My sister was in the MCHS, 550 S Carlin Springs Rd, Arlington, Virginia, for a short stay some of the caregiver were awful, no work ethics. No professionalism at all. Their were some professional nurses like (nurse Marie and Ann ) at the center, but some of them were as I said awful. They would not response to the call bottom, and the social worker (Tonya Joyner) were of very little help to us. . I asked to meet with her one afternoon I called her the day of and told her I was going to be a little late. She came to my sister’s room before I got there, she told my sister she would be right back that she had a meeting to attend. I waited for her for almost an hour and a half, I needed to leave so I went looking for her, I found her sitting in her office and not in a meeting. We mentioned to her that their was a couple of errors on the focus document we received and she reprinted the document with the same errors on the document. The document stated that my sister was a “Patient has a diagnosis of brain injury, comatose, dementia, late stage terminal illness”. The social worker told me at 2:00 o’clock Friday February the 4th, the day before my sister was scheduled to be released that my sister could not get a bed for home care. I asked her why we were just told, she said she just found out. What happen to communication between offices. Any way the social worker told me she would send me a list of places to get a hospital bed and help me get one for my sister. I have yet to hear back from her. All I’am saying is if this is how they treat short time care what happens to the long time care patients. I’am not only upset for the way my sister, and I were treated but for all the human being who look for care at places like MCHS. They are suppose to be there for people, but they don’t treat people right. Thank you!! Mary Gordon

My name is Laurie Coulter, I am representing AARP. We support House Bill 646. Both my parents were in a nursing home here in VA and were private pay. Staffing at the 2 different nursing homes where my parents resided were often understaffed and because my mother was a 2 person assist she had to wait for hours for 2 CNA's or a Med tech to get her in and out of her wheelchair and bed. Both my parents were never on Medicaid. Often the nursing homes were understaffed especially in the evenings and on weekends. Full Staffing was 2 CNA's for 16 people and the CNA barely had time to take care of the basic needs of the residents If another unit was understaffed they took a CNA from my mother's wing to another wing in the facility. My mother was paying $365/day or over $11,000/month and her care was minimal. She had to sit in her wheelchair for sometimes 60-75 minutes waiting for someone to change her or help her with any of her needs. I often had to call the nursing home when my parents would tell me that no on in the facility would come to help them go to the bathroom or take care of their needs, to get someone down to my parents rooms to help them. Staffing is the Biggest issue at nursing homes. The facilities do not have enough help for the number of residents. So the staff that is there is overworked and often leave the profession because of burn out from the number of residents the staff has to take care of. Virginia is one of the few states that does not have minimum staffing level per resident. Please support HB 646

Chairman Head and Members of the Committee My name is Laurie Coulter, I am representing AARP. We support House Bill 330. Both my parents were in a nursing home here in VA and were private pay. Staffing at the 2 different nursing homes where my parents resided were often understaffed and because my mother was a 2 person assist she had to wait for hours for 2 CNA's or a Med tech to get her in and out of her wheelchair and bed. Both my parents were never on Medicaid. Often the nursing homes were understaffed especially in the evenings and on weekends. Full Staffing was 2 CNA's for 16 people and the CNA barely had time to take care of the basic needs of the residents If another unit was understaffed they took a CNA from my mother's wing to another wing in the facility. My mother was paying $365/day or over $11,000/month and her care was minimal. She had to sit in her wheelchair for sometimes 60-75 minutes waiting for someone to change her or help her with any of her needs. I often had to call the nursing home when my parents would tell me that no on in the facility would come to help them go to the bathroom or take care of their needs, to get someone down to my parents rooms to help them. Staffing is the Biggest issue at nursing homes. The facilities do not have enough help for the number of residents. So the staff that is there is overworked and often leave the profession because of burn out from the number of residents the staff has to take care of. Virginia is one of the few states that does not have minimum staffing level per resident. Please support HB 330

I am asking that you vote to make facilities safer and protect those who live and work in Nursing homes.

I believe standards and good paying wages and benefits are essential for nursing home staff. I wouldn’t want my family members to receive substandard care, although I realize many care workers are kind, compassionate people ( we want them too). Ask yourself, would you prefer to be cared for by people well educated in the diverse needs of the elderly or someone who is just kind?

Comments Document

Please see attached comments from Margaret Rothenhoefer re: HB330/HB646

I am very concerned about the treatment of our seniors in nursing homes. The pandemic brought to light the lack of staffing, lack of supervision and training, lack of procedures and capabilities for so many of these facilities. As a result thousands of seniors needlessly suffered and many died. We need to change how we oversee nursing homes, how we pay staff, how we monitor treatments and services to this most vulnerable population. I urge you to consider the passage of these two bills to ensure the safety and security of seniors living in nursing homes.

It has been terrible and tragic to see what has happened at Nursing Homes during Covid. It should have not happened in the Most Powerful Country in the World. Now is our Chance to fix it. So Please do this and don't let this opportunity pass by. Thanks

HB 646 and HB 330 both should be passed. Covid - 19 proved that lives could be saved with proper staffing levels.

I'm writing in support of HB646 to establish minimum staffing requirements for nursing homes. For anyone that has had a loved one in a nursing home and spent any length of time visiting, the need for minimum staffing requirements is obvious. Without sufficient staff, residents that need assistance wait far too long for basic needs. I have witnessed residents being refused requests to go to the bathroom because it wasn't "time" for their toileting or because a meal was being served. Residents sit or lie in their own excrement resulting in not only a loss of dignity, but very real health implications. Insufficient staff results in a myriad of other issues from medications not being administered according to the prescribed schedule, residents falling when they try to do things for themselves, residents having to wait over a week for a bath and many other problems. Please vote to pass minimum staffing in the state of Virginia. We owe this to our most vulnerable residents.

Our elderly should not be considered a liability but a precious asset. Nursing homes need to provide their residents with high quality care by trained professional staff. This includes physical well being as well as mental health. A hug, a kind word, a smile go a long way. Ensure that nursing homes have the necessary assets to make this happen. Do the right thing!

Please pass these bills as I have witnessed personally how corrupt nursing homes are. I lost a grandparent who had bed sores all over her when she died in the nursing home. It was reported but nothing ever came of it.

We must treat our seniors respectfully when they can no longer care for themselves. They have worked all their lives, paid taxes, been a part of their communities and they deserve the best care that can be provided at this time of their lives.when living alone is no longer an option. It is simply the right thing to do.

Most seniors are vulnerable so can be subjected to terrible situations. One way to protect them is to have rules and regulations that govern nursing facilities. My wife was lucky because she had me to speak up for her when I saw something wrong at both facilities. Too many times seniors know not to say anything because the end result will be that things get worse! Please protect our seniors by sending these two bills forward. Thanks you, Jim Morris President AARP Chapter #284 Arlington

The current staffing of nursing homes is abysmal! Staff work long hours for very little pay and in the midst of the COVID crisis have had an extra layer of difficulty thrust on them. The state needs to assist here with minimum hourly standards of care, and by ensuring that there is long term funding to help cover the constantly rising costs of nursing care. As a 77 year old male who lives rurally, I know that when I need nursing care it will be 1) difficult to find and 2) expensive. I am part of the Boomer Generation and we will soon be flooding caregiving facilities and needing competent, skilled, enthusiastic and adequately paid staff to help us in our later years. Please ensure the passage of House Bills 646 and 330 to help address a current healthcare crisis, and one that will be getting even greater in the very near future.

Dear Virginia House of Delegates Health, Welfare, and Institutions Subcommittee members, I am writing to ask you to vote in favor of bills HB 330 and HB 646 to help ensure adequate staffing and funding to provide proper care for nursing home residents in Virginia. Over the past year, my 96-year old mother has had two extended stays in a nursing home in Maryland for physical and occupational therapy and now is in an assisted living home there. So I know the vital importance of having adequate levels of trained staff in such facilities. Residents of nursing homes in particular are typically quite disabled and really depend on trained staff to ensure that their medical and daily care needs are being properly attended. Such care is necessary to keep the residents from suffering further illness and injury, including bed sores, falls, urinary tract infections, embolisms, and other problems related to immobility and illness. I support staffing and funding standards to ensure that nursing homes and other such facilities provide proper care, not only for folks who already are in the facilities but also for the rest of us who may end up needing such facilities in the future. Thank you to the sponsors for proposing these bills and to the subcommittee for moving them forward. Best wishes, Henri

Dear Delegates of HHW subcommittee #3, Part of my role as AARP Virginia State President is to advocate for legislation that benefits people 50+ but today I am advocating for people of ALL ages who are captives of our nursing home facilities, people whose wellbeing, perhaps even their lives are dependent on the quality of the care they receive. These are the most vulnerable in our society and need people in your position in our esteemed General Assembly to protect them. I implore you to support the measures in HB646 and HB330 and vote to send them to the floor of the House of Delegates for passage. Thank you on behalf of all those who need your support!

Please vote FOR … HB646 which will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. Also vote FOR … HB330 which will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. Please vote FOR nursing home reform. Us older folks need and deserve these improved protections. Thank you.

You have the ability to provide this vulnerable group of people with the change they so desperately need. You, as legislators, bear the responsibility to your constituents to do the right thing for them and their families. Residents in nursing homes depend on the staff for everything. This group and their families have truly been devastated by the Covid pandemic and if you do not pass these bills, this population will be decimated. The nursing home industry has a responsibility to these residents when they bring them through their doors. These broad issues are not the residents' or their families' fault! Make the nursing homes honor their promise! Enough of letting the nursing home lobby harm your constituents! These are your people! Amanda Joyce Local Long Term Care Ombudsman District 12 Martinsville, Virginia

Nursing home residents are often the most vulnerable of Virginians. Nursing facilities cannot provide adequate care to their residents without adequate staffing. Please support the passage of HB 646 and HB 330 to provide standards for the number of direct care hours being provided to nursing home residents, support the bills to provide professional training to long-term care staff. They took care of us, we need to take care of them.

I have served as an advocate the rights of the disabled since 1982; I continue to serve in an advocacy role for those individuals receiving long-term services and supports. I have seen the highest quality of long-term care and I have seen the worst. The pandemic over the past two years has significantly highlighted the impact of limited / minimal staffing has had on the delivery of direct care services in the nursing facilities in the Commonwealth and it has reached the point of being a health care crisis. I understand that the legislators in the General Assembly are at pivotal moment to decide whether you support requiring nursing facilities to provide a MINIMAL DIRECT CARE HOURS or you allow the nursing facilities to determine whether they follow the "bottom dollar" pathway toward profits or have them provide adequate and appropriate care to the hundreds of thousands of vulnerable adults. No nursing home resident should be forced to settle for poor quality care; but that’s what’s happening at many nursing homes in Virginia. We are constantly aware of the chronic issues residents and staff face in nursing homes that have a direct relationship to inadequate staffing. Many of these issues include the development of pressure wounds, increase of resident falls, limited personal hygiene care, and restricted access to needed health care services both in the facilities and outside of the facilities. Nursing homes must be held accountable to provide safe, high-quality care for residents by trained professional staff. We understand that recruitment of staff, ongoing professional training, and measures for retention are equally vital. These bills provide a pathway to accomplish all of this. And if you are "on the fence" about deciding whether or not to support these bills, let me offer these short anecdotal moments to help you "see the faces" of the residents who could have benefited from what these bills have to offer: * Roy , who sat in his own body waste for almost 24 hours because of the shortage of staff (only 2 CNA's for an entire skilled nursing wing), and the direct care staff thought it was appropriate to stand in the doorway and "laid eyes on him" instead of providing him care * Gail, who waited 2 weeks for the linens on her bed to be changed after they were soiled * Denise, with limited mobility, was told that she had to get herself from the dining room back to her room because staff were being pulled in different directions due to limited staffing * Countless numbers of direct care providers who worked 16 hours shifts to ensure that they supported adequate coverage to care for their residents. With this being said, I am asking that you support the passage of HB 646 and HB 330 to provide standards for the number of direct care hours being provided to nursing home residents, support the bills to provide professional training to long-term care staff. I am confident that you will all stand up and support residents' rights to good care and let them know they matter. We are urging you to support these bills TODAY !!!

As a patient recovering from three different joint replacement surgeries and serious back surgery I spent weeks in three different nursing homes and experienced neglect, abuse and injury. I was served hot dogs for lunch, dinner and lunch the next day while on a doctor prescribed low sodium diet. I had to beg for prescribed pain meds administered by unqualified “nurses” who did not know my name or the name of the meds they were giving me. Nurses aides cleaned bedpans in sinks where I brushed my teeth and no one on staff spoke English. I nearly fell off a broken shower chair and waited at least 20 minutes for someone to answer my emergency call bell in the shower. You must require a better level of care for vulnerable patients. We are an aging population and our needs for qualified nurses, doctors and nutritionist will only grow and most of us grow old. Please care enough to pass protective legislation. All of my nursing home stays were in Springfield and Warrenton Virginia. So many “call bells” went unanswered . So many unqualified, abusive people were expected to provide care to the most vulnerable and elderly patients. The aides who injured me did not seek to hurt me, they were not trained on how to assist handicapped patients. They were not trained in how to properly maintain a healthy and clean environment. There were no standards of care or standards of facilities mandated by law. It falls to you to enact these basic standards under the law or greed for profit will continue to cause neglect, suffering, injury and death. Protect the most vulnerable citizens of Virginia who are depending on you.

Please, just check of your Mom and Dad and what you would want for them.

I speak in support of HB330. Today, in too many Virginia nursing homes, call buttons are going unanswered, and residents are suffering in the very facilities that are supposed to be caring for them. The resident is not calling for the CEO, or a lobbyist, or a legislator… they need nursing staff; however, understaffing is all too common. In 1999, the General Assembly directed a study be done regarding safe staffing in nursing homes. It was held awaiting CMS’s federal report being done at the same time. CMS reported to Congress in 2001 with recommendations of minimums that Virginia has YET to meet. Since 1999, at least 21 bills have been introduced attempting to implement safe staffing standards here in Virginia… 19 died in committee. After years of tabling legislation and especially now, upon the conclusion of a Senate directed two-year JCHC work-study, it is time for passage. HB330 even incorporates a JCHC work-study approved recommendation for staffing improvement. Opponents complain that safe staffing is too expensive… every year… with or without a pandemic. However, inadequate staffing also has costs for: medical errors, treating pressure ulcers, higher injury rates for staff & residents, hospital readmissions of residents and yes, death. Cost reductions resulting from improved staffing must also be included to provide accurate fiscal assessment of HB330. PLEASE make a difference… HELP those call buttons be answered! Pass this bill.

LIFE AS A NURSING ASSISTANT     I was a Nursing Assistant for 30 years Let me give you a look into the Life of a Nursing Assistant. Your 8 hour shift( 7am-3pm) consists of: Shift Report which could take up to 30mins, God forbid a nursing assistant calls out sick because now you get more residents added to your assignment. Passing food Trays (That's if the trays are on time from the kitchen). Feeding( Sometimes you could have 3 total feeds on your assignment, Some that are slow eaters), Bathing, and Dressing( This is the time  to monitor  your residents skin for signs of  breakdown. (REPORT YOUR FINDINGS TO NURSE IMMEDIATELY) (Depending on your assignment you could have some residents that are able to bathe and dress themselves and all you have to do is lay out their clothes, Make their bed and straighten their room. Now, On  to your Total Care Residents(Bathing or Shower(Yes, Total Care Residents  get showers) This is where your Training  comes in, so as not to injure yourself or the resident, you need to get help from your coworkers. Turning, Repostiong, Carefully assisting from Bed to Chair(This is where your training comes in so as not to injure your back or the resident. Yes, You may need to get the Hoyer Lift or Sit to Stand Lift( These devices help with getting a resident from bed to chair or vice versa. Depending on your Facility, you may need to go and get the device because it is shared with other floors. Now get your resident down to Activity or Dining Room or around the Nurses Station(Depending on your Facility). Once you are done with all your residents, use this time to Pass Ice and Water, Answer Call Lights and  start some of your charting. Your  bedridden residents have to be  turned every 2 hours,  Some  residents are having Activities or visiting with family. Lunch time:Pass and Feed again. You are given a 30min Lunch Break on Paper, However,  Some days its hard to take(Good Luck)   around 1pm or so your residents that want to go to bed for nap time,  can. You will assist them with diaper changes and transfer back to bed.  You try to squeeze in finish charting and last minute  requests from residents.  When your next shift arrives you will need to walk with them to each residents room and give them a report of your residents day, All while working in a Toxic Environment.....Come back tomorrow and do it all again....There are times that you will be pushed to your limit from dealing with pressure from department heads and you will need to  remember why you chose this profession and try to keep your morale up. I say all of this to say that a Nursing Assistant's job is Hard Work!  I met and built relationships with some wonderful residents and worked with some Amazing Nurses, whom I am still in contact with to this day.  I got into this profession because I wanted to help people.   Burnout and Low Staffing is a major cause of Abuse and Neglect. But, there has to be accountability.  Why is it that when these  corporations  want  to cut back, Staffing is a consideration?  These Corporations focus is MONEY!!! Not the welfare of the residents!  Because of this, Quality of Care is lacking and families will continue to suffer the outcome which is Death or Injury of their loved one. When State Inspectors come in, the facility has Nurses and Nursing Assistants falling over each other Fully Staffed! VIRGINIA YOU ARE BEING DECEIVED

I AM WRITTING IN SUPPORT OF HB330...My Dad, David Leland Jones went to Glenburnie Rehab on Libby Av for Physical Therapy, 5 days later he was dead. During my investigation( I was a Nursing Assistant for 30years) We found that he was complaining of pain and vomiting stool several times over the course of the day, and Glenburnie REFUSED to send him to a hospital 4 miles away! On this day Glenburnie had my Dad sign the Arbitration Agreement giving up his rights(My dad could not read very well, so he did not know what he was signing. To add insult to a grieving family, VDH refused to fine Glenburnie for their Negligence, even though in the investigators report they admitted that they were wrong and should have sent him to a hospital immediately. My dad David Leland Jones was Denied his right to get medical treatment and died face down on the floor of his room. Please pass this bill, Families are suffering. Not everyone is fortunate to have a house built for there elderly loved one and have round the clock care. OUR SENIORS NEED YOUR VOTE!!! https://www.wtvr.com/2017/04/11/man-dies-at-richmond-rehab-facility?_amp=true

I strongly support legislation that will establish minimum standards and funding for nursing home staff and care. As a resident whose family members have resided in nursing homes in the state, I have seen first hand the serious harm that has occurred due to inadequate staffing and funding of nursing home care. Nursing home residents are often the most vulnerable of Virginians. The grossly disproportionate death rates that these communities suffered from COVID should be a wakeup call for this Assembly and the Governor to act urgently to prevent more harm to the defenseless elderly and infirm in our nursing homes and to those who care for them. You can tell everything about the priorities of our state government from how it cares for its most vulnerable citizens. Please approve legislation that protects nursing home residents from needless harm.

