Find Reports and Papers

Please feel free to use Older Dominion Partnership's resources under the terms of this site, and contact us with feedback and suggestions, and/or submit a study.

For a complete listing of studies and reports click here, or search by the study's sponsor, the topic, and/or date of the study:


Health & Well-Being » Nursing Care

Why It's Important

Nursing care is professional treatment by a skilled nurse during an illness or injury. Nurses participate in the care process from the very beginning, often providing the vast majority of the hands-on care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based and chronic care patients.

How Richmond Is Doing

According to Genworth's Cost of Care Survey, 2009, except for home-based health care, the costs of long-term care also are poised for steady increases.

  • The cost of labor is a key factor driving the price of care at facilities, though that has abated somewhat because of the availability of workers as unemployment has risen and because of higher retention rates.
  • Nationally, the average annual cost for a private room in a nursing home is $74,208 or $208 per day, a 4.7 percent increase over the past year and 4.3 percent more annually over the past five years.
  • In Richmond and Roanoke, the cost for a private room has risen 8 percent a year since 2005 and 5 percent a year in the Norfolk-Virginia Beach region.
  • The median annual cost for a private nursing home room in Richmond is $78,658.
  • In Richmond, costs for a private room in an assisted-living facility rose even faster, increasing 16 percent a year over the past five years to a median annual cost of $37,752.
  • Nationally, the cost for a one-bedroom unit in an assisted-living facility is $33,903 annually or $2,825 monthly, marking an increase of 1.4 percent over 2008 and 4.7 percent annually over the past five years.
  • A bright spot in the company's survey is the relatively flat cost of in-home care. The hourly cost for in-home care for non-Medicare-certified workers rose a half-percent to $18.50 from a year ago and increased 1.7 percent annually over the past five years.
  • In Richmond, however, the median rate is $19, which represents an annual growth rate of 5 percent since 2005. The cost ranges from $15 to $21 in Virginia.



Rate of nursing home residence among people age 65 and over, by age group, selected years 1985-2004


Percent of medicare enrollees age 65 and over residing in selected residential settings, by age group, 2005

How Virginia Is Doing

According to the Virginia Department of Healthcare Professions:

  • By 2020 there will be a projected shortage of 1500 physicians and 22,600 registered nurses in Virginia.
  • Currently in Virginia there is a lack of accurate healthcare data.
  • The area of direct support professionals (DSP) lacks the most data where there is a projected 45 % increase in demand by 2010.


How the U.S. Is Doing

According to a report by Marla Salmon on the future roles and services of nursing for older adults: Older adults have greatest need for nursing services

  • Two-thirds have two or more chronic diseases
  • Hospitalized 3X more often & stay 50 percent longer
  • 70 percent have cognitive impairment or at least one ADL limitation
  • 40 percent over 85 suffer cognitive impairment
  • 25 percent over 85 suffer severe depression

The reality: nursing care of older adults

  • Relies heavily on unskilled, unprepared workforce
  • Lacks oversight & appropriate supports
  • Disparities are significant
  • Shortage of all providers is worsening
  • Most promising models not widely adopted

A closer look: assistants, aides and attendants

  • Growing need: 1.3 million more by 2012
  • Poor career options
    • 30 percent live in poverty
    • Frequent turnover
    • Difficult work conditions
    • Few advancement opportunities
  • Lack of training, support & functional teams

A closer look: informal care

  • 57 percent of community care is informal
  • Usually women, average age 46
  • $257 B/yr. "savings"
  • Decreasing availability
  • Significant economic, social & health impact

A closer look: nurses

  • Primary care (particularly advanced practice nurses) & prevention/promotion
  • Chronic disease management (particularly advanced practice nurses)
  • Direct care provision (particularly LPNs in long term care) & coordination
  • Informal care provider training & support
  • Team interface & coordination
  • Family health, education & support

(SALMON, 2004)

Data & Information Sources

Genworth Financial, Cost of Care Survey, 2009

Health Workforce Information Center

Roadmap for Virginia’s Health, A Report of the Governor’s Health Reform Commission, 2007

Salmon, Marla, Nursing and Care for Older Adults, Future Roles and Services in the Face of Scarcity, 2004

U.S. Census Bureau, American Community Survey

Virginia Department of Health Professions, 2009

Virginia Employment Commission, Labor Market Data, 2009

Virginia Nurses Survey, Virginia Department of Health Professions, 2001