RICHMOND, Va. (WRIC) — Fillmore Place, an assisted living facility in Petersburg, was placed under review by the state after failing an inspection in December 2021. Three months after the facility’s June deadline passed, evidence mounted that the facility still wasn’t cleaning up its act.

Finally, in mid-September 2022, the Virginia Department of Social Services (DSS) determined the facility needed to close and residents needed to be moved. Virginia officials are now addressing concerns about how the conditions got so bad and why other assisted living facilities across the state are facing challenges too.

Tara Davis-Ragland, the Licensing Programs Director, said there were two reasons Fillmore Place stayed open as long as it did—the regulatory allowances for time to fix problems and the desire at DSS to see facilities work if at all possible.

“It’s not easy when [residents] have to be placed, you know, elsewhere. There’s a lot of trauma that comes with that for folks,” Davis-Ragland said.

When inspectors determined it was necessary to deny the facility its license renewal in December 2021 and grant only a provisional license, she said they hoped Fillmore Place would be like other assisted living facilities that have successfully used the six-month provisional license in the past.

“We try to break things down and help make it easy for them to understand where they are, what they need to do to come into compliance and offer some technical assistance,” Davis-Ragland said.

Unfortunately, Fillmore continually failed to meet minimum standards and racked up several dozen more violations between December 2021 and when they closed. An 8News Taking Action Investigation revealed the conditions two former employees had found — with filth still piling up three to four months after the state put Fillmore Place on notice.

Additionally, state inspectors found shoddy record-keeping, administrative disrepair and no direct staff members awake and on duty at night. An inspection executed just three weeks before Fillmore’s provisional license was set to expire — when they were most at risk of losing the license for good — found the facility rife with the longest list of violations yet.

An assistant marshal reportedly visited multiple times to inspect broken elevators and an inoperable fire alarm system.

From the agency’s perspective, Davis-Ragland said they didn’t seem to be acting like other facilities similarly under scrutiny.

“It’s really, you know, it’s about communication. And we didn’t necessarily see a lot of that with Fillmore,” Davis-Ragland said. “Unfortunately, sometimes it’s just, you know, the facility needs a better management plan. They need people who are going to be there to be able to exact change in that facility. And, you know, I think with Fillmore, unfortunately, that wasn’t there and that didn’t happen.”

In the meantime, as the agency was trying to deal with Fillmore, they were wrestling with the reality that more and more of Virginia’s assisted living facilities are also struggling, with Davis-Ragland confirming an increase in the number of provisional licenses, a trend 8News had reported for the last six months. Eleven were provisionally licensed in April and nineteen had that status by November. 8News is still awaiting confirmation of December’s numbers.

“I think the workforce issues that both assisted living facilities and nursing homes are facing are very concerning,” said DSS Commissioner Danny Avula. “This problem is only going to get more significant as people are living longer.”

Commissioner Avula said that even facilities trying their best to keep up, simply don’t have the staff with the necessary training to provide the highest quality care. He says pay in the industry isn’t high enough to retain staff who are highly qualified. And, in some cases, he and Davis-Ragland say, the facilities don’t have the means to provide better pay. The residents are paying so little for housing and care that there isn’t enough sufficiently leftover to substantially increase wages.

Avula and Davis-Ragland say so many facilities already closed during the pandemic. So if those facilities fail because they’re unable to help them get substantially in compliance with state regulations and standards, the struggle they just endured finding new homes for several dozen Fillmore residents—many of whom have little means to pay—is likely to play out again and again.

“I think largely it’s [that] are we funding these entities enough to both do the physical upkeep of their facilities as they age, but also ensure that they have the stability and quality of staff to provide the service that our residents need and more,” Avula said. “More and more we’re seeing that shift to self-pay, right? People are having to pay more and more out of pocket. The whole industry of long-term insurance has really grown over the last 15 years because of that escalating cost. But who gets left behind? There are low-income individuals and families.”

Avula said he thinks as a society we have to carefully look at how the plight of low-income individuals is being exacerbated by these challenges and how we can support these needs as people age, particularly as our population as a whole gets older.

David DeBiasi of AARP Virginia has said that Virginia will need to loosen its restrictions on who qualifies for nursing homes so more people can access federal and state funds for care.

“In Virginia, we’re one of the most restrictive states in the country,” said DeBiasi. “For us, you have to not need assistance with five basic activities of daily living … So if you don’t have five out of five, you don’t get Medicaid dollars. So you end up in an assisted living facility.”

He said that’s caused a disproportionate strain on assisted living facilities which are increasingly caring for more challenging residents who need considerable healthcare attention but are in facilities that aren’t overseen by the health department. And that’s in addition to the mounting mental health challenges facilities have also been forced to navigate among their patients.

“It’s not licensed by the Health Department, which I think shocks people, it’s licensed by the Department of Social Services,” said DeBiasi. “[And] yet, they can take people who have significant needs — they can take people who can’t bathe themselves, toilet themselves, dress themselves [or] feed themselves — which is a lot of care, but that’s not technically health care.”

Avula said throwing money at the problem isn’t the only solution. He also said he believes a complete reimagining of end-of-life and high-needs care is needed. He said that will require better supporting people so they can stay in their own homes or with family longer and relieve the pressure on long-term care facilities currently to accommodate so many Virginians.