Transparency = Accountability

Transparency = Accountability

Everyone agrees of the significance of safe staffing levels on quality of care, and the prevention of abuse and neglect. However, the financial practices of for-profit NHs result in the failure to fund adequate and appropriate staffing. For-profit ownership is strongly associated with failing to meet safe staffing minimums. Insufficient staffing leads to neglect, burn-out, and abuse.

“Staffing levels are strongly associated with improved outcomes for nursing home (NH) residents.”

A new commentary from JAGS Commentary, 2022 discusses proposed reforms to solve the lack of financial transparency and accountability in for-profit nursing homes. This lack of transparency and accountability allows operators to hide profits and divert funds to related-party organizations.

In fact, 95% of NHs failed to meet all the recommended minimum staffing levels. It is well-known that 4.1 total nurse staffing hours per resident day [hprd]), including 0.75 registered nurses (RNs) hprd, 0.55 licensed practical nurses (LPNs) hrpd, and 2.8 certified nursing assistants (CNAs) hrpd. The recommendation for a minimum total nursing staff of 4.10 hprd and 0.75 RN hprd should be a minimum safe threshold. However, the safety and well-being of the residents require staffing to increase as resident acuity increases to meet the needs of residents.


The article mentions that States have introduced legislation to address nursing home staffing and quality issues. The proposed reforms would require for-profit chains dedicate funds for adequate staffing. California passed legislation requiring NHs to file annual consolidated financial reports (S.B. 650) in 2021.

Some solutions to increase financial transparency and accountability:

Requiring each nursing home to provide an annual consolidated and certified audited financial cost report. Not just for the facility but the entire chain, meaning the parent company and all related-party companies (management and real estate companies).

Another option is to limit the diversion of taxpayer funds. Three states (New Jersey, New York, and Massachusetts) even passed legislation requiring that most expenditures are for direct care services. Place a limit on revenue. The combined annual profits, “administrative” costs and “rental” costs of each nursing home, its related-parties, and parent companies should be reasonable.

Taxpayers should not pay for poor care and horrible conditions.