Many testimonies have been given relaying personal horror stories of loved ones in nursing homes, which pull on all our heart strings. Almost half of complaints to the Virginia Office of the State Long-Term Care Ombudsman are related to staffing. Each case is sad, but this has not yet moved this Virginia Assembly to act. In 2020, I spoke before both the Senate and House subcommittees in support of legislation for safe staffing levels in our nursing homes. The House bill died in committee, as did the 15 previously proposed bills and the subsequent 2021 House bill. However, the Senate bill was amended to form a “Joint Commission on Health Care (JCHC) Nursing Facilities Workforce Workgroup” to study potential solutions. Today’s HB330 proposes implementation of an acuity-based staffing standard (one of the recommended resolution options reported to the Governor by the JCHC on January 7, 2022). Most often the downfall in the past has been insufficient funding. Per the JCHC report, the baseline estimated cost for this option would be $30.1 million, which would be partially covered by $10.7 million in Federal Medicaid funds. The 2021 Budget Item 313.LLLL.2.a called for DMAS to develop a unified, Value Based Purchasing (VBP) Program for Nursing Facilities under Medicaid. The program is targeted to begin on July1, 2022 with a budget of approximately $93.5 million. Under this Program, funds would be available to “participating” nursing facilities, some of which may be utilized for staffing. Virginia reportedly had a record surplus in 2021 of nearly $2.6 Billion and financial reserves of nearly $4 Billion. Governor Northam proposed onetime tax rebates for all individual tax filers. Additionally, he proposed $1.7 billion for Revenue Stabilization Fund, and $2.8 billion for capital projects in state government and higher education buildings. Each of these proposals price tags begin with B and not M. The baseline estimated cost of HB330 is about 1% of the 2021 surplus. Instead of investing in more buildings, it is time to invest in staffing the facilities that care for those who have spent their lives living and working in Virginia. Opponents will say this bill it is too harsh. They reported to the Senate Health Committee on February 3, 2022, that they felt like Moses “at the bottom of the Red Sea…look to the right and you see a wave coming at you because you are not being reimbursed enough…look to the left and you see a wave coming at you because when you want to hire people nobody shows up.” While Covid has complicated the issue, this was their similar argument in 2020 before Covid. Now the response is wait for the VBP Program in July. The legislature’s failure to resolve this issue is not monetary but a failure to place priority on the care of residents, many of which are senior citizens, in these facilities. SUPPORT THIS BILL

Virginia’s nursing homes are in crisis. The pandemic has shown us they need to have staffing standards to improve the quality of care. Either HB330 or HB646 would provide staffing standards. HB646 would have an hourly requirement of care per resident; HB330 would be based on an acuity standard of care. Please vote to report one or both of them out. The full HWI Committee needs to vote to improve nursing homes in the Commonwealth.

In regards to HB330 /Watts. : Nursing facilities cannot provide adequate care to their residents without adequate staffing. Accepting payment for services they do not provide is false advertising at minimum, but the stark reality is that it is abusive and neglectful.

Please look after our seniors. They all deserve respect and the best care. Just remember one day you may have to go to a nursing home, don't you want to be cared for?

Care for elderly : my wife had altzheimers for about 5 or 6 years. I quit my job to help her survive. Being a care giver is not a pleasant job..we need some changes to help these people in their last days, Put her in a nursing home for 2wks.until they told me that they could not handle her that I would have to move her. So, I went and got her and brought her home where she stayed until her passing. I was really pissed because I had looked everywhere for a home for her could not find.one that would help. Now I am in bad shape , wondering what is going to happen to me..,,

Please pass this nursing home bill to better staff and educate the needed staff for these facilities. The residents at nursing homes are usually totally dependent on employees at these facilities. With my own parent I have seen good care and sadly , poor care. The employees need better education, better pay. Some facilities are very lacking in knowledge regarding infection control . Nursing homes are in dire need of many improvements, this bill will certainly help.

Nursing homes need to provide adequate, safe, and proficient care for the residents in their care. There should be competent staffing in sufficient numbers to provide the care that these individuals need to be able to live in a safe environment.

I'm going to be brief because I know you have a lot of bills to consider. HB 330 & HB 646 seek to help solve the most urgent need in nursing home care. My mother spent her last years in a nursing home and I have considered them for myself because of my medical needs. What I've learned from my experience is that sufficient staffing is essential to quality care and this has been demonstrated most dramatically during the COVID-19 pandemic. If you don't have enough staff serious consequences will be the result. Please send these bills to the full committee with a recommendation to pass. Thank you so much for your consideration.

Please vote for nursing home residents and staff. Thank you for your attention.

Long before the COVID-19 pandemic, many nursing homes in Virginia were cited frequently for problems related to under-staffing such as pressure wounds and resident falls. Nursing homes and long term care facilities should be held accountable to provide safe, high-quality care for residents by trained professional staff. These state licensed facilities should all meet minimum standards of care. Trained and certified staffing ratios are critical elements of standards that should be set for these licensed facilities. Time and again commercial health providers have demonstrated their incapability to provide minimum standards of care for residents absent specific government regulations that also include stiff penalties for violations of such standards. I encourage you to develop and vote for such standards for nursing homes doing business within the Commonwealth of Virginia. Additionally, I encourage that provisions for stiff penalties be added to the legislative language currently under consideration.

Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff.

Every nursing home resident deserves quality care you must provide nursing home reform. Just put yourself in the future or your family member now who may have to experience poor quality of care and act accordingly. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. I pray you will act accordingly. Jo Ann Obie

Conditions in nursing homes and assisted living facilities are bordering on inhumane. My Dad lived in several, in an attempt to find a facility where they provided even just adequate care. He died before we could accomplish this. They are understaffed. The staff who do show up are overworked and burned out to the point that they just do not care. The residents and their families all suffer. Please vote for these bills!

I want to stress my support for nursing home residents and workers. Residents of nursing homes are very vulnerable and need our protection in all areas of their life to enhance their quality of life and keep them safe and as well as they can be. I support any measures that aim to enhance their protections. The persons who care for them need a living wage and programs that keep them well- trained, mentally and physically able to care for their patients in a reasonable, well managed environment. The profits of owners and management companies should come second to the welfare of the residents and their caretakers. Thank you.

Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. It is critical that you support this legislation. Peoples' lives and quality of care care are depending on you.

Please please pass nursing home reform. I struggled to keep my mother out of a nursing home. My wife’s family has not been as fortunate with theirs. The home struggles to keep Covid out, adequate staff and service’s. Going months without a visit. A continually struggle to make contact with their mother or even getting a response from the over worked staff.

Please pass nursing home reform. No nursing home resident should ever have to settle for poor quality care. That happens in many nursing homes in Virginia. These homes should be held accountable to provide safe, high-quality care for their residents by trained professional staff. These two bills checked above will make facilities safer, and protect those who live and work there. HB 646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum n number of nurse and certified nurse aide hours per resident per day. HB 330 will also require nursing homes to have a minimum staffing level and puts into place a long-term care services fund to help pay for the cost of increase staffing. Thank you.

I work in healthcare and have witnessed firsthand what it is like to try and care for people with insufficient staff. It can be inhumane to both caregivers and those receiving care. Nursing home administrators would love to have this bill not pass so that they can continue to profit.

Please vote yes to support Virginia’s nursing home residents! My friend was in a nursing home this summer and I visited I was appalled to see the poor conditions he had to endure. The nurses and supporting staff are stretched then and Virginia can and should do better for our elder and disabled friends and family.

Having worked in the past for the Association for Professionals in Infection Control and Epidemiology, and specifically with the nursing home specialists, I know that infection control regulations in nursing homes are often nonexistent and/or not enforced. This problem became extremely evident during the onset of Covid-19. Every facility should have an infection control nurse and be required to certify the caregivers in infection control. In 2020, my husband (68 yrs old w hip fracture) had to spend 50 days in a rehabilitation/nursing home facility (Potomac Falls Health and Rehab, Sterling VA). He was active in his care and overall the staff were very good, but he also experienced a number of serious problems. 1. Given wrong medication. 2. Pain medication went “missing” 3. Diet restrictions (pescatarian) and preferences (non fried) were often ignored and alternatives were non-existent to poor. Finally resorted to food delivery services. 4. Prescriptions filled by a pharmacy 50+ miles away. In one instance, patient’s spouse had to pu pain meds at a local pharmacy (or wait over the weekend). 5. 17 patients died from Covid during his stay. (He did not contract Covid.) Nursing homes need to be properly staffed (including a doctor and/or nurse at all times). Staff need to be certified in infection control to ensure proper training. Staff need to be fairly compensated. Fines must be higher and inspections more frequent. There are nursing homes in Fairfax County and surrounding area that doctors will tell you adamantly to avoid. They often have many multiple violations. Usually the poorest patients (Medicaid) end up at these facilities and they are the least represented patients. (The worst is Manor Care Health Services - Alexandria, 1510 Collingwood Road, Alexandria, VA 22308. ) Thank you for your time.

Please consider passing HB 330 and HB 646. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. These bills will help ensure improved cares for residents of nursing homes.

The state of elder care, particularly in nursing homes, in this country is a disgrace. My own father was left lying on the floor in a nursing home dining hall. Any congressman who fails to vote for these reform bills had damned well better be able to explain himself--or herself.

I'm writing in support of HB330. My mother, who passed away last year, spent most of the last two years of her life in a nursing home, so I learned first-hand of the lack of staffing at these facilities. My mother was often left unattended in a wheelchair long after she needed to be helped to the restroom or allowed to elevate her feet. She would go many days between being seen by a doctor or nurse practitioner. Standards are needed to try to ensure adequate staffing and care.

I urge you to support HB646 and HB330. If the subcommittee votes the bills down, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. No nursing home resident should ever have to settle for poor quality care. But that’s what’s happening at many nursing homes in Virginia. I urge the subcommittee and legislature to protect our most vulnerable neighbors and vote in favor of these bills.

As a former employee of a nursing home and now as an ordained Deacon with the ELCA (Evangelical Lutheran Church in America), I cannot stress strongly enough that staffing is never at the level to provide even minimal care to the residents of nursing homes. If you could have heard the threats I heard made to defenseless residents to keep them from complaining about the lack of care or seen the bedsores resulting from staffing shortages, you would consider this a mandate to “do unto others as you would have them do to you”, as Jesus said!

having worked in nursing homes for over 30 years, i have seen a wide range of care, unfortunately, many residents do not recieve the good care they deserve. please pass nursing home reform. the people living there deserve it

Please vote i favor of HB 330 and HB 646. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. Our nursing home residents deserve excellent care and our nursing home workers deserve excellent working conditions. Thank you.

My name is Lynda Grine & i am a retired RN, BSN after more than 30 years of practicing. I worked in nursing homes while i was a student & have had family members admitted to nursing homes. If you have the money, its best to sign up for life care. However, everyone i know does NOT have that type of financial backing!! Staffing has & will always be a problem. The aides come & go for a $0.50/hr raise in another facility. They’re jobs are very difficult, overwhelming & have physical demands most people would not do! The RN’s & LPN’s are a little more loyal. They pass meds & have very little patient contact. Until this area of nursing is elevated in professionalism, salaries & the staffing needed to provide the care our elderly are so deserving, nothing will change. Nursing Homes have been forced to hire travel nurses & aides, costing them the salaries of 2 people!! This is a bandaid approach they have to do currently but is NOT sustainable. If their benefits were comparable to hospitals & doctor offices, more people would stay put because of their investment in a 401k, life insurance, PTO & short & long term disability. People have to feel their worth at these jobs before they’d stay in one place or losing the 401k deposits. These are tough jobs & the patients are coming in much sicker than ever before. They need training to maintain & increase their skill levels. Our profession has always been known to eat the young, meaning we do not want to spend our time training new people, esp., new graduates! Its also long been known that working in a nursing home is the lowest of the lowest admired areas to work. Critical care nurses are heroes. No one wants to be looked down upon, paid less & work harder than anywhere else & no one to help you navigate the ropes!! Alot needs to change. For example, dietary needs to upgrade meals to be seen as palateable, tasty & nutritous. This is NOT happening. I’ve seen PB & J offered at dinnertime!! Is this what you want for your elderly family members? Food becomes more important because the elderly have little to look forward to. Hygiene is NOT where it should be at all. Laying in urine & feces will almost definitely produce skin breakdown. This is painful & preventable!! It’s a dirty, back breaking task, but someone has to do it! In summary, the nursing profession, administration, dietary & all other deartments in these facilities need to up their game! They need to hire quality professionals to actually do the work & be monitored frequently. People should be proud of what they do & where they’re doing it. Medicare & Medicaid have basic requirements & limited reimbursements. This needs to be addressed. Most patients will end up on Medicaid because of the high cost of care. Not to say they’re getting their moneys worth at all. I see a complete overhaul of the nursing home sector of healthcare!! It’s long overdue!! Thank you for your attention to this crisis in nursing homes. It cannot happen too soon, our loved ones are suffering!! Lynda Grine

I speak for three relatives confined to nursing homes over the past 24 years: Each person received poor treatment and staff had to be medically monitored and written up on several occasions for stealing personal items. The three relatives as patients received improper or no care for ADL's. The three relatives are deceased now; however, I would have wanted to spend quality time with them during my visits rather than addressing all of the healthcare, social service and maintenance issues. So, HB330-Watts and HB646-Carr need to be passed to protect me and others who enter the nursing homes now and in the future.

Simply wish to voice my concern for nursing home patients: at all times they should receive the finest individual care for not only their physical well being but also for their emotional well being. You folks know what I mean so I don't have to list all the matters that make nursing home care so awful and scary. Whatever time these seniors have should be given with love, care, concern, healthy, cleanliness and the finest medical and emotional care possible. I'm 83 and will never go to a nursing home in its present state.

