What is the quality of Virginia's nursing homes? If you ask one advocate, he says "bad."

Jared Calfee, state advocacy director for AARP Virginia, said nursing home inspectors are "woefully" behind.

A possible legislative fix is a bill that would update what Calfee called the outdated fee structure for medical facilities.

The Virginia Department of Health would use those extra funds to increase recruitment and retention of inspectors. Calfee added understaffing can lead to worsening health for nursing home residents.

"What we know is that understaffing leads to negative outcomes, like pressure sores, falls, and ultimately sickness, and even death in a lot of cases," said Calfee. "And so the best thing that we can do for nursing home residents is ensure that there is adequate staff to provide quality care in our facilities."

The Virginia Joint Legislative Audit and Review Commission finds that nearly 40% of nursing homes are in need of their biennial state licensing inspection.

And the Commonwealth has the sixth highest proportion of nursing homes that have not been inspected within two years.

Another budget proposal would include $3.5 million to train Virginians as certified nurse aides, or CNAs.

CNAs provide the bulk of assistance within nursing facilities. Calfee said this small budget ask could have big impacts for nursing home staff.

"This is a high-demand area where we badly need staff," said Calfee, "so a program like this could take a relatively small amount of money, and hopefully infuse the workforce with badly needed staff - to make sure that our nursing homes can staff adequately."

A Virginia Health Care Association survey in 2022 found that 93% of facilities in the Commonwealth have openings for CNAs.

Michigan is home to more than 470,000 veterans, yet many have never accessed the military benefits to which they are entitled. The gap in support prompted a local war veteran to take action.

During the COVID-19 pandemic, nearly 200 Michigan veterans died by suicide, well above the state's average, and the number is growing.

Joshua Parish, president of the nonprofit service organization VETLIFE and an Iraq War veteran, is working to change it. His organization, which started in 2018, provides veterans with sustainable resources, free events and community support to help them navigate civilian life. Parish said one of their flagship events called VetFest attracts more than 3,000 people at each event.

"We have 60 resource providers that help connect the dots," Parish explained. "What we're seeing is one month after the VetFest event, a 60% increase in veterans going down to their local resources, which is what we want."

Parish emphasized his main goal is to educate and empower veterans to be their own best advocate. He believes by doing so, it will decrease the veteran suicide rate.

More than 8 million U.S. veterans are 65 and older, nearly half of the veteran population. Many face isolation, depression and struggles transitioning to civilian life, even decades later. As a veteran, Parish has battled mental health challenges himself. He added many feel a loss of purpose and betrayed by the government they once served.

"If you can give these veterans or help cultivate the sense of purpose, the sense of identity, and just make them feel like a person again, I feel like that's going to drastically reduce the veterans' suicide rate," Parish contended.

Many veterans rely on VA pensions, Social Security or disability benefits, making it crucial for them to know and access the resources they have earned.

Oregon's population, along with the rest of the country, is getting older. Within 10 years there will be more Oregonians age 65 and older than children younger than 18.

New legislation would establish a task force to create a blueprint for the state to prepare for the massive change.

Bandana Shrestha, state director of AARP Oregon, said having an older population will affect every sector of the state including housing, transportation and health. She emphasized the task force would bring representatives from many of these sectors to the table.

"It's not just the needs that we're going to be responding to," Shrestha pointed out. "People talk about aging as a net deficit in some ways. Aging also can be very positive."

Shrestha noted older adults benefit the state by contributing billions of dollars in unpaid care to other adults and children, as well as volunteer hours to schools and nonprofits. Public testimony for the bill has been overwhelmingly positive.

Rep. Mari Watanabe, D-Bethany, a sponsor of the bill, said the shifting age demographics will also affect the state's workforce and older people who want or need to keep working will be able to help fill in gaps.

"They bring skills, they bring knowledge, they bring their acumen that they've learned all through the years," Watanabe outlined. "To keep them in the workplace would be great for Oregon."

Shrestha stressed the need for financial support as more families care for older adults at home. She also highlighted the rising homelessness among older adults and urges state investment in housing for aging in place. Despite all the work needing to be done, Shrestha is optimistic about the plan the legislation lays out.

"It's proactive," Shrestha acknowledged. "It's not waiting 'til there is an emergency. We still have a nice timeline to work towards it. And everybody should be invested because it's about our future."

The Montana governor's proposed budget includes cuts to funding for senior long-term care. Those in the already-struggling industry said as more Montanans enter their 80s, a wider community will feel the effects.

Within the last three years, 11 of Montana's nursing homes closed in a single 12-month period. It adds pressure to those providers left, like Big Sky Senior Services in Billings, which provides payee services for over 100 people and offers in-home care for seniors on a sliding-fee scale.

Tyler Amundsen, executive director of Big Sky Senior Services, said keeping seniors in their homes as long as possible is the goal but there is usually a point where outside care becomes necessary.

"Then they're in crisis because we don't have enough places to send them," Amundsen observed. "Or the places that are available to send them aren't getting funded well. And so the quality of care is going down."

Amundsen added reimbursement rates are not keeping up with the rise of inflation. Gov. Greg Gianforte has proposed $50 million in cuts over the next biennium to senior and long-term care services via the Department of Public Health and Human Services, amounting to nearly 6%.

As there are fewer services and increased need, more people will likely become caregivers for family, which Amundsen emphasized will affect the workforce. He is predicting a trend called the "sandwich generation."

"They'll be taking care of their parents as well as their kids at the same time," Amundsen explained. "It just puts more strain on our communities to be able to do all the things we hope we can do."

He advises people and groups in the state pay attention to this rising issue now, before it worsens. Nearly 100,000 Montanans will enter their 80s this decade, nearly 70% more than did between 2010 and 2019.


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