(The Center Square) – Virginia’s Health Department is seeking funding for 14 more inspectors as it faces a backlog of more than 2,000 overdue inspections of home care organizations.

The Joint Legislative Audit and Review Commission reported Monday that 2,123 of Virginia’s 2,334 active home care organizations, about 90%, were overdue for a routine inspection. State regulations require unannounced inspections at least every two years.

Hal Greer, the commission’s staff director, called the Health Department’s regulation of in-home care “abysmally weak” and said it needed to be stronger.

Budget amendments adopted in 2025 provided $853,098 from the state’s general fund for six positions and travel costs in fiscal 2026 to help the department meet that requirement, according to a legislative budget summary.

The commission also found that assisted living cost nearly $7,000 a month on average in 2025.

Researchers estimated Virginia would need an additional $15.8 million to $27.6 million a year for area agencies on aging to reach the 3,200 to 5,500 eligible older adults who need in-home care and aren’t getting it.

The 2026 budget added $2.5 million a year in fiscal 2027 and 2028 for area agencies on aging to help cover in-home care, transportation, meals and other services.

State Health Commissioner Dr. Cameron Webb told the commission the department began pursuing 18 additional positions several months ago.

In an Oct. 30 letter to the commission, he outlined the request for 14 inspectors, two supervisors and two licensing or program support positions. Webb gave no cost for the new positions at the meeting.

Webb wrote that long delays in inspections and initial licensing, staffing shortages and gaps in enforcement had weakened the department’s oversight.

Four of the department’s 10 home care inspector positions were filled when researchers reviewed staffing. Three positions rely on temporary federal funding that expires in late 2027, the report says.

The department was completing about 150 of the roughly 1,000 routine inspections due each year. Those same inspectors also check new agencies and investigate complaints.

The commission estimated the department would need about 10 additional inspectors to handle its workload even if it filled every vacancy.

State inspectors found at least one violation in 96% of the routine inspections they conducted from fiscal 2024 through fiscal 2026, according to the report.

Inspectors generally review records at agency offices and rarely interview clients or visit them at home. Commission staff recommended adding interviews and home visits to routine inspections for a sample of agencies.

Sen. Mark Obenshain, R-Harrisonburg, asked whether the department needed stronger enforcement powers. The report says the department lacks authority to fine home care agencies.

It recommends allowing the department to fine agencies that are closed during posted business hours when inspectors arrive unannounced. It also recommends making inspection results public.

Webb said the department is checking which inspections are overdue and assessing staffing before setting monthly targets and a timeline to catch up.

According to his Oct. 30 letter, the department is also pursuing a plan to put one supervisor in charge of Northern Virginia inspections and another in charge of the rest of the state to reduce travel time.

Webb said seniors and their families count on the department to make sure the agencies caring for them at home are qualified and follow state rules. “The current system has not lived up to that trust,” he said.