Response to Virginia HB 330. It will always feel like the wrong time to do a difficult thing. Now, is ALWAYS the right time to do the right thing. The studies on Nursing Home staffing levels date back for years and the negative results of low staffing are documented and well known issues, as are the solutions. There are honorable and heroic healthcare workers fighting through challenges with gallant efforts to do what is best for their patients. They need your help as reports from previous years already indicate. “Staffing insufficient for quality care: U.S. Government Accountability Office (GAO)” | AUG 10, 2021, U.S. Government Accountability Office (GAO), https://www.gao.gov/products/gao-21-408 “Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations” | Published July 2019, Healthaffairs.org, https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05322 “Most nursing homes are not adequately staffed, new federal data says” | Jul 18, 2018, PBS.org, https://www.pbs.org/newshour/health/most-nursing-homes-are-not-adequately-staffed-new-federal-data-says “...in 2013 total national spending for paid long-term care services was almost $339 billion” https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf, | February 2019, CDC.gov, Vital and Health Statistics Series 3, No. 43 “Nursing Assistants provide as much as 80-90% of the direct care received...” | 2021 https://cna-network.org/career-nursing-assistance/ Respectfully, let us say what we won’t say out loud. Erase the images in your mind of feeble "old folks" who have lived a good life and their share of years. We are talking about mid-life and older Veterans, Mothers, Fathers, Grandparents, Brother and Sisters, and former Blue Collar workers, Scientists, Educators, Architects, Carpenters, Mathematicians, Nurses, Doctors, Dancers, Homemakers, Lawyers, and yes, even Politicians. We are talking about Americans, Constituents who need specialized care and happen to share a residences with similarities. Many of these Americans are ready to share their wisdom, life long lessons, skills, talents, laughter, love and advice if you would only ask. Let's all stop treating them like their days of contribution are over. I would ask you to get a detailed account of the billions of dollars collectively spent regionally and nationally each year. Begin to understand the true profit margins, wages at all employment levels and training before saying the right solution is cost prohibitive. We find the money to do what we must do. With all do respect Legislators, you can do better for these Americans. You must do better for these Americans. Your legacy is written not by how well you campaigned, raised money or even your ability to convince the public to give you their vote. Your legacy is written by what you do, even in behind closed doors, in honor of the oath you took to serve those in need. Please don’t count a number of responses from the public as an all inclusive instruction to vote no. Count the number of residents that need your help, now and for years to come. The past studies show you the trend. These maters do not resolve themselves. You already know the countless numbers of Americans counting on you to protect them. You actually already know the nursing homes you would and would not want to reside in should you need specialized care and why. NOW, is the right time to do the right thing. Thank you.

Please support HB330-Watts and HB646-Carr.

As a disabled senior citizen, I feel that nursing homes are at best a "warehouse for the elderly", and at worst, a place for exploitation and abuse. Seniors deserve to live with dignity, until their time comes to die.

I support, HB646 “establishing minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. I also support HB330 requiring that “nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing.”

If the subcommittee votes the bills down tomorrow, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing.

Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. I am writing in support of HB646 and HB330, which will make facilities safer and protect those who live and work there. Thank you.

I am speaking on behalf of all seniors my self included... we deserve the best care, including safety practices in place for our well being. Thank you

Help is needed for all nursing homes in the VA area. The following problems exist: • very little direct care given to patients • the room floors are filthy, sticky • insufficient staff • clothes often lost and not folded • no backup for equipment breakage…this effects patients that need to be holstered from the bed to a chair and back into the bed. • these facilities need to be monitored very closely to meet a higher standards than what they have now. •. HELP HELP HELP!!!!

Both of parents had strokes within 6 months of each other, making it necessaryfor them to be in nursing homes. For 3 years, until they both passed away, I was deeply involved in their lives . . . and care. I lived within 10-45 minutes of the various facilities where they were and was able to be there many times during the week after work and always on weekends. This enabled me to monitor the level of care they received. My Husband's mother was also in a nursing home and her care received the same level of attention. In many cases, the level of staffing was not sufficient to give the the care they needed, resulting in bed sores, frantic calls for help, etc. I strongly urge you to pass HB330 and HB646.

Please pass these two bills to provide better care for nursing home residents, and to protect those that live and work in nursing homes.

If the subcommittee votes the bills down tomorrow, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. No nursing home resident should ever have to settle for poor quality care.

I pray that all of you voting will vote for the safety of the residents and staff in all the homes. Please set a higher wage for workers so the turnover will not be so high. Please put in place laws that will protect the residents. They all need your votes for positive change and protection.

Good afternoon I am a registered nurse and I would like to request that you support nursing home staffing standards. This measure will go a long way to ensure adequate staffing. Adequate nurse staffing has been shown to reduce adverse events such as trips/ falls, bed sores, infections, medication errors, delayed care and unnecessary hospitalizations. All of these adverse events are costly and harmful. I also believe adequate nurse staffing will go a long way to improve nurse retention. The nursing profession estimates 30% of nurses will leave/ retire by 2030. We are already experiencing nurse shortages causing facilities to limit admissions or close. It is the right thing to do for both patients and staff. Most importantly-improved staffing ratios will be a cost saving for our state. Thank you for your consideration of these house bills. Marjorie Cohen RN BS MA

As a Cna, I have seen employers work with as little help as possible, just to save money, when others were begging to work, it happens everywhere. If affects the quality of care, and more accident occur when staff is short. As a CNA WE HAVE TO DO AND WORK AS WE ARE TOLD OR WE LOOSE OUR JOB EVEN WHEN WE KNOW ITS NOT RIGHT.. I AM A CNA OF 38 YRS. NO LONGER RENEWING MY LICENSE.

The Northern Virginia Aging Network (NVAN) strongly supports the establishment of nursing home staffing standards now. and we appreciate De. Watts sponsorship of the Joint Commission on Health Care recommendations. Virginia is one of only 18 states without staffing standards -- and with our high Medicaid level of care criteria, we have residents among the frailest in the nation, so the need for standards is even greater. Staffing standards would in human terms reduce pressure ulcers, reduce infections, reduce hospital admissions. Facilities with a high proportion of poor residents on Medicaid, often with low staffing and low CMS ratings especially need staffing standards to help prevent these occurrences. A strong feature of HB 330 is the establishment of a Long-Term Care Services Fund to help pay for the costs of implementing a staffing standard. The provision of a range of intermediate sanctions is also a valuable tool. Thank you. Erica Wood, NVAN

until we mandate staffing in nursing homes residents will continue to get minimal care at high prices The chains have one thing in mind profits. The first are of trimming the budget by cutting the staffing.These chains will never staff appropriately until they are made to

Comments Document

My Mother, Merlene Alma Cartwright, was a resident of Bonview Rehabilitation and Healthcare. During her stay at this Facility, I was privy to seeing just how broken the system is when it comes to the care and concern regarding our vulnerable elderly in these facilities, as well as the environment that CNA's in particular, are working in. My mother sat in her wheelchair with life-threatening issues as a direct result of neglect and various incidents of abuse while I was on the phone begging the nurse in charge to please check on her because I was unable to get her on her cell phone. She insisted she had just checked on her and she was fine, that she had just given her her medicine and was fine. I knew something was very wrong and insisted that someone check on her. After ten minutes of this, she decided 'I'll check on her, but I'm telling you she's fine.' The next call seven minutes later was to say 'we are calling the ambulance for your mother'. When I arrived at the emergency room, she was non-responsive. The EMS attendant said after the state they saw her in, they chose to take her to Chippingham Medical as opposed to MCV because it was life or death. My mother's oxygen level was at 34. Her heart rate was very low. Prior to all of this, My mother's cardiologist ordered a CPAP machine and oxygen to help her breathe. The nursing facility did not adhere to the order. Upon returning to the cardiologist, she stressed again the urgent need for both CPAP and oxygen in order to help my mother breathe. It was not fulfilled. My mother never made it out of the hospital. This was two years ago, and it still feels like yesterday. This is one of many, many stories I can tell you about the abuse and neglect she experienced at the hands of Bonview Rehabilitation and Healthcare. There was no accountability for what happened. Many families have reached out to our Organization to tell their experiences, many of whom are going through the same or worse at present. We feel that this Bill is a first step toward what appears to be a long journey toward ensuring that our elderly and those entering a nursing facility for physical therapy, have a chance to receive quality care as they deserve to. This Bill also will put a foundation in place for administration within the facility to begin creating schedules for CNAs and nursing staff fairly and appropriately that will provide a better quality of care for residents. For too many years this issue has been selectively ignored by our government, and it must not be ignored and longer, as lives are at stake here. Why should one live all their years as a part of society, contributing to society, to end up abused and neglected in a facility that is bound by law to provide proper care to the individuals that they accept within the facility? There is absolutely no reason for it. It is hoped that this government in Virginia will no longer have a blind eye and deaf ears to the cries of nursing home residents and their families, for profit. My mother's life was priceless, and what I personally journeyed through during her time at this nursing facility seems to be quite common, and that is unacceptable. Please pass this bill so we can move forward toward change and save lives!

I am writing in support of HB 330, which provides for staffing mandates for nursing homes. While I am aware that the pandemic has caused tremendous upheaval in healthcare staffing at nursing facilities, I believe this is temporary. I know there were shortfalls in staffing prior to the pandemic, but I would venture to say the reasons for that may be different than the reasons for the shortfall during the pandemic. In the long term, patients/residents can only benefit from much needed guaranteed staff ratios. The nursing home where my family member resides had this statement on their website: “…legislation is being considered by the state to implement unattainable staffing standards that could potentially put access to care for seniors at risk. Here’s how you can help, please take a few moments to email your legislators today urging them to oppose legislation that would implement staffing standards. Your email would encourage other solutions to help nursing homes remedy the staffing crisis like improvements to the Medicaid rate, which pays for the care of 6 in 10 nursing home residents and doesn’t currently cover the cost of this care and clinical staff workforce development initiatives.” I can only speak from my long experience with “for profit” nursing homes. With few alternatives for the average person, they provide a necessary service for some of the most vulnerable people in our community. This care is not free, but when residents who CAN pay are paying upwards of $9000 a month, where is all that money going, in addition to state provided funding, if in the end the residents are not even guaranteed appropriate staffing? A mandate would not solve the present problem of lack of supply of workers, but it would ensure that when supply improves, those workers will have the support THEY need to do a very difficult job by having appropriate staff levels. Money should not be thrown at nursing homes without the expectation of reasonable service. Money needs to go to better training for these employees and for better pay for well trained, knowledgeable employees.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I am Amy Clodius, epilepsy advocate and mother of twin daughters with epilepsy. Ashton is 25, and Madison is forever 22. My daughters were diagnosed in 2009 and through many medication adjustments, emergency hospitalizations and a helicopter ride to VCU medical system when one went into status epilepticus, we have been living with epilepsy. We were made aware of the risks and followed all of the suggested protocol. Of special notice, were the warnings of my daughter's having seizures while driving, swimming or bathing. We were warned of head injuries during a seizure. I was never warned of the possibility of SUDEP. My daughter, Madison Rose Clodius who was engaged to married was a massage therapist at the Advanced Wellness Centre. She had a petit mal seizure on May 10, 2019. She recovered quickly and went home to rest that evening. A petite mal seizure does not indicate a trip to the hospital. Maddie went to sleep that evening and she never woke up. She did not hit her head, she did not have a car accident, she did not drown. She never woke up on May 11, 2019. Her cause of death on her death certificate was "death due to epileptic seizure." So, maybe we are "lucky" that we are one of the statistics. The 1 in 1,000 we never heard about. I never was given information that she was at a high risk of SUDEP. I have to think that one reason we were not informed of the risks of SUDEP is because the risk is so "rare?" My hope is that with this bill, there will be more realistic statistics, and therefore more research and warning of the risks of SUDEP. I am the voice of my daughter Madison Rose Clodius. I am her hands and her feet, and I will do all I can to get this legislation passed for all those with epilepsy, including my daughter Ashton, who is a twin-less twin. Thank you for your consideration.

As a patient recovering from three different joint replacement surgeries and serious back surgery I spent weeks in three different nursing homes and experienced neglect, abuse and injury. I was served hot dogs for lunch, dinner and lunch the next day while on a doctor prescribed low sodium diet. I had to beg for prescribed pain meds administered by unqualified “nurses” who did not know my name or the name of the meds they were giving me. Nurses aides cleaned bedpans in sinks where I brushed my teeth and no one on staff spoke English. I nearly fell off a broken shower chair and waited at least 20 minutes for someone to answer my emergency call bell in the shower. You must require a better level of care for vulnerable patients. We are an aging population and our needs for qualified nurses, doctors and nutritionist will only grow and most of us grow old. Please care enough to pass protective legislation. All of my nursing home stays were in Springfield and Warrenton Virginia. So many “call bells” went unanswered . So many unqualified, abusive people were expected to provide care to the most vulnerable and elderly patients. The aides who injured me did not seek to hurt me, they were not trained on how to assist handicapped patients. They were not trained in how to properly maintain a healthy and clean environment. There were no standards of care or standards of facilities mandated by law. It falls to you to enact these basic standards under the law or greed for profit will continue to cause neglect, suffering, injury and death. Protect the most vulnerable citizens of Virginia who are depending on you.

Please look after our seniors. They all deserve respect and the best care. Just remember one day you may have to go to a nursing home, don't you want to be cared for?

As a disabled senior citizen, I feel that nursing homes are at best a "warehouse for the elderly", and at worst, a place for exploitation and abuse. Seniors deserve to live with dignity, until their time comes to die.

I pray that all of you voting will vote for the safety of the residents and staff in all the homes. Please set a higher wage for workers so the turnover will not be so high. Please put in place laws that will protect the residents. They all need your votes for positive change and protection.

My son was diagnosed with Juvenile Myoclonic Epilepsy (JME) that consist of uncontrollable, brief shock-like jerking movements in one or both arms and legs, at the age of 15. Before we knew what it was, we thought he was just very clumsy. He was always falling or dropping things. As a parent, you think you know everything about your kids. When he was 4 y/o, I realized that he would stop breathing in his sleep for a couple of seconds. I informed his pediatrician, he was referred to an ENT doctor where we found out that he had enlarged tonsils and adenoids and had to have them surgically removed. He had his first surgery at 4 y/o. So how did I miss this? I had seen seizures before. I took care of patients who had seizures but I did not know what this was. Johnell had numerous injuries from his falls, the last one fracturing his jaw. When he was in high school, we had to adjust his schedule for his safety, utilize accommodations through the school, and he had to change events he participated in with track. My son is now 18 y/o, second semester freshmen at Longwood University. I'm extremely thankful that his seizures are controlled on medications to where he's able to function in life. He knows his triggers and is more open about his diagnosis. As a parent, I will always have fear of losing my son to SUDEP because of his epilepsy. No parent wants to bury their child or not have answers as to how they died. "Inconclusive" is not an answer. I support this bill 100%. I'm not sure if you know anyone who has seizures or epilepsy, but if not, please consider those who are actually living with this reality.

I lost my son Barry Raphael Adams at age 30 to SUDEP, so this bill is of great importance to me, other grief-stricken parents, and the epilepsy community of Virginia. My son was diagnosed back in 2013 with Epilepsy and suffered many bad episodes which landed him in the hospital on several occasions. One incident where he was in a coma for 3 days and upon waking he had amnesia and couldn't remember who he was nor his family. He has been to numerous doctors from Virginia to New York, seeing specialists undergoing studies to help gain control of his condition. He was restricted from driving because of how severe his seizures were. The battle with this condition ultimately took his life during the time of him launching his vegan food truck business. The Epilepsy Foundation of Virginia would provide this training for free. National health organizations like the CDC, Epilepsy Foundation, and NIH support this legislation. The states of Connecticut, Illinois, New Jersey, New York, and North Carolina have already passed this law. Virginia can be next. I ask that you support this bill and that you encourage your colleagues to do the same.

As a constituent and member of the epilepsy community in Virginia, I am urging you to support the bill on Sudden Unexpected Death in Epilepsy (SUDEP) investigation of deaths (HB 392). I am the mother of twin girls, both diagnosed with epilepsy in 2008. My daughter, Madison Clodius died at age 22 as a result of a seizure. Her death certificate cites her cause of death as: seizure due to epilepsy. She did not drown, she did not hit her head, she did not have an accident. These were all risk factors explained to me from her neurologists. Despite what I considered top notch medical care I had never been warned of the risks of SUDEP (sudden unexpected death in epilepsy). The aforementioned bill asks that medical examiners participate in a training developed by the Epilepsy Foundation of Virginia that provides guidelines for the proper identification of sudden unexpected death in epilepsy (SUDEP). I urge you to support this bill and to ask your colleagues to support the bill and help move it forward.

