Enforce Quality of Care

Quality of Care

Newsday had a remarkable article about how the pandemic revealed the pre-existing problems in the nursing home industry. Short-staffing, poor infection control, and high turnover rates for caregivers lead to neglect, abuse, and wrongful death. The article states nursing home residents account for less than half-of-1-percent of the U.S. population but roughly a quarter of the deaths related to COVID-19. [I’ve seen it estimates over 33%].

The pandemic exposed long-standing problems in the nursing home industry that stem from chronic understaffing and underspending on care for residents — problems often motivated by owners who place profit-seeking above their residents’ welfare.

Transparency and spending limits would increase care and prevent abuse and neglect. Laws requiring financial disclosures would prevent and deter facilities hiding payments to related entities as expenses. Money should go to staff and residents. Now, taxpayer funds go to the corporate landlord owned by a REIT and leveraged by a private equity company. Researchers know the minimum level of direct caregivers for safe quality care is 4.1 Hours per patient day. The industry needs to meet that minimum standard.


As a lawyer trying to make nursing homes accountable for reckless behavior, we knew this was the state of the industry for the last decade. The lack of enforcement by state agencies hurts the quality of care. The federal regulations contains best practices and reasonable standards but without fair, efficient, and honest oversight, they mean nothing. Regulators hardly never issue fines, conduct meaningful investigations, or suspend payments.

A ProPublica database reveals that fines are imposed in less than 2% of cases in which inspectors find violations, and the fines levied are usually so small that they are little more than a slap on the wrist, manageable as an everyday cost of doing business.

KSDK reported that many facilities received bonuses at the same time they were cited for violations of safety standards. Earlier this year, the federal government fined many nursing homes for infection control problems at the same time it paid them incentive money for low infection rates. We need to do better for the most vulnerable among us.