also improving application tracking, standardizing readiness requirements, and reviewing pending applications by age and status. We need a licensing process that’s rigorous, predictable, and accountable at every stage.
Third, strengthening enforcement and accountability. Finding deficiencies isn’t enough. We must ensure they’re corrected. We’re strengthening how we track corrective action plans, verify corrections, and address unresolved cases. We’re developing a consistent enforcement protocol with clearer escalation procedures and reviewing whether additional statutory or regulatory tools are needed. Accountability cannot end with identifying a problem. There must be consequences when problems aren’t corrected.
Finally, building sustainable operating capacity. Virginia has over 2,200 home care organizations licensed or awaiting initial licensure, with just seven regular inspector positions statewide and three additional positions supported by time-limited federal funding. That workforce handles initial inspections, routine inspections, complaints, and enforcement follow-up. Recognizing this, several months ago we began pursuing 18 additional positions: 14 inspectors, two supervisors, and two licensing or program-support positions. But staffing alone won’t solve this. We also need stronger supervision, training, and systems that make better use of our workforce.
Our objective isn’t simply to clear today’s backlog. It’s to prevent us from ending up here again.
These priorities reflect work already underway and our leadership team’s commitment to measurable, sustained improvement. In closing, I want to return to where I started. The current system needs substantial improvement. None of our work on staffing, backlogs, operations, or licensing means much if Virginia’s seniors aren’t safe, healthy, and treated with dignity.
That’s the measure that matters.
Seniors and their loved ones place tremendous trust in this agency to ensure organizations caring for them at home are qualified, accountable, and following state laws and regulations. The current system hasn’t lived up to that trust. With the support of the Spanberger administration, our job is to earn it back and keep it — by doing the work I’ve laid out today and showing results.
