Nursing Home Problems: Quality, Safety, and Federal Oversight
This paper examines widespread problems in American nursing homes, including inadequate staffing, preventable patient deaths, financial instability, and failures of federal enforcement. Drawing on a U.S. Senate committee hearing, state-level incident reports from Missouri, a Washington Post investigation into an Arizona veterans' facility, and a Government Accountability Office report, the paper documents how repeat violators face insufficient sanctions and cycle in and out of compliance with federal regulations. The paper concludes with policy recommendations aligned with GAO findings, calling for stronger enforcement, expedited penalty collection, and improved data systems to protect elderly and veteran residents.
- Introduction: The Challenge of Elderly Care in America: Aging burdens families, driving reliance on nursing homes
- Financial Instability in the Nursing Home Industry: Budget cuts and bankruptcy plague nursing home chains
- Documented Harm to Nursing Home Residents: Missouri cases reveal preventable deaths and neglect
- Failures at Veterans' Care Facilities: Arizona veterans home scandal exposes nepotism and neglect
- GAO Findings on Federal Enforcement: Repeat violators face weak sanctions and poor oversight
- Recommendations for Reform: GAO-aligned policy reforms to strengthen enforcement
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What makes this paper effective
- Uses multiple primary and secondary sources — a Senate hearing, state coalition reports, a GAO report, and news articles — to build a multi-layered case for systemic failure.
- Grounds abstract policy arguments in concrete, named incidents with specific outcomes, making the stakes tangible for the reader.
- Moves logically from financial instability, to patient harm, to federal enforcement failure, before arriving at actionable policy recommendations.
Key academic technique demonstrated
The paper demonstrates effective use of government and institutional sources — particularly the GAO report — to substantiate a policy argument. By citing specific statistics (63 nursing homes investigated, 19 cycling in and out of compliance four or more times, 22% with no sanction record), the writer translates bureaucratic findings into persuasive evidence of systemic neglect.
Structure breakdown
The paper opens with the social context of aging and family caregiving, then moves through financial crisis in the industry, documented patient harm at the state level, a high-profile veterans' facility scandal, and federal enforcement data from the GAO. It closes with a four-point reform agenda drawn directly from GAO recommendations, tying the conclusion back to the evidence presented throughout.
Introduction: The Challenge of Elderly Care in America
There are many problems associated with old age. As the human body begins to break down physically, the mind can deteriorate as well, resulting in memory loss, psychological issues, and in some cases dementia or even Alzheimer's disease.
For most families in America, caring for elderly grandparents or parents at home is not a realistic option