I lost my son, Jonathan, at 21 years of age to SUDEP, so this bill is of great importance to me, other grief-stricken parents, and the epilepsy community of Virginia. My son, Jonathan, had his first seizure at fifteen months old and was officially diagnosed with epilepsy at the age of five. As a result of his father's status as a veteran Jonathan received excellent care from the neurologists and epileptologists at Walter Reed National Military Medical Center in Bethesda, MD. However, despite receiving a Vagus Nerve Stimulator (VNS) implant, adoption of a ketogenic diet, and taking five different highly potent medications three times a day, when he was sixteen years old Jonathan's seizures could no longer be controlled. Although we were informed about the possibility of SUDEP, my family was not prepared to actually experience it. On the morning of his passing (January 3, 2020), I spoke to Jonathan and made breakfast for him, as usual, prior to going to work. He was upbeat and happy and there were no indicators of the tragedy that our family would later endure. When I returned home that evening, I checked on Jonathan. He was in his bed and appeared to be sleeping. Since it is common for epileptics, to include Jonathan, to require considerable amounts of sleep this was not an anomaly. Later that evening, I checked on him again, this time more thoroughly, only to discover that my bright and talented son had passed away in his sleep, the result of a seizure that he had suffered earlier that day. Notwithstanding all of the epilepsy related challenges that Jonathan faced, to include frequent visits to the Emergency room and numerous hospitalizations, he enjoyed a well-rounded life. Jonathan persevered and was able to graduate from Potomac Senior High School on time with his twin brother Christopher. At the time of his passing, Jonathan was enrolled and taking courses at Northern Virginia Community College in pursuit of his degree. As he managed the challenges associated with epilepsy, Jonathan predicted that he would, in his words, “die early”. Sadly, this is a reality that many children and adults with epilepsy face. Jonathan also often lamented on the fact that epilepsy is not a well understood medical condition. In one conversation with Jonathan, he said that he wished “he had cancer instead of epilepsy.” When I asked him why, he provided a simple response. "People understand cancer, but not epilepsy.” These words will forever echo in my mind and heart. The loss of Jonathan has devastated my family. However, passing HB 392 (Sudden Unexpected Death in Epilepsy; investigation of deaths) can be a first step in ensuring that other families do not experience this same heartbreak. Though SUDEP is similar to sudden infant death syndrome or SIDS, it is a less recognized cause of death. SUDEP is misunderstood in the medical community and there isn't much information about what causes it. More research is needed to identify its triggers, which is why it's important that we accurately know how common it is. SUDEP reportedly kills 3,000 Americans each year, but the number is believed to be an underreport because medical examiners don't always look for it. HB 392 would change this by requiring medical examiners to receive training in epilepsy and SUDEP and establishing a process for its reporting to the North American SUDEP Registry, a global leader in epilepsy research.

I lost my son Todd Mathis Parker, 31, to SUDEP, something I had never heard of before, so this bill is very important to me, other grief-stricken parents, and the epilepsy community of Virginia. My son Todd suffered his first tonic clonic seizure in middle school. He was diagnosed with a seizure disorder and was put on medication. Despite being called “seizure boy” at school, Todd enjoyed an active lifestyle: swimming, skiing, collecting arrowheads and fishing in Swift Creek Reservoir. Following high school and community college, he landed a job with Capital One and moved out on his own. Because of his health issues, Todd was a compassionate soul. He studied very hard to become an EMT with Manchester Rescue Squad. He wanted to give back and save lives. One evening in 2006, I received urgent calls from Todd’s friends who hadn’t heard from him all day. We raced to his house to find emergency vehicles everywhere. Todd was found dead, lying face down beside his bed with no sign of trauma. Our world was shattered that night. Had we known about SUDEP and its risk factors, my son might be here today. The medical examiner who handled Todd’s case had never heard of SUDEP, nor had the Richmond Ambulance Authority that rushed to his house. They all have now. Hundreds of people came to honor Todd at a memorial service at the edge of the lake where he loved to fish. The next day, his sister posted a question about sudden death on the Epilepsy Foundation website. A grieving mother in Montana responded that her 33-year-old daughter had just died in the same manner as Todd. It was the first time I heard the term SUDEP. We searched for more information online and were shocked to learn we were not alone in our grief. I called Todd’s neurologist to ask him why he had never warned us about SUDEP and he said, “Because you wouldn’t have let him live a normal life.” More research is needed to identify its triggers, which is why it is important we accurately know how common it is. SUDEP reportedly kills 3,000 Americans each year. The number is believed to be under-reported because medical examiners don't always look for it. HB 392 would change this by requiring medical examiners to receive training in epilepsy and SUDEP and establishing a process for reporting to the North American SUDEP Registry, a global leader in epilepsy research. Fortunately, the medical examiner helped provide Todd’s DNA to the registry and a research study STOP SUDEP at Baylor College. The Epilepsy Foundation of Virginia would provide this training for free. National health organizations like the CDC, Epilepsy Foundation, and NIH support this legislation. The states of Connecticut, Illinois, New Jersey, New York, and North Carolina have already passed this law. Virginia can be next. I ask that you support this bill and that you encourage your colleagues to do the same. Supporting this bill and bringing awareness to SUDEP will surely help save lives.

As a parent of a child with epilepsy, I have held my breath every morning before walking into her room, or waited to hear her move, to know she has survived the night. I check on her throughout the night - every night. SUDEP is real. It is much like the feeling you have as a young parent checking on your baby throughout the night, touching her to make sure she is breathing. Imagine that feeling never ending. That is epilepsy and the very real fear of SUDEP. By passing this bill you are affirming the very real need for a cure - but without DATA there will be no CURE. Please, Virginia, help put an end to SUDEP.

The Epilepsy Foundation of Virginia, representing more than 84,800 Virginians with epilepsy strongly supports this legislation. SUDEP is misunderstood in the death investigation community and often goes unreported. Underreporting SUDEP, which is currently known to kill about 1 in 1,000 people with epilepsy and 3,000 Americans annually, is a disservice to the epilepsy community. Death incidence informs research funding. The same research that could in the future prevent SUDEP. So, we're asking that medical examiners take a one-hour training (provided for free by the EFVA) every 3 years to ensure they are up to date on protocols for investigating and identifying SUDEP. Upon a finding of SUDEP, medical examiners are to report this finding to the North American SUDEP Registry, a global leader in epilepsy research. This legislation is supported by the Epilepsy Foundation, CDC, NIH, and other nationally recognized healthcare organizations. It has been passed in five other states: CT, IL, NJ, NY, and NC.

I have a personal experience with SUDEP. My precious daughter, Elizabeth died on June 18, 2020 from SUDEP. She was a 26 year old college graduate who wished to live a full life without epilepsy but suffered daily with epilepsy and side effects. She died in her sleep, in her bed. Her wonderful neurologist at VCU, who specializes in epilepsy, talked to the first responders over the phone about epilepsy and SUDEP. As a result, SUDEP was listed on her death certificate. I am afraid that many SUDEP deaths go unreported. And many more lives will be lost. As a member of the epilepsy community in Virginia, I am urging you to support the bill on Sudden Unexpected Death in Epilepsy (SUDEP) investigation of deaths (HB 392). This bill asks that medical examiners participate in a training developed by the Epilepsy Foundation of Virginia that provides guidelines for the proper identification of sudden unexpected death in epilepsy (SUDEP). The bill was referred to the Committee on Health, Welfare, and Institutions and I urge you to support this bill and to ask your colleagues on this committee to support the bill and help move it forward. Epilepsy is a disorder of the brain causing reoccurring seizures affecting a variety of mental and physical functions. 84,800 Virginians live with epilepsy. There is a wide range of seizure types and control varying from person-to-person. About two thirds of those with epilepsy take seizure medication that helps them lead perfectly normal, seizure-free lives. However, the remaining third have drug-resistant epilepsy. This means that medication is unable to control their seizures. One in 150 people living with uncontrolled seizures each year die of SUDEP. While SUDEP is most common in those with uncontrolled seizures like Jonathan, it can happen to anyone with epilepsy. Each year 1 in 1,000 people with epilepsy, even those who have been living seizure free, die of SUDEP. SUDEP is quite similar to sudden infant death syndrome—commonly known as SIDS. However, unlike SIDS, SUDEP is not a sufficiently recognized or studied cause of death. A diagnosis of SIDS is made after an autopsy and death scene investigation determine no other cause of death. However, SUDEP is often not indicated as the cause of death for those, which it affects. While the Virginia Office of the Medical Examiner’s office lists helpful information and resources on SIDS, including a reporting form, there is nothing on SUDEP. This public health disservice prevents loved ones from getting proper closure and cuts advancements in epilepsy research short. HB 392 would require the medical examiners receive the training needed to properly investigate and identify a SUDEP case. Upon the finding, the medical examiner would need to notify the North American SUDEP Registry, which tracks all SUDEP deaths for funding and research purposes. The need for this law is clear. SUDEP deaths are under -reported despite it killing an estimated 3,000 Americans annually. Accurate reporting of SUDEP deaths helps advance research on its triggers and preventative measures—of which there exists little today. Five other states — Connecticut, Illinois, New Jersey, New York, and North Carolina have already passed this law. Virginia can be next. Several state and federal organizations, the CDC, Epilepsy Foundation, and NIH support this legislation. I urge you to support this bill and to ask your colleagues to support the bill and help move it forward. Susan Dalton

Comments Document

The Healthcare Distribution Alliance (HDA) once again would like to respectfully voice it's opposition to HB 478 and to a drug importation program. We would also like to request that the committee vote to continue the bill to 2023, since there are too many concerning factors for this bill to safely move forward in 2022. The main concerns regarding the implementation of a drug importation program in Virginia that we would like to highlight for the committee are: - that it would conflict with the United State’s highly efficient and secure drug supply chain system, protected by federal law through the Drug Supply Chain Security Act (DSCSA). This is especially significant since enhanced drug security requirements though the DSCSA will be going into effect in 2023. -that it would significantly increase the likelihood of allowing counterfeit or contaminated medications to enter the U.S. supply chain, putting Virginia patient safety at great risk. HDA is the national trade association representing primary healthcare wholesale distributors — the vital link between the nation’s pharmaceutical manufacturers and more than 180,000 pharmacies and other healthcare settings nationwide. Please see the attached full letter for more details regarding our concerns, and contact us with any questions. Thank you for your consideration. Sincerely, Kelly Memphis HDA

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Comments Document

I have submitted written testimony outlining the reasons a program like this cannot be implemented, including: Canada’s ban on bulk exports designed specifically to stop programs like these; and The fact that state Medicaid programs already get better pricing than Canadian provinces and therefore cannot save money by importing Canadian medications. Both Florida, Colorado and New Mexico have all applied to HHS to ask for permission to operate a Canadian drug importation program, and Florida has even committed $40 million to set it up, with $10 million spent so far. To date no state has received federal approval and at each stage, Canada has placed stronger restrictions on any Canadian wholesaler who would consider contracting with a U.S. state. I know that removing financial barriers to healthcare are an important priority for elected officials at every level of government. However these programs cannot be implemented in the current environment and are poor candidates for addressing these barriers. Thank you for your consideration, Shabbir Imber Safdar Executive Director, Partnership for Safe Medicines www.safemedicines.org

Comments Document

On behalf of the Healthcare Distribution Alliance (HDA), I would like to thank you for the opportunity to submit for the record our views regarding HB 478, which would establish a Wholesale Prescription Drug Importation Program in Virginia. HDA is the national trade association representing primary healthcare wholesale distributors — the vital link between the nation’s pharmaceutical manufacturers and more than 180,000 pharmacies and other healthcare settings nationwide. We oppose HB 478 and offer these comments to respectfully express our concerns regarding the implementation of any Drug Importation program, and most importantly our concern that it would conflict with the United State’s highly efficient and secure drug supply chain system, protected by federal law. This bill would also significantly increase the likelihood of allowing counterfeit or contaminated medications to enter the U.S. supply chain, at great risk to patient safety. Canadian importation conflicts with US federal law (Drug Supply Chain Security Act). The U.S. pharmaceutical supply chain is the most sophisticated, efficient, and highly secure drug supply chain system in the world, and the security of the supply chain was further strengthened in 2013 by the passage of the federal Drug Supply Chain Security Act, commonly referred to as DSCSA. The DSCSA adopted a comprehensive, practical approach to increase safety, continue efficiency, and minimize inconsistencies among competing state requirements. Drugs that are sold or designated for sale in Canada and other countries do not conform with U.S. traceability regulations, nor would these countries be required to modify or change their regulations to comply with U.S. law. Allowing for the importation of drugs from Canada or other countries would impede the efforts of the DSCSA regulations in further securing the U.S. supply chain, and thereby increase the risk of illegitimate or counterfeit medications entering the U.S. market. HDA recognizes this measure includes a provision for Virginia to comply with the DSCSA to “the extent feasible,” but we do not see a way for this compliance to be achieved. Additionally, drugs approval by the FDA are contingent upon the strictest guidelines for product integrity, good manufacturing practices, scientific data analysis and public safety. Although there are drugs available for sale in Canada or other countries that may be priced at a lower cost for varying reasons, it is important to recognize other countries’ regulatory agencies have different approval guidelines, dosage recommendations, and quality assurances. Internationally manufactured drugs are susceptible to counterfeiting, containing insufficient or too much of an approved medicine’s active ingredient or to being contaminated by unsanitary manufacturing conditions. It should also be noted that Canada has consistently expressed its unwillingness and incapability to become a supplier for the United States’ demand for prescription medicines over the past two years, stating that Canada’s market is too small to meet U.S. demands, importing drugs from Canada would not significantly lower U.S. prices, and Canada’s priority remains ensuring a steady and affordable supply of pharmaceuticals for Canadians. To protect patients and uphold U.S. standards, the Healthcare Distribution Alliance respectfully opposes this bill. Thank you for your consideration.

Comments Document

The Healthcare Distribution Alliance (HDA) respectfully opposes HB 478 and offer the attached letter to outline our concerns regarding the implementation of any Drug Importation program. In the letter, we highlight to the members of Subcommittee #3 the ways a drug importation program would conflict with the United State’s highly efficient and secure drug supply chain system and with federal law, as well as significantly increase the likelihood of allowing counterfeit or contaminated medications to enter the U.S. supply chain, putting the safety of Virginia patients at great risk. Please see the attached letter for more information, and thank you for your consideration. Sincerely, Kelly Memphis Director State Government Affairs, HDA kmemphis@hda.org

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Comments Document

Please see attached support letter for HB 481, including a presentation of the evidence as to why the bill is so important for health care purchasers in the Commonwealth. Thank you!

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Comments Document

Please see the attached letter explaining the National Community Pharmacists Association's support for HB 560.

Honorable Delegates: I hope you allow me to speak to the issue. Though I am not a resident of Boykins, I am licensed to practice Pharmacy in Virginia, and I did own a Pharmacy there for sixteen years, a Pharmacy that had been in existence for decades. It is now closed because of the issue this bill will help to address. Up until the last five or so years of this Pharmacy's history people were free to choose where they wanted to have their medications filled. When the PBMs gained control of prescription dispensing by dictating terms of place and price all freedom disappeared. There were several industries in the area who contracted with the PBMs for prescription insurance that mandated that maintenance medications had to be filled by their mail-order or chain pharmacies. Private policies did the same. When that happened the prescription volume, total patient traffic, and profitability went below a sustainable level. I was forced to close. With the closing went the loss of decades of service to a community of 600 people. Service that included immunization services, compounding service (humans and veterinary), disease state counseling, medication therapy management, and after-hours emergency availability, plus knowing patients one-on-one and their needs. That is all gone. Now, those 600 people, not the wealthiest, have to drive 16 miles one-way to Franklin, or Emporia (~30miles), Murfreesboro, NC (18 miles), Conway, NC (now closed) to purchase any prescription or wait for the mail to come, which adds to the cost of healthcare. Their freedom has been taken away. Their access to one on one -get your questions answered in a way that helps because I know you- healthcare is gone. Prescriptions to PBMs are just a means of profit and profit only. They have no interest in the person in need of medical assistance. That is why they dictate by place and price access to medications. Passing this legislation will at the very least let people know they DO HAVE A CHOICE. It will not correct the past, but my prayer is that it will stop the erosion of healthcare. Healthcare, by definition, was meant to be one-on-one, not en masse. This will at least allow that to take place again. Please stop the erosion! Thank you for allowing me to speak.

My sister was in the MCHS, 550 S Carlin Springs Rd, Arlington, Virginia, for a short stay some of the caregiver were awful, no work ethics. No professionalism at all. Their were some professional nurses like (nurse Marie and Ann ) at the center, but some of them were as I said awful. They would not response to the call bottom, and the social worker (Tonya Joyner) were of very little help to us. . I asked to meet with her one afternoon I called her the day of and told her I was going to be a little late. She came to my sister’s room before I got there, she told my sister she would be right back that she had a meeting to attend. I waited for her for almost an hour and a half, I needed to leave so I went looking for her, I found her sitting in her office and not in a meeting. We mentioned to her that their was a couple of errors on the focus document we received and she reprinted the document with the same errors on the document. The document stated that my sister was a “Patient has a diagnosis of brain injury, comatose, dementia, late stage terminal illness”. The social worker told me at 2:00 o’clock Friday February the 4th, the day before my sister was scheduled to be released that my sister could not get a bed for home care. I asked her why we were just told, she said she just found out. What happen to communication between offices. Any way the social worker told me she would send me a list of places to get a hospital bed and help me get one for my sister. I have yet to hear back from her. All I’am saying is if this is how they treat short time care what happens to the long time care patients. I’am not only upset for the way my sister, and I were treated but for all the human being who look for care at places like MCHS. They are suppose to be there for people, but they don’t treat people right. Thank you!! Mary Gordon

One of the last memories I have of my dad is that of him arriving at a nursing home. He sat in the bed hanging his head while holding up the call button. I asked him if he was sad because he knew what that cord meant. He looked at me over the top of his glasses and shook his head yes. More fully competent staffed facilities are desperately needed.

My name is Laurie Coulter, I am representing AARP. We support House Bill 646. Both my parents were in a nursing home here in VA and were private pay. Staffing at the 2 different nursing homes where my parents resided were often understaffed and because my mother was a 2 person assist she had to wait for hours for 2 CNA's or a Med tech to get her in and out of her wheelchair and bed. Both my parents were never on Medicaid. Often the nursing homes were understaffed especially in the evenings and on weekends. Full Staffing was 2 CNA's for 16 people and the CNA barely had time to take care of the basic needs of the residents If another unit was understaffed they took a CNA from my mother's wing to another wing in the facility. My mother was paying $365/day or over $11,000/month and her care was minimal. She had to sit in her wheelchair for sometimes 60-75 minutes waiting for someone to change her or help her with any of her needs. I often had to call the nursing home when my parents would tell me that no on in the facility would come to help them go to the bathroom or take care of their needs, to get someone down to my parents rooms to help them. Staffing is the Biggest issue at nursing homes. The facilities do not have enough help for the number of residents. So the staff that is there is overworked and often leave the profession because of burn out from the number of residents the staff has to take care of. Virginia is one of the few states that does not have minimum staffing level per resident. Please support HB 646

Chairman Head and Members of the Committee My name is Laurie Coulter, I am representing AARP. We support House Bill 330. Both my parents were in a nursing home here in VA and were private pay. Staffing at the 2 different nursing homes where my parents resided were often understaffed and because my mother was a 2 person assist she had to wait for hours for 2 CNA's or a Med tech to get her in and out of her wheelchair and bed. Both my parents were never on Medicaid. Often the nursing homes were understaffed especially in the evenings and on weekends. Full Staffing was 2 CNA's for 16 people and the CNA barely had time to take care of the basic needs of the residents If another unit was understaffed they took a CNA from my mother's wing to another wing in the facility. My mother was paying $365/day or over $11,000/month and her care was minimal. She had to sit in her wheelchair for sometimes 60-75 minutes waiting for someone to change her or help her with any of her needs. I often had to call the nursing home when my parents would tell me that no on in the facility would come to help them go to the bathroom or take care of their needs, to get someone down to my parents rooms to help them. Staffing is the Biggest issue at nursing homes. The facilities do not have enough help for the number of residents. So the staff that is there is overworked and often leave the profession because of burn out from the number of residents the staff has to take care of. Virginia is one of the few states that does not have minimum staffing level per resident. Please support HB 330

I would like to speak about the importance of raising the minimum staffing standards. Charlene

I am asking that you vote to make facilities safer and protect those who live and work in Nursing homes.

I am asking you to support key legislation that would improve nursing home staffing - House Bill 646 - to be heard in subcommittee #3 of the Health, Welfare, and Institutions (HWI) Committee. Quality of life, health, and safety for the residents of skilled nursing facilities is directly correlated to staffing levels. Staff quality and retention are also at stake with the demanding work required in order to provide quality care. I have enough personal experience as a family caregiver and professional experience as an Area Agency on Aging Program Director to know firsthand the critical impact of direct care staffing levels. The pandemic experience of the last two years has magnified the issue, but it has been a long standing problem; we must do better to support our most vulnerable citizens in long term care. Thank you.

I believe standards and good paying wages and benefits are essential for nursing home staff. I wouldn’t want my family members to receive substandard care, although I realize many care workers are kind, compassionate people ( we want them too). Ask yourself, would you prefer to be cared for by people well educated in the diverse needs of the elderly or someone who is just kind?

Comments Document

Please see attached comments from Margaret Rothenhoefer re: HB330/HB646

I am writing to strongly support this legislation to raise the minimum staffing standard in Virginia to a level recommended by research to protect the health and safety of residents. USCMS study in 2001 established the importance of having a minimum of 0.75 RN hours per resident day (hprd), 0.55 LVN/LPN hprd, and 2.8 (to 3.0) CNA hprd, for a total of 4.1 nursing hprd to meet the federal quality standards. As part of this study, a simulation model of CNAs established the minimum number of staff necessary to provide five basic aspects of daily care in a facility with different levels of resident acuity. The results found that the minimum threshold for CNA staffing is 2.8 hprd to ensure consistent, timely care to residents. This recommended minimum threshold level was later confirmed in a 2004 observational study of nursing home staffing and in a reanalysis by Abt Associates in 2011. Across the entire distribution of staffing levels, there is a strong association between higher total staffing levels and better outcomes as defined by lower survey deficiencies and improved resident quality measures from the Minimum Data Set (MDS) (eg, pressure ulcers).

I am very concerned about the treatment of our seniors in nursing homes. The pandemic brought to light the lack of staffing, lack of supervision and training, lack of procedures and capabilities for so many of these facilities. As a result thousands of seniors needlessly suffered and many died. We need to change how we oversee nursing homes, how we pay staff, how we monitor treatments and services to this most vulnerable population. I urge you to consider the passage of these two bills to ensure the safety and security of seniors living in nursing homes.

It has been terrible and tragic to see what has happened at Nursing Homes during Covid. It should have not happened in the Most Powerful Country in the World. Now is our Chance to fix it. So Please do this and don't let this opportunity pass by. Thanks

HB 646 and HB 330 both should be passed. Covid - 19 proved that lives could be saved with proper staffing levels.

I'm writing in support of HB646 to establish minimum staffing requirements for nursing homes. For anyone that has had a loved one in a nursing home and spent any length of time visiting, the need for minimum staffing requirements is obvious. Without sufficient staff, residents that need assistance wait far too long for basic needs. I have witnessed residents being refused requests to go to the bathroom because it wasn't "time" for their toileting or because a meal was being served. Residents sit or lie in their own excrement resulting in not only a loss of dignity, but very real health implications. Insufficient staff results in a myriad of other issues from medications not being administered according to the prescribed schedule, residents falling when they try to do things for themselves, residents having to wait over a week for a bath and many other problems. Please vote to pass minimum staffing in the state of Virginia. We owe this to our most vulnerable residents.

Our elderly should not be considered a liability but a precious asset. Nursing homes need to provide their residents with high quality care by trained professional staff. This includes physical well being as well as mental health. A hug, a kind word, a smile go a long way. Ensure that nursing homes have the necessary assets to make this happen. Do the right thing!

Please pass these bills as I have witnessed personally how corrupt nursing homes are. I lost a grandparent who had bed sores all over her when she died in the nursing home. It was reported but nothing ever came of it.

We must treat our seniors respectfully when they can no longer care for themselves. They have worked all their lives, paid taxes, been a part of their communities and they deserve the best care that can be provided at this time of their lives.when living alone is no longer an option. It is simply the right thing to do.

Most seniors are vulnerable so can be subjected to terrible situations. One way to protect them is to have rules and regulations that govern nursing facilities. My wife was lucky because she had me to speak up for her when I saw something wrong at both facilities. Too many times seniors know not to say anything because the end result will be that things get worse! Please protect our seniors by sending these two bills forward. Thanks you, Jim Morris President AARP Chapter #284 Arlington

The current staffing of nursing homes is abysmal! Staff work long hours for very little pay and in the midst of the COVID crisis have had an extra layer of difficulty thrust on them. The state needs to assist here with minimum hourly standards of care, and by ensuring that there is long term funding to help cover the constantly rising costs of nursing care. As a 77 year old male who lives rurally, I know that when I need nursing care it will be 1) difficult to find and 2) expensive. I am part of the Boomer Generation and we will soon be flooding caregiving facilities and needing competent, skilled, enthusiastic and adequately paid staff to help us in our later years. Please ensure the passage of House Bills 646 and 330 to help address a current healthcare crisis, and one that will be getting even greater in the very near future.

Dear Virginia House of Delegates Health, Welfare, and Institutions Subcommittee members, I am writing to ask you to vote in favor of bills HB 330 and HB 646 to help ensure adequate staffing and funding to provide proper care for nursing home residents in Virginia. Over the past year, my 96-year old mother has had two extended stays in a nursing home in Maryland for physical and occupational therapy and now is in an assisted living home there. So I know the vital importance of having adequate levels of trained staff in such facilities. Residents of nursing homes in particular are typically quite disabled and really depend on trained staff to ensure that their medical and daily care needs are being properly attended. Such care is necessary to keep the residents from suffering further illness and injury, including bed sores, falls, urinary tract infections, embolisms, and other problems related to immobility and illness. I support staffing and funding standards to ensure that nursing homes and other such facilities provide proper care, not only for folks who already are in the facilities but also for the rest of us who may end up needing such facilities in the future. Thank you to the sponsors for proposing these bills and to the subcommittee for moving them forward. Best wishes, Henri

Dear Delegates of HHW subcommittee #3, Part of my role as AARP Virginia State President is to advocate for legislation that benefits people 50+ but today I am advocating for people of ALL ages who are captives of our nursing home facilities, people whose wellbeing, perhaps even their lives are dependent on the quality of the care they receive. These are the most vulnerable in our society and need people in your position in our esteemed General Assembly to protect them. I implore you to support the measures in HB646 and HB330 and vote to send them to the floor of the House of Delegates for passage. Thank you on behalf of all those who need your support!

Please vote FOR … HB646 which will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. Also vote FOR … HB330 which will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. Please vote FOR nursing home reform. Us older folks need and deserve these improved protections. Thank you.

You have the ability to provide this vulnerable group of people with the change they so desperately need. You, as legislators, bear the responsibility to your constituents to do the right thing for them and their families. Residents in nursing homes depend on the staff for everything. This group and their families have truly been devastated by the Covid pandemic and if you do not pass these bills, this population will be decimated. The nursing home industry has a responsibility to these residents when they bring them through their doors. These broad issues are not the residents' or their families' fault! Make the nursing homes honor their promise! Enough of letting the nursing home lobby harm your constituents! These are your people! Amanda Joyce Local Long Term Care Ombudsman District 12 Martinsville, Virginia

Nursing home residents are often the most vulnerable of Virginians. Nursing facilities cannot provide adequate care to their residents without adequate staffing. Please support the passage of HB 646 and HB 330 to provide standards for the number of direct care hours being provided to nursing home residents, support the bills to provide professional training to long-term care staff. They took care of us, we need to take care of them.

I have served as an advocate the rights of the disabled since 1982; I continue to serve in an advocacy role for those individuals receiving long-term services and supports. I have seen the highest quality of long-term care and I have seen the worst. The pandemic over the past two years has significantly highlighted the impact of limited / minimal staffing has had on the delivery of direct care services in the nursing facilities in the Commonwealth and it has reached the point of being a health care crisis. I understand that the legislators in the General Assembly are at pivotal moment to decide whether you support requiring nursing facilities to provide a MINIMAL DIRECT CARE HOURS or you allow the nursing facilities to determine whether they follow the "bottom dollar" pathway toward profits or have them provide adequate and appropriate care to the hundreds of thousands of vulnerable adults. No nursing home resident should be forced to settle for poor quality care; but that’s what’s happening at many nursing homes in Virginia. We are constantly aware of the chronic issues residents and staff face in nursing homes that have a direct relationship to inadequate staffing. Many of these issues include the development of pressure wounds, increase of resident falls, limited personal hygiene care, and restricted access to needed health care services both in the facilities and outside of the facilities. Nursing homes must be held accountable to provide safe, high-quality care for residents by trained professional staff. We understand that recruitment of staff, ongoing professional training, and measures for retention are equally vital. These bills provide a pathway to accomplish all of this. And if you are "on the fence" about deciding whether or not to support these bills, let me offer these short anecdotal moments to help you "see the faces" of the residents who could have benefited from what these bills have to offer: * Roy , who sat in his own body waste for almost 24 hours because of the shortage of staff (only 2 CNA's for an entire skilled nursing wing), and the direct care staff thought it was appropriate to stand in the doorway and "laid eyes on him" instead of providing him care * Gail, who waited 2 weeks for the linens on her bed to be changed after they were soiled * Denise, with limited mobility, was told that she had to get herself from the dining room back to her room because staff were being pulled in different directions due to limited staffing * Countless numbers of direct care providers who worked 16 hours shifts to ensure that they supported adequate coverage to care for their residents. With this being said, I am asking that you support the passage of HB 646 and HB 330 to provide standards for the number of direct care hours being provided to nursing home residents, support the bills to provide professional training to long-term care staff. I am confident that you will all stand up and support residents' rights to good care and let them know they matter. We are urging you to support these bills TODAY !!!

I support HB 646 and 330. It will always feel like the wrong time to do a difficult thing. Now, is ALWAYS the right time to do the right thing. The studies on Nursing Home staff levels date back years and the negative results of low staff are documented and well known issues, as are the solutions. The honorable, heroic healthcare workers fight through challenges with gallant effort to do what is best for their patients. They need your help as reports from previous years indicate. “Staffing insufficient for quality care: U.S. Government Accountability Office (GAO)” | AUG 10, 2021, U.S. Government Accountability Office (GAO), https://www.gao.gov/products/gao-21-408 || “Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations” | Published July 2019, Healthaffairs.org, https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05322 || “Most nursing homes are not adequately staffed, new federal data says” | Jul 18, 2018, PBS.org, https://www.pbs.org/newshour/health/most-nursing-homes-are-not-adequately-staffed-new-federal-data-says || “According to a recent estimate, in 2013 total national spending for paid long-term care services was almost $339 billion” https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf, | February 2019, CDC.gov, Vital and Health Statistics Series 3, No. 43 || “Nursing Assistants provide as much as 80-90% of the direct care received...” | 2021 https://cna-network.org/career-nursing-assistance/ || Respectfully, let us say what we won’t say out loud. Erase the images in your mind of feeble "old folks" who have lived a good life and their share of years. We are talking about young, mid-life and older Veterans, Mothers, Fathers, Grandparents, Brothers, Sisters, former Blue Collar workers, Scientists, Educators, Architects, Carpenters, Mathematicians, Nurses, Doctors, Dancers, Homemakers, Lawyers, and yes, even Politicians. We are talking about Americans, Constituents who need specialized care and happen to reside in residences to receive that care. Many of these Americans are ready to share their wisdom, life long lessons, skills, talents, laughter, love and advice if you would only ask. Many desire to return to work. Let's all stop treating them like their days of contribution are over. Please get an account of the billions of dollars collectively spent regionally and nationally each year. Discover the true profit margins, wages at all employment levels and training required before saying the right solution is cost prohibitive. We find the money to do what we must do. With all do respect, you can do better for these Americans. You must do better for these Americans. Your legacy is written not by how well you campaigned, raised money or your ability to convince the public to give you their vote. Your legacy is written by what you do, even behind closed doors, in honor of the oath you took to serve those in need. Please don’t count a number of responses from the public as an instruction to vote "no". Count the number of residents that need your help, now and for years to come. The past studies show you the trend. These matters do not resolve themselves. You already know the countless numbers of Americans counting on you to protect them. You actually already know the nursing homes you would and would not want to reside in should you need specialized care and why. NOW, is the right time to do the right thing. Thank you.

As a patient recovering from three different joint replacement surgeries and serious back surgery I spent weeks in three different nursing homes and experienced neglect, abuse and injury. I was served hot dogs for lunch, dinner and lunch the next day while on a doctor prescribed low sodium diet. I had to beg for prescribed pain meds administered by unqualified “nurses” who did not know my name or the name of the meds they were giving me. Nurses aides cleaned bedpans in sinks where I brushed my teeth and no one on staff spoke English. I nearly fell off a broken shower chair and waited at least 20 minutes for someone to answer my emergency call bell in the shower. You must require a better level of care for vulnerable patients. We are an aging population and our needs for qualified nurses, doctors and nutritionist will only grow and most of us grow old. Please care enough to pass protective legislation. All of my nursing home stays were in Springfield and Warrenton Virginia. So many “call bells” went unanswered . So many unqualified, abusive people were expected to provide care to the most vulnerable and elderly patients. The aides who injured me did not seek to hurt me, they were not trained on how to assist handicapped patients. They were not trained in how to properly maintain a healthy and clean environment. There were no standards of care or standards of facilities mandated by law. It falls to you to enact these basic standards under the law or greed for profit will continue to cause neglect, suffering, injury and death. Protect the most vulnerable citizens of Virginia who are depending on you.

Please, just check of your Mom and Dad and what you would want for them.

LIFE AS A NURSING ASSISTANT *I SUPPORT HB646*     I was a Nursing Assistant for 30 years Let me give you a look into the Life of a Nursing Assistant. Your 8 hour shift( 7am-3pm) consists of: Shift Report which could take up to 30mins, God forbid a nursing assistant calls out sick because now you get more residents added to your assignment. Passing food Trays (That's if the trays are on time from the kitchen). Feeding( Sometimes you could have 3 total feeds on your assignment, Some that are slow eaters), Bathing, and Dressing( This is the time  to monitor  your residents skin for signs of  breakdown. (REPORT YOUR FINDINGS TO NURSE IMMEDIATELY) (Depending on your assignment you could have some residents that are able to bathe and dress themselves and all you have to do is lay out their clothes, Make their bed and straighten their room. Now, On  to your Total Care Residents(Bathing or Shower(Yes, Total Care Residents  get showers) This is where your Training  comes in, so as not to injure yourself or the resident, you need to get help from your coworkers. Turning, Repostiong, Carefully assisting from Bed to Chair(This is where your training comes in so as not to injure your back or the resident. Yes, You may need to get the Hoyer Lift or Sit to Stand Lift( These devices help with getting a resident from bed to chair or vice versa. Depending on your Facility, you may need to go and get the device because it is shared with other floors. Now get your resident down to Activity or Dining Room or around the Nurses Station(Depending on your Facility). Once you are done with all your residents, use this time to Pass Ice and Water, Answer Call Lights and  start some of your charting. Your  bedridden residents have to be  turned every 2 hours,  Some  residents are having Activities or visiting with family. Lunch time:Pass and Feed again. You are given a 30min Lunch Break on Paper, However,  Some days its hard to take(Good Luck)   around 1pm or so your residents that want to go to bed for nap time,  can. You will assist them with diaper changes and transfer back to bed.  You try to squeeze in finish charting and last minute  requests from residents.  When your next shift arrives you will need to walk with them to each residents room and give them a report of your residents day, All while working in a Toxic Environment.....Come back tomorrow and do it all again....There are times that you will be pushed to your limit from dealing with pressure from department heads and you will need to  remember why you chose this profession and try to keep your morale up. I say all of this to say that a Nursing Assistant's job is Hard Work!  I met and built relationships with some wonderful residents and worked with some Amazing Nurses, whom I am still in contact with to this day.  I got into this profession because I wanted to help people.   Burnout and Low Staffing is a major cause of Abuse and Neglect. But, there has to be accountability.  Why is it that when these  corporations  want  to cut back, Staffing is a consideration?  These Corporations focus is MONEY!!! Not the welfare of the residents!  Because of this, Quality of Care is lacking and families will continue to suffer the outcome which is Death or Injury of their loved one. When State Inspectors come in, the facility has Nurses and Nursing Assistants falling over each other Fully Staffed! VIRGINIA YOU ARE BEING DECEIVED

I AM WRITTING IN SUPPORT OF HB646.....My Dad, David Leland Jones went to Glenburnie Rehab on Libby Av for Physical Therapy, 5 days later he was dead. During my investigation( I was a Nursing Assistant for 30years) We found that he was complaining of pain and vomiting stool several times over the course of the day, and Glenburnie REFUSED to send him to a hospital 4 miles away! On this day Glenburnie had my Dad sign the Arbitration Agreement giving up his rights(My dad could not read very well, so he did not know what he was signing. To add insult to a grieving family, VDH refused to fine Glenburnie for their Negligence, even though in the investigators report they admitted that they were wrong and should have sent him to a hospital immediately. My dad David Leland Jones was Denied his right to get medical treatment and died face down on the floor of his room. Please pass this bill, Families are suffering. Not everyone is fortunate to have a house built for there elderly loved one and have round the clock care. OUR SENIORS NEED YOUR VOTE!!! https://www.wtvr.com/2017/04/11/man-dies-at-richmond-rehab-facility?_amp=true

I strongly support legislation that will establish minimum standards and funding for nursing home staff and care. As a resident whose family members have resided in nursing homes in the state, I have seen first hand the serious harm that has occurred due to inadequate staffing and funding of nursing home care. Nursing home residents are often the most vulnerable of Virginians. The grossly disproportionate death rates that these communities suffered from COVID should be a wakeup call for this Assembly and the Governor to act urgently to prevent more harm to the defenseless elderly and infirm in our nursing homes and to those who care for them. You can tell everything about the priorities of our state government from how it cares for its most vulnerable citizens. Please approve legislation that protects nursing home residents from needless harm.

Virginia’s nursing homes are in crisis. The pandemic has shown us they need to have staffing standards to improve the quality of care. Either HB330 or HB646 would provide staffing standards. HB646 would have an hourly requirement of care per resident; HB330 would be based on an acuity standard of care. Please vote to report one or both of them out. The full HWI Committee needs to vote to improve nursing homes in the Commonwealth.

In regards to HB 646 / Carr: Nursing facilities cannot provide adequate care to their residents without adequate staffing. Accepting payment for services they do not provide is false advertising at minimum, but the stark reality is that it is abusive and neglectful.

Please look after our seniors. They all deserve respect and the best care. Just remember one day you may have to go to a nursing home, don't you want to be cared for?

Please pay attention to this bill. I see first hand how short handed snd over worked these men and women are working in nursing homes, retirement or rehab centers. If I didn’t go to see my husband everyday he would not get the attention he needs. I watch so many patients being neglected because the poor nurses and NAs are sooo busy. Please these facilities need your help. It may be your family member being neglected.

Care for elderly : my wife had altzheimers for about 5 or 6 years. I quit my job to help her survive. Being a care giver is not a pleasant job..we need some changes to help these people in their last days, Put her in a nursing home for 2wks.until they told me that they could not handle her that I would have to move her. So, I went and got her and brought her home where she stayed until her passing. I was really pissed because I had looked everywhere for a home for her could not find.one that would help. Now I am in bad shape , wondering what is going to happen to me..,,

Please pass this nursing home bill to better staff and educate the needed staff for these facilities. The residents at nursing homes are usually totally dependent on employees at these facilities. With my own parent I have seen good care and sadly , poor care. The employees need better education, better pay. Some facilities are very lacking in knowledge regarding infection control . Nursing homes are in dire need of many improvements, this bill will certainly help.

Nursing homes need to provide adequate, safe, and proficient care for the residents in their care. There should be competent staffing in sufficient numbers to provide the care that these individuals need to be able to live in a safe environment.

I'm going to be brief because I know you have a lot of bills to consider. HB 330 & HB 646 seek to help solve the most urgent need in nursing home care. My mother spent her last years in a nursing home and I have considered them for myself because of my medical needs. What I've learned from my experience is that sufficient staffing is essential to quality care and this has been demonstrated most dramatically during the COVID-19 pandemic. If you don't have enough staff serious consequences will be the result. Please send these bills to the full committee with a recommendation to pass. Thank you so much for your consideration.

Please vote for nursing home residents and staff. Thank you for your attention.

Long before the COVID-19 pandemic, many nursing homes in Virginia were cited frequently for problems related to under-staffing such as pressure wounds and resident falls. Nursing homes and long term care facilities should be held accountable to provide safe, high-quality care for residents by trained professional staff. These state licensed facilities should all meet minimum standards of care. Trained and certified staffing ratios are critical elements of standards that should be set for these licensed facilities. Time and again commercial health providers have demonstrated their incapability to provide minimum standards of care for residents absent specific government regulations that also include stiff penalties for violations of such standards. I encourage you to develop and vote for such standards for nursing homes doing business within the Commonwealth of Virginia. Additionally, I encourage that provisions for stiff penalties be added to the legislative language currently under consideration.

Every nursing home resident deserves quality care you must provide nursing home reform. Just put yourself in the future or your family member now who may have to experience poor quality of care and act accordingly. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. I pray you will act accordingly. Jo Ann Obie

Conditions in nursing homes and assisted living facilities are bordering on inhumane. My Dad lived in several, in an attempt to find a facility where they provided even just adequate care. He died before we could accomplish this. They are understaffed. The staff who do show up are overworked and burned out to the point that they just do not care. The residents and their families all suffer. Please vote for these bills!

I want to stress my support for nursing home residents and workers. Residents of nursing homes are very vulnerable and need our protection in all areas of their life to enhance their quality of life and keep them safe and as well as they can be. I support any measures that aim to enhance their protections. The persons who care for them need a living wage and programs that keep them well- trained, mentally and physically able to care for their patients in a reasonable, well managed environment. The profits of owners and management companies should come second to the welfare of the residents and their caretakers. Thank you.

Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. It is critical that you support this legislation. Peoples' lives and quality of care care are depending on you.

Please please pass nursing home reform. I struggled to keep my mother out of a nursing home. My wife’s family has not been as fortunate with theirs. The home struggles to keep Covid out, adequate staff and service’s. Going months without a visit. A continually struggle to make contact with their mother or even getting a response from the over worked staff.

Please pass nursing home reform. No nursing home resident should ever have to settle for poor quality care. That happens in many nursing homes in Virginia. These homes should be held accountable to provide safe, high-quality care for their residents by trained professional staff. These two bills checked above will make facilities safer, and protect those who live and work there. HB 646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum n number of nurse and certified nurse aide hours per resident per day. HB 330 will also require nursing homes to have a minimum staffing level and puts into place a long-term care services fund to help pay for the cost of increase staffing. Thank you.

I work in healthcare and have witnessed firsthand what it is like to try and care for people with insufficient staff. It can be inhumane to both caregivers and those receiving care. Nursing home administrators would love to have this bill not pass so that they can continue to profit.

Please vote yes to support Virginia’s nursing home residents! My friend was in a nursing home this summer and I visited I was appalled to see the poor conditions he had to endure. The nurses and supporting staff are stretched then and Virginia can and should do better for our elder and disabled friends and family.

Having worked in the past for the Association for Professionals in Infection Control and Epidemiology, and specifically with the nursing home specialists, I know that infection control regulations in nursing homes are often nonexistent and/or not enforced. This problem became extremely evident during the onset of Covid-19. Every facility should have an infection control nurse and be required to certify the caregivers in infection control. In 2020, my husband (68 yrs old w hip fracture) had to spend 50 days in a rehabilitation/nursing home facility (Potomac Falls Health and Rehab, Sterling VA). He was active in his care and overall the staff were very good, but he also experienced a number of serious problems. 1. Given wrong medication. 2. Pain medication went “missing” 3. Diet restrictions (pescatarian) and preferences (non fried) were often ignored and alternatives were non-existent to poor. Finally resorted to food delivery services. 4. Prescriptions filled by a pharmacy 50+ miles away. In one instance, patient’s spouse had to pu pain meds at a local pharmacy (or wait over the weekend). 5. 17 patients died from Covid during his stay. (He did not contract Covid.) Nursing homes need to be properly staffed (including a doctor and/or nurse at all times). Staff need to be certified in infection control to ensure proper training. Staff need to be fairly compensated. Fines must be higher and inspections more frequent. There are nursing homes in Fairfax County and surrounding area that doctors will tell you adamantly to avoid. They often have many multiple violations. Usually the poorest patients (Medicaid) end up at these facilities and they are the least represented patients. (The worst is Manor Care Health Services - Alexandria, 1510 Collingwood Road, Alexandria, VA 22308. ) Thank you for your time.

Please consider passing HB 330 and HB 646. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. These bills will help ensure improved cares for residents of nursing homes.

I'm writing in support of HB646. Increased care standards are needed to try to ensure that nursing home residents receive adequate visits from health care professionals to check on their health. My mother spent most of the last two years of her life in a nursing home (during a Covid lockdown) and I learned then of the staffing inadequacies and infrequency of professional nurse / doctor visits at nursing homes.

The state of elder care, particularly in nursing homes, in this country is a disgrace. My own father was left lying on the floor in a nursing home dining hall. Any congressman who fails to vote for these reform bills had damned well better be able to explain himself--or herself.

I urge you to support HB646 and HB330. If the subcommittee votes the bills down, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. No nursing home resident should ever have to settle for poor quality care. But that’s what’s happening at many nursing homes in Virginia. I urge the subcommittee and legislature to protect our most vulnerable neighbors and vote in favor of these bills.

As a former employee of a nursing home and now as an ordained Deacon with the ELCA (Evangelical Lutheran Church in America), I cannot stress strongly enough that staffing is never at the level to provide even minimal care to the residents of nursing homes. If you could have heard the threats I heard made to defenseless residents to keep them from complaining about the lack of care or seen the bedsores resulting from staffing shortages, you would consider this a mandate to “do unto others as you would have them do to you”, as Jesus said!

having worked in nursing homes for over 30 years, i have seen a wide range of care, unfortunately, many residents do not recieve the good care they deserve. please pass nursing home reform. the people living there deserve it

Please vote i favor of HB 330 and HB 646. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. Our nursing home residents deserve excellent care and our nursing home workers deserve excellent working conditions. Thank you.

As a child of parents who were both provided care for aging parents at home, I am so glad we had the resources to provide round the clock care for them. My father in law said to us “spend every penny I have before you put me in a nursing home” because he knew the horror stories of friends that had poor experiences with understaffed and underpaid caretakers. When for profit nursing homes squeeze every penny by cutting and underpaying staff, residents suffer. Please protect them and us by passing this bill.

I speak for three relatives confined to nursing homes over the past 24 years: Each person received poor treatment and staff had to be medically monitored and written up on several occasions for stealing personal items. The three relatives as patients received improper or no care for ADL's. The three relatives are deceased now; however, I would have wanted to spend quality time with them during my visits rather than addressing all of the healthcare, social service and maintenance issues. So, HB330-Watts and HB646-Carr need to be passed to protect me and others who enter the nursing homes now and in the future.

Simply wish to voice my concern for nursing home patients: at all times they should receive the finest individual care for not only their physical well being but also for their emotional well being. You folks know what I mean so I don't have to list all the matters that make nursing home care so awful and scary. Whatever time these seniors have should be given with love, care, concern, healthy, cleanliness and the finest medical and emotional care possible. I'm 83 and will never go to a nursing home in its present state.

Please support HB330-Watts and HB646-Carr.

As a disabled senior citizen, I feel that nursing homes are at best a "warehouse for the elderly", and at worst, a place for exploitation and abuse. Seniors deserve to live with dignity, until their time comes to die.

I support, HB646 “establishing minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. I also support HB330 requiring that “nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing.”

If the subcommittee votes the bills down tomorrow, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing.

Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. I am writing in support of HB646 and HB330, which will make facilities safer and protect those who live and work there. Thank you.

I am speaking on behalf of all seniors my self included... we deserve the best care, including safety practices in place for our well being. Thank you

Help is needed for all nursing homes in the VA area. The following problems exist: • very little direct care given to patients • the room floors are filthy, sticky • insufficient staff • clothes often lost and not folded • no backup for equipment breakage…this effects patients that need to be holstered from the bed to a chair and back into the bed. • these facilities need to be monitored very closely to meet a higher standards than what they have now. •. HELP HELP HELP!!!!

Both of parents had strokes within 6 months of each other, making it necessaryfor them to be in nursing homes. For 3 years, until they both passed away, I was deeply involved in their lives . . . and care. I lived within 10-45 minutes of the various facilities where they were and was able to be there many times during the week after work and always on weekends. This enabled me to monitor the level of care they received. My Husband's mother was also in a nursing home and her care received the same level of attention. In many cases, the level of staffing was not sufficient to give the the care they needed, resulting in bed sores, frantic calls for help, etc. I strongly urge you to pass HB330 and HB646.

Please pass these two bills to provide better care for nursing home residents, and to protect those that live and work in nursing homes.

If the subcommittee votes the bills down tomorrow, many of Virginia’s nursing home residents will continue to endure poor conditions. HB646 will establish minimum hourly staffing standards for nursing homes, requiring that nursing homes provide a minimum number of nurse and certified nurse aide hours per resident per day. HB330 will also require nursing homes to have a minimum staffing level and puts into place a Long-Term Care Services Fund to help pay for the costs of increased staffing. Nursing homes should be held accountable to provide safe, high-quality care for residents by trained professional staff. No nursing home resident should ever have to settle for poor quality care.

I pray that all of you voting will vote for the safety of the residents and staff in all the homes. Please set a higher wage for workers so the turnover will not be so high. Please put in place laws that will protect the residents. They all need your votes for positive change and protection.

Good afternoon I am a registered nurse and I would like to request that you support nursing home staffing standards. This measure will go a long way to ensure adequate staffing. Adequate nurse staffing has been shown to reduce adverse events such as trips/ falls, bed sores, infections, medication errors, delayed care and unnecessary hospitalizations. All of these adverse events are costly and harmful. I also believe adequate nurse staffing will go a long way to improve nurse retention. The nursing profession estimates 30% of nurses will leave/ retire by 2030. We are already experiencing nurse shortages causing facilities to limit admissions or close. It is the right thing to do for both patients and staff. Most importantly-improved staffing ratios will be a cost saving for our state. Thank you for your consideration of these house bills. Marjorie Cohen RN BS MA

As a Cna, I have seen employers work with as little help as possible, just to save money, when others were begging to work, it happens everywhere. If affects the quality of care, and more accident occur when staff is short. As a CNA WE HAVE TO DO AND WORK AS WE ARE TOLD OR WE LOOSE OUR JOB EVEN WHEN WE KNOW ITS NOT RIGHT.. I AM A CNA OF 38 YRS. NO LONGER RENEWING MY LICENSE.

Please support hb646. I may need nursing home care myself. Thanks Bradie Allman

The Northern Virginia Aging Network (NVAN) strongly supports the establishment of nursing home staffing standards now. We appreciate Del. Carr's sponsorship of HB 646, which would enact a staffing standard based on hours of care per resident per day. Virginia is one of only 18 states without staffing standards. Such standards are particularly important because of Virginia's high Medicaid level of care criteria, It means our nursing homes have residents among the frailest in the nation, requiring more care. Staffing standards would in human terms reduce pressure ulcers, reduce infections, and reduce hospital admissions. It is especially important to have staffing standards in facilities with a high proportion of poor residents on Medicaid, frequently low staffing, and low CMS ratings, as found in the Joint Commission on Health Care study. Thank you, Erica Wood, NVAN

I support this HB 646 to allow better CNA staffing at Rehab and nursing facilities in Virginia. My siblings and i Were witnesses to the short staffing concerns at the Henrico County facility our mother was in for over 2 years. We made daily visits to see mom and did some tasks ourselves and informed Nurses and CNAs when we saw something wth mom that needed prompt attention. Needless to say they couldn't always drop what they were doing for another resident. WE DESPERATELY NEED TO SUPPORT OUR RESIDENTS AND MEDICAL PROFFESIONALS WITH PASSAGE OF THIS BILL. AND ONCE PASSED, THE NURSING FACILITGY OWNERS SHOULD BE ACCOUNTABLE IF THEY DON'T COMPLY. Linda Garnett

until we mandate staffing in nursing homes residents will continue to get minimal care at high prices The chains have one thing in mind profits. The first are of trimming the budget by cutting the staffing.These chains will never staff appropriately until they are made to

Comments Document

My Mother, Merlene Alma Cartwright, was a resident of Bonview Rehabilitation and Healthcare. During her stay at this Facility, I was privy to seeing just how broken the system is when it comes to the care and concern regarding our vulnerable elderly in these facilities, as well as the environment that CNA's in particular, are working in. My mother sat in her wheelchair with life-threatening issues as a direct result of neglect and various incidents of abuse while I was on the phone begging the nurse in charge to please check on her because I was unable to get her on her cell phone. She insisted she had just checked on her and she was fine, that she had just given her her medicine and was fine. I knew something was very wrong and insisted that someone check on her. After ten minutes of this, she decided 'I'll check on her, but I'm telling you she's fine.' The next call seven minutes later was to say 'we are calling the ambulance for your mother'. When I arrived at the emergency room, she was non-responsive. The EMS attendant said after the state they saw her in, they chose to take her to Chippingham Medical as opposed to MCV because it was life or death. My mother's oxygen level was at 34. Her heart rate was very low. Prior to all of this, My mother's cardiologist ordered a CPAP machine and oxygen to help her breathe. The nursing facility did not adhere to the order. Upon returning to the cardiologist, she stressed again the urgent need for both CPAP and oxygen in order to help my mother breathe. It was not fulfilled. My mother never made it out of the hospital. This was two years ago, and it still feels like yesterday. This is one of many, many stories I can tell you about the abuse and neglect she experienced at the hands of Bonview Rehabilitation and Healthcare. There was no accountability for what happened. Many families have reached out to our Organization to tell their experiences, many of whom are going through the same or worse at present. We feel that this Bill is a first step toward what appears to be a long journey toward ensuring that our elderly and those entering a nursing facility for physical therapy, have a chance to receive quality care as they deserve to. This Bill also will put a foundation in place for administration within the facility to begin creating schedules for CNAs and nursing staff fairly and appropriately that will provide a better quality of care for residents. For too many years this issue has been selectively ignored by our government, and it must not be ignored and longer, as lives are at stake here. Why should one live all their years as a part of society, contributing to society, to end up abused and neglected in a facility that is bound by law to provide proper care to the individuals that they accept within the facility? There is absolutely no reason for it. It is hoped that this government in Virginia will no longer have a blind eye and deaf ears to the cries of nursing home residents and their families, for profit. My mother's life was priceless, and what I personally journeyed through during her time at this nursing facility seems to be quite common, and that is unacceptable. Please pass this bill so we can move forward toward change and save lives!

Comments Document

My Mother, Merlene Alma Cartwright, was a resident of Bonview Rehabilitation and Healthcare. During her stay at this Facility, I was privy to seeing just how broken the system is when it comes to the care and concern regarding our vulnerable elderly in these facilities, as well as the environment that CNA's in particular, are working in. My mother sat in her wheelchair with life-threatening issues as a direct result of neglect and various incidents of abuse while I was on the phone begging the nurse in charge to please check on her because I was unable to get her on her cell phone. She insisted she had just checked on her and she was fine, that she had just given her her medicine and was fine. I knew something was very wrong and insisted that someone check on her. After ten minutes of this, she decided 'I'll check on her, but I'm telling you she's fine.' The next call seven minutes later was to say 'we are calling the ambulance for your mother'. When I arrived at the emergency room, she was non-responsive. The EMS attendant said after the state they saw her in, they chose to take her to Chippingham Medical as opposed to MCV because it was life or death. My mother's oxygen level was at 34. Her heart rate was very low. Prior to all of this, My mother's cardiologist ordered a CPAP machine and oxygen to help her breathe. The nursing facility did not adhere to the order. Upon returning to the cardiologist, she stressed again the urgent need for both CPAP and oxygen in order to help my mother breathe. It was not fulfilled. My mother never made it out of the hospital. This was two years ago, and it still feels like yesterday. This is one of many, many stories I can tell you about the abuse and neglect she experienced at the hands of Bonview Rehabilitation and Healthcare. There was no accountability for what happened. Many families have reached out to our Organization to tell their experiences, many of whom are going through the same or worse at present. We feel that this Bill is a first step toward what appears to be a long journey toward ensuring that our elderly and those entering a nursing facility for physical therapy, have a chance to receive quality care as they deserve to. This Bill also will put a foundation in place for administration within the facility to begin creating schedules for CNAs and nursing staff fairly and appropriately that will provide a better quality of care for residents. For too many years this issue has been selectively ignored by our government, and it must not be ignored and longer, as lives are at stake here. Why should one live all their years as a part of society, contributing to society, to end up abused and neglected in a facility that is bound by law to provide proper care to the individuals that they accept within the facility? There is absolutely no reason for it. It is hoped that this government in Virginia will no longer have a blind eye and deaf ears to the cries of nursing home residents and their families, for profit. My mother's life was priceless, and what I personally journeyed through during her time at this nursing facility seems to be quite common, and that is unacceptable. Please pass this bill so we can move forward toward change and save lives!

To the Honorable Members of Health, Welfare, and Institutions Subcommittee #3: I’m Ginger Thompson with AARP Virginia, but I write today as a daughter with a mother in a Virginia nursing home. Passing HB646 is vital to the safety of nursing home residents and the morale of the staff who care for them. My mother spent all her modest assets paying for assisted living, and I tried to care for her at home while applying for a Medicaid waiver for home care services. The process took too long, and I was advised that the program wouldn't pay a caregiver for 40 hours/week so I could work. I placed her in a for-profit nursing home owned by a local company in 2018. I chose the facility closest to my residence that accepted Medicaid and received good Medicare.gov ratings. It made a profit, which I wrongly thought guaranteed they wouldn’t cut corners to cut costs. The facility had a $923,000 profit that year. It received $250/per day from Virginia’s Medicaid program for her care while she was there, more than $100,000. On Mother’s Day 2019, when I walked into her room with lunch at noon, Mom was still in bed, not dressed. A bedpan containing feces was sitting on top of a pile of clothes in her guest chair. They often didn’t have enough staff to put her on the toilet (even though she had a bedside commode), so they had her use a bedpan. Her roommate, wheelchair-bound and completely incontinent, wasn’t changed often enough. At night, when no one answered her calls, she would throw her feces on the floor. She could sit in her own feces or get rid of it the only way she could, because no one checked on her at night. The facility did not purchase waterproof pads to be used under incontinent residents in bed. A CNA told me the facility didn’t buy waterproof pads. It’s a profitable facility with 70 residents, most of whom on Medicaid, which now pays $270 per resident per day, or nearly $100,000 per resident per year. I secured Mom one of 9 Medicaid beds in a nursing home at a non-profit retirement community. Her care improved, and the facility is very transparent about its operations, holds regular conference calls with families to keep us updated, and sends us emails every time there is an issue, such as a COVID-19 positive resident or staff member. It is one of the best facilities in the state and I'm grateful for the management and staff. Despite the well-funded operation ($270/day for Medicaid residents and $400/day private pay), I regularly witness a CNA using a mechanical lift alone to take Mom to the bathroom; two staff are necessary (and required by the facility) to prevent falls. Mom can’t walk and has fallen out of her chair a few times. In late 2020 she acquired an infection in her dialysis port and was hospitalized for over a month. The staff that care for my mother do it out of commitment to the cause. Nurses are paid less than they would be doing easier jobs that pay better, where they wouldn’t have to lift people, give bed baths, or change adult diapers. CNAs can make more money working retail or at a fast food chain. Many work two jobs to make ends meet. It is imperative that HB646 pass for nursing homes to be fully staffed. You (through the state Medicaid program) are paying nearly $100,000 per resident per year for substandard care. Facilities should be held accountable. Thank you, Ginger Thompson

I’m am writing to urge you to pass HB 646. I can say from experience that skilled nursing facilities vary in the quality and type of care given to their patients/residents. Without required minimum direct care hours, for profit nursing homes have little incentive to provide the care they purport to provide on their websites. Staffing increases are also an essential part of this equation. The people providing the most care to patients should not be required to meet direct care hours if there is not sufficient staff to provide it. Patients and long term residents are paying upwards of $9000 a month for care which in many cases is not adequate. If someone is determined to need nursing home level care, shouldn’t we ensure they are, in fact, being given that care? The odds are many of us will one day spend some time in one of these facilities and it behooves us to ask ourselves what kind of care can we reasonably expect.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

The Virginia Board for People with Disabilities supports transparency and accountability for the utilization and cost of services in intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs). This bill would give policymakers and other stakeholders the information needed to oversee key utilization and cost trends in ICF/IIDs, as well a better understanding of the barriers to discharge to a home- or community-based setting, as recommended in our June 2021 assessment of the topic. ICF/IIDs are one the most segregated settings for individuals with disabilities to receive residential care. Oversight is necessary to ensure that the Commonwealth is serving people in the most integrated setting, appropriate to their needs and desires, as required by the Americans with Disabilities Act and enforced by the Commonwealth’s Settlement Agreement with the U.S. Department of Justice. ICF/IIDs are also one of the most expensive settings for the Commonwealth in terms of cost per bed. Excess utilization poses a cost to the Commonwealth because it is less expensive to serve someone in a home- or community-based setting. According to available federal data, Virginia added the second highest number of ICF/IDDs out of all 50 states between 2010 and 2020. Currently, the Commonwealth only publishes utilization and cost data for ICF/IIDs that are owned by the Commonwealth, known as Training Centers. However, the vast majority of ICF/IIDs are not owned by the Commonwealth. House Bill 651 would fix this information gap.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

As an aquatic director, the Fairfax County Health Code 69.1 provides my facility with very clear guidelines for safety and facility management. It helps me ensure that we keep a high level of chemical safety, ensure a safe aquatic experience for our customers, and helps me defend having trained staff ready to respond to emergencies. All residents of the Commonwealth of Virginia deserve the same experience, and having the referenced workgroup to help establish some state code guidelines can do that. Please pass HB669 and keep our citizens safer around the water.

I fully support HB 669 - we need all jurisdictions to have some sort of pool regulations moving forward. Thank you! Kat

Comments Document

February 1, 2022 The Honorable Wendell S. Walker House Health, Welfare, and Institutions Subcommittee Pocahontas Building, Room E310 900 East Main Street Richmond, Virginia 23219 The Honorable Christopher T. Head House Health, Welfare, and Institutions Subcommittee Pocahontas Building, Room E210 900 East Main Street Richmond, Virginia 23219 Re: Consideration of House Bill 669 – Public Swimming Pools; Regulations. Dear Chairman Walker and Vice-Chair Head: This bill, directing the Virginia Department of Health to promulgate regulations governing swimming pools and spas for public use and convene a stakeholder work group provide recommendations related to regulations required to be adopted is supported by the Pool & Hot Tub Alliance (PHTA). Currently, the Virginia Department of Health only has authority to govern and promulgate regulations for pools and spas at campgrounds, summer camps, and hotels. Additionally, only 20 local jurisdictions in Virginia have a code that regulates the operations, maintenance, and safety of public pools. HB 669 will drastically increase the safety and welfare of public pools in Virginia and further protect Virginia residents. HB 669 will not take away a local jurisdiction’s authority to enforce or adopt its own operations, maintenance, and safety code for pools and spas or limit its ability to be more stringent then regulations promulgated by the Virginia Department of Health. The proposed legislation will provide a baseline of standards for local jurisdictions to follow in the absence of an established operations, maintenance, and safety code. The bill establishes a workgroup of industry leaders to assist the Virginia Department of Health and provide recommendations related to regulations required to be adopted. Additionally, the establishment of the workgroup creates an environment for industry leaders and the Virginia Department of Health to discuss current and best practices and opportunity for future collaboration. On behalf of the many Virginia pool and spa professionals represented by PHTA, as well as those in neighboring states that do business in Virginia, we respectfully request that you consider moving this important legislation out of your committee. Sincerely, Jason Davidson PHTA, Director of Government Relations jdavidson@phta.org

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I would like to speak please -Amy Lee Story

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

Hi I am writing on behalf of being a parent of 6 children in chesterfield 4 being in chesterfield county public schools .Has the government lost all common sense ? It's unbelievable that a law would be pass that a 12 year has to give permission for I as her parent an adult would need her permission to access her medical records .My child can not even make a decision on what to wear to school everyday let alone knowing anything medical records or giving her signature to documents or even understanding permission . Try 18 years old then let them decide .when they pay bills and know what the meaning of permission or decisions are.

I fully support the passage of HB916. It makes no sense for a parent to be responsible for a minor in all things yet be denied access to their child’s medical record.

Parents definitely need to be able to access their children’s medical information without their permission. My 13-year-old is not old enough to check his prescriptions order the medication or set up appointments on his own without my parental supervision. This is ridiculous And kids this young are not meant to shoulder such a responsibility. I could not even set up my own child’s health portal on my phone because he is 13 years old so now I cannot access any of his things without him having to have his own account and his own phone so I never can know what’s going on.

As a parent I have a right to my child's medical records without needing their permission

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

I am requesting you vote yes on HB 306. The State Health Commisioner has entirely too much power and this bill will protect our citizens from having to submit to unwanted therapies. Too much is being revealed about the Covid 19 vaccines and we can never, never let this happen again Thank you

Vote YES on Bill 306. Our religious freedom is as critical as freedom of speech. Religious exemption is part of that. Please support Bill 306. Vote YES

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

Dear Delegate, Protect religious freedom, vote YES for HB 306! Our religious freedoms do not end just because government bureaucrats declare a public health emergency. Our First Amendment rights apply at all times. Thank you, Kellie M. Good

Correction: Please vote YES for house bill 306! No one should be punished for exercising their right to religious freedom!!!!!

Please vote YES for house bill 106! No one should be punished for exercising their right to religious freedom!!!!!

The National Multiple Sclerosis Society supports HB 1071, to require all hospitals in the Commonwealth to screen each patient to determine household income for Medicaid and financial assistance eligibility, and to require this screening to occur prior to taking extraordinary debt collection actions against the patient. Multiple sclerosis (MS) is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms vary from person to person and range from numbness and tingling to walking difficulties, fatigue, dizziness, pain, depression, blindness and paralysis. The Society has serious concerns about the high risk of medical debt for people impacted by MS and others with specialized and complex healthcare needs. People living with MS may require care from neurology, rehabilitation, mental health and other specialists in addition to other treatments and services. Falls and relapses could require costly emergency department visits and hospitalizations. In order to protect Virginians from high medical bills, especially those currently without health coverage, Virginia hospitals should screen for Medicaid and financial assistance eligibility and help uninsured and underinsured Virginians receive coverage or financial assistance prior to receiving unaffordable medical bills. This legislation provides a great opportunity to screen uninsured individuals and connect them with quality coverage or financial/charitable assistance, which would help to prevent unnecessary stress and financial hardship that comes with high medical bills. According to the Virginia Health Care Foundation, 60.5% of Virginia’s uninsured non-elderly adults have income below 200% FPL, meaning they are very like eligible for Medicaid or a $0 premium plan through the Marketplace. Thank you for the opportunity to provide comments in support of the bill. We urge the committee to favorably report this legislation.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Please gently PBI HB877. We need to give any benefits to those who *legally* and only legally come here. I know many folks who have, who follow the laws and work hard. Stop penalizing them for obeying the law. Please move to report HB1098 for obesity. Tough disease. It is a linchpin in many others, and treating it would be best. HB1105, please gently PBI. I didn't take courses but have been introduced to a lot of people of all backgrounds and that positive interaction is going to do more than any training that is not scientifically proven. Please move to report HB1359 because we need to know who of these admins (hospitals) are in our health records snooping around.

I support all of these bills to increase coverage for children, to train care providers in the pernicious influence of cultural bias and systematic racism that can skew our medical decisions (without us even realizing it). I worked as a hospital RN, and then a Nurse Practitioner for 23 years. Nurse practitioners have the education and professional certification requirements to work collaboratively. We do not need practice agreements or supervision by a medical doctor to work within the law and limits of our profession. I do not agree with any measures to limit the dissemination of birth control to women who seek help in limiting conception. I do not know the details of Mr LaRock’s bill, but I have followed his history of preference for the State to control women in their choices for their contraception and well-being within their life limitations. I believe doing all we can to educate girls and women to be their own decision makers, and equal to men spiritually, mentally, and legally will reduce the incidence of unwanted and too early pregnancy better than any heavy-handed scare tactics.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Please gently PBI HB877. We need to give any benefits to those who *legally* and only legally come here. I know many folks who have, who follow the laws and work hard. Stop penalizing them for obeying the law. Please move to report HB1098 for obesity. Tough disease. It is a linchpin in many others, and treating it would be best. HB1105, please gently PBI. I didn't take courses but have been introduced to a lot of people of all backgrounds and that positive interaction is going to do more than any training that is not scientifically proven. Please move to report HB1359 because we need to know who of these admins (hospitals) are in our health records snooping around.

I oppose HB 1105. Recognizing implicit bias and cultural competency is important. Medical school and residency training includes this in their training. The challenges are physicians are overwhelmed with required/mandated educational requirements from the Federal government, Joint Commission, medical malpractice carriers, Board recertification requirements, CME requirement. The Commonwealth of Virginia already requires 30 hours of CME per year for physicians plus 2 hours relating to opioids. My board recertification requires 50 hours of CME per year. There is truly little evidence that requiring 2 hours every two years of implicit bias and cultural competency for everyone is going to accomplish its goals. In many cases health providers are pulled from patient care to complete the above requirements. Adding 2 additional hours of CME to all health care providers who are burned out from the pandemic is not effective use of their time. I would suggest health organizations, or the Board of Medicine be more focused on which health care providers would benefit from an intervention/specific training related to implicit bias and cultural competency. Sincerely yours, Roger Hofford, M.D. Roanoke, VA

Comments Document

Although my name is Dr. Ladd, I have a doctorate in political science, not medicine. I am writing because HB1105 concerns our fundamental responsibility to provide equal protection of the laws. Although a member of the Senate committee considering this bill recently suggested that there was no proof that race bias is causing adverse health outcomes, the New England Journal of Medicine has an article in their current issue that has a long list of studies proving otherwise. Since we therefore know that human beings are prone to hold biases that can interfere with critical medical decisions, it is incumbent on the government to protect the public from this harm. HB1105 is a modest step toward addressing this complex failing of the profession. It is not an intrusion into the field of medicine by government, the medical profession itself has identified this problem and called for steps to address it.

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

Please support HB1105. Having a young child with sickle cell and dealing with medical staff who was not familiar with the disease or on how to treat my child lead to them calling CPS on my husband and I. We waited for hours while the doctor was trying to get in contact with a pharmacist until we decided to leave and go elsewhere for care. Instead of the doctor admitting that they were not trained on how to treat my son, she just made us wait for hours in a room while my son was in pain with a fever and wheezing. We decided to leave and take him elsewhere. The doctor assumed we were leaving with our son to do who knows what. CPS was contacted and they called while we were finally receiving care from another hospital. I honestly believe more training would have eliminated this horrible situation. I had to make sure my son got treatment immediately, but this doctor tried to make us feel guilty for doing what was best for our son and receiving the care he deserved.

It is clear that something must be done about implicit bias in healthcare. As an RN of 37 yrs, and Women's Health Nurse Practitioner for 27yrs, I have personally seen the result of bias . Black women are dying two to three times more than their counterparts in pregnancy associated deaths, and in Virginia, the mortality rate is three to four times more. I am 100% supportive of this bill which establishes two hours of Unconscious (implicit and cultural competency) Bias Training as a criterion of eligibility for all health care professionals seeking renewed licensure every biennium by the Virginia Board of Medicine. It would certainly benefit the over 13000 Advanced Practice Nurses as well. Healthcare providers already participate in opportunities for continuing education, and this topic, as with the opioid crisis, is needed and timely. There is no fiscal impact.

I support all of these bills to increase coverage for children, to train care providers in the pernicious influence of cultural bias and systematic racism that can skew our medical decisions (without us even realizing it). I worked as a hospital RN, and then a Nurse Practitioner for 23 years. Nurse practitioners have the education and professional certification requirements to work collaboratively. We do not need practice agreements or supervision by a medical doctor to work within the law and limits of our profession. I do not agree with any measures to limit the dissemination of birth control to women who seek help in limiting conception. I do not know the details of Mr LaRock’s bill, but I have followed his history of preference for the State to control women in their choices for their contraception and well-being within their life limitations. I believe doing all we can to educate girls and women to be their own decision makers, and equal to men spiritually, mentally, and legally will reduce the incidence of unwanted and too early pregnancy better than any heavy-handed scare tactics.

As the author of a book on Unconscious Bias (Overcoming Bias: Building Authentic Relationships Across Differences), there is indisputable evidence that unconscious bias affects all well-meaning people in ever profession. In health care, it is literally a life or death matter to ensure that health care professionals are aware of their biases and trained on how to interrupt them. Please support this crucial bill to ensure access to quality health care for all Virginians.

Please support HB1105. This bill will help bring an immediate solution to the maternal mortality crisis that is costing the lives of women and infants

Unconscious bias is a very practical bill that can have significant long term impact.

Please support HB1105

Please support HB 1105 as everyone deserves the same level of health care in our community. We often don't realize the subtle biases that influence our decisions and consequently might impact another person in a less than desirable manner. Having training to recognize those implicit biases will help to mitigate the disparity that is evident in maternal mortality rates. This disparity is completely unacceptable for this time and our community.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I would like to speak please -Amy Lee Story

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I would like to speak please -Amy Lee Story

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I would like to speak please -Amy Lee Story

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

I support all of these bills to increase coverage for children, to train care providers in the pernicious influence of cultural bias and systematic racism that can skew our medical decisions (without us even realizing it). I worked as a hospital RN, and then a Nurse Practitioner for 23 years. Nurse practitioners have the education and professional certification requirements to work collaboratively. We do not need practice agreements or supervision by a medical doctor to work within the law and limits of our profession. I do not agree with any measures to limit the dissemination of birth control to women who seek help in limiting conception. I do not know the details of Mr LaRock’s bill, but I have followed his history of preference for the State to control women in their choices for their contraception and well-being within their life limitations. I believe doing all we can to educate girls and women to be their own decision makers, and equal to men spiritually, mentally, and legally will reduce the incidence of unwanted and too early pregnancy better than any heavy-handed scare tactics.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Please increase the number of individuals with lived experience for the workgroup. These folks have a critical perspective that is essential and cannot be represented by other members. Why are more insurance reps than people with lived experience proposed?

I appreciate the sentiment to study this important issue. However, I am appalled that only one out of eleven representatives are those who have experienced mental health issues personally and first-hand. The additional 3 insurance representatives should be replaced with 3 individuals who directly experienced or were impacted by mental health issues. Further, this study should include a section that articulates medical causes of mental health issues and tests and treatments that should be utilized rather than solely psychiatric drugs or therapy. And, at least one of the additional personally affected workgroup members should represent this sub-set of mental illness. And, finally, the study should evaluate care facilities available to treat medically-induced mental health issues and establish at least one care facility in Virginia to meet this unique need.

Delegate Hope- thank you for this bill- but you only have one family member or individual - Can you add more? Please

Coordinated Specialty Care is an evidence-based practice to provide early intervention to those with emerging psychosis. To date Virginia has established eleven programs providing this treatment. This falls far short of the need. For these programs to be developed and sustained the Commonwealth will need to establish resources for ongoing funding. Medicaid and commercial insurance are logical sources of funding for Coordinated Specialty Care. This work group will develop the foundation for future funding. I support the passage of this important bill.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I am really wanting you all not to pass this bill because Oxford House gives me a place to live at a price I can afford on disability it gives me stability Oxford House I would be homeless and if the bill does pass that means I rent would go up and I would be homeless again and I am doing very well I enjoy living in the Oxford House we have meetings once a week for our house and we have committee meetings and everything So please do not pass this bill I in begging you

Dear Chairman Head: On behalf of our members jointly operating nearly 1200 pharmacies in the Commonwealth of Virginia, the Virginia Association of Chain Drug Stores (VACDS) and National Association of Chain Drug Stores (NACDS) appreciate the opportunity to express our support for HB 1323. The bill would continue the access to vaccines Virginians have widely taken advantage of during the current Public Health Emergency under the Federal PREP Act. We applaud the Committee for recognizing the valuable impact in making these services permanently available to your constituents and thank Delegate Orrock for sponsoring this bill. It is important to keep in mind that Virginia pharmacies have a PROVEN track record of safely providing vaccines to Virginians: In 2020 and 2021 alone, pharmacists provided nearly 9 million vaccines1 to Virginians, including to children and adolescents. In fact, according to VDH data drawn this week, during the epidemic pharmacies provided 37% of all the vaccines given to five- to 11-year-olds and 54% percent of those received by twelve- to 17-year-olds. Moreover, pharmacy-based immunizations have been a well-established practice in the Commonwealth, long before the COVID-19 pandemic. We thank legislators for their history of support for pharmacy, most recently with the unanimous advancement of SB 672, a bill that has similar vaccine access provisions, last week in Senate Subcommittee. The COVID-19 pandemic has clearly demonstrated that patient access to care at community pharmacies was critical and necessary. Given the strain the pandemic put on the healthcare system and the inequities it exposed in access, now is the time to permanently recognize the full skillset of pharmacists to deliver patient care while supporting the larger healthcare team. Pharmacists have proven time and again that they have the knowledge and know-how to bring accessible and convenient healthcare into communities. Pharmacists are highly educated and trained in vaccines having earned a Doctor of Pharmacy (PharmD). Pharmacists also are quite literally the medication experts of the healthcare professions. Therefore, they have in-depth knowledge of vaccinations, medication side effects and avoiding contraindications – as well as providing emergency care in the rare case of an adverse reaction. Pharmacists regularly communicate with patients’ primary care providers, offering referrals, and counseling patients on the importance of both routine and follow-up medical care. We are also mandated reporters to the state vaccine registry. We understand that the medical community is seeking “friendly amendments” to this bill. We are approaching that process in the spirit of patient safety and collaboration with medical profession We thank the Subcommittee for considering HB 1323. Pharmacies are the face of neighborhood care and continually strive to help Americans in times of need. If we can provide further assistance, please contact VACDS’ Jodi Roth or NACDS’ Jill McCormack. Sincerely, Jill McCormack

As a patient recovering from three different joint replacement surgeries and serious back surgery I spent weeks in three different nursing homes and experienced neglect, abuse and injury. I was served hot dogs for lunch, dinner and lunch the next day while on a doctor prescribed low sodium diet. I had to beg for prescribed pain meds administered by unqualified “nurses” who did not know my name or the name of the meds they were giving me. Nurses aides cleaned bedpans in sinks where I brushed my teeth and no one on staff spoke English. I nearly fell off a broken shower chair and waited at least 20 minutes for someone to answer my emergency call bell in the shower. You must require a better level of care for vulnerable patients. We are an aging population and our needs for qualified nurses, doctors and nutritionist will only grow and most of us grow old. Please care enough to pass protective legislation. All of my nursing home stays were in Springfield and Warrenton Virginia. So many “call bells” went unanswered . So many unqualified, abusive people were expected to provide care to the most vulnerable and elderly patients. The aides who injured me did not seek to hurt me, they were not trained on how to assist handicapped patients. They were not trained in how to properly maintain a healthy and clean environment. There were no standards of care or standards of facilities mandated by law. It falls to you to enact these basic standards under the law or greed for profit will continue to cause neglect, suffering, injury and death. Protect the most vulnerable citizens of Virginia who are depending on you.

Please move to report HB22, HB27, HB512, HB514, HB519, HB915, HB962, HB1038 HB1323. All these bills resolve discrimination and follow the medical science that is out there, from not just the USA but all over the world.

Dear Honorable Virginia Delegates, My name is Steve Thompson. I am a Virginia resident and an active voter. I am writing you today to urge you to vote YES on House Bills 22, 27, 156, 512, 514, 783, 915, 962, 1038, and 1323. Medical Freedom and bodily autonomy are foundational and critical parts of our freedom as Virginian and American citizens. I find it angering, dismaying, and personally offensive that any government would attempt to force me or my family to undergo a medical procedure that we do not trust and do not disagree with. “Forced vaccination” is frankly something that belongs in Communist China, Nazi Germany, or Soviet Russia. It has NO place in Virginia or America. I strongly urge you to vote YES on House Bills 22, 27, 156, 512, 514, 783, 915, 962, 1038, and 1323. Sincerely, Stephen Donald Thompson

Please look after our seniors. They all deserve respect and the best care. Just remember one day you may have to go to a nursing home, don't you want to be cared for?

As a disabled senior citizen, I feel that nursing homes are at best a "warehouse for the elderly", and at worst, a place for exploitation and abuse. Seniors deserve to live with dignity, until their time comes to die.

Comments Document

See attachment for testimony.

I am writing in support of HB 306 to be heard in committee tomorrow morning, which will allow a religious exemption to vaccines during an epidemic. Religious exemptions exist so that citizens can act freely in mind, body and spirit. Even in a time of an epidemic, citizens must have the opportunity to act on their conscience whatever that may be. The Nuremberg Code requires bodily autonomy and informed consent for any medical treatments to one’s body. Having religious exemption makes sure that remains the rule of law. As we’ve seen over the last two years, government has retained control over persons and their bodies in a way that would make Thomas Jefferson role over in his grave. Let Virginia continue to be religiously free, as the birthplace of religious freedom. Support HB 306.

I would like to speak-AMY Lee Story

I would like to speak please -Amy Lee Story

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As a SALT (Social Action Linking Together) and Cornerstones advocate, I encourage you to support HB 484, with Delegate Dan Helmer as patron. This legislation exempts from mandatory participation in the Virginia Initiative for Education and Work recipients of Temporary Assistance for Needy Families those enrolled full-time in an accredited public institution of higher education or other postsecondary school licensed or certified by the Board of Education or the State Council of Higher Education for Virginia and are taking courses as part of a curriculum that leads to a postsecondary credential, such as a degree or an industry-recognized credential, certification, or license. Passing this legislation would make moving off welfare into the workforce a much easier task, which would be a win-win for both those receiving TANF and taxpayers. Post-secondary education, GED, vocational education, and most credentialing programs, as well as apprenticeships, require more than 24 months for the screening, access and completion process. Eliminating the two-year limit is the right thing to do. Preparing adult TANF recipients for jobs to fully support their families should be a primary goal for Virginia. Attaining this goal would be a win-win for both TANF recipients and taxpayers. However, the current two-year time limit on the continuous receipt of TANF benefits is an impediment, making that goal unattainable. Regards, Sarah Newman

Please gently PBI HB877. We need to give any benefits to those who *legally* and only legally come here. I know many folks who have, who follow the laws and work hard. Stop penalizing them for obeying the law. Please move to report HB1098 for obesity. Tough disease. It is a linchpin in many others, and treating it would be best. HB1105, please gently PBI. I didn't take courses but have been introduced to a lot of people of all backgrounds and that positive interaction is going to do more than any training that is not scientifically proven. Please move to report HB1359 because we need to know who of these admins (hospitals) are in our health records snooping around.

I SUPPORT HB 388, 481, 484, 538, 877, 878, 1012, 1105, 1106, 1211, 1329, and 1342. Also, I object to the language used to describe non-citizens - the word "alien" is dehumanizing and I suggest retiring it permanently when referring to non-citizens. I OPPOSE HB 937 and 1359. It is everybody's right to control their own fertility and to NOT be forced to carry an unwanted pregnancy to term. Both of these bills directly or indirectly undermine that right.

Fluvanna County’s Community and Policy Management Team opposes the passage of this bill. This public body asserts that this bill would have a net negative impact on the mental health treatment of many youths served in the Commonwealth of Virginia. Reading between the lines, we would like parents to be more involved, but not all parents are seen by their children as a safe space; this bill could very likely reaffirm this perception, and cause any mental health provider to also be seen as an equally unsafe space, resulting in any pursuit of mental health treatment of many children to be, ultimately, a futile endeavor, due to the consequences of this bill becoming a barrier to many children accepting the help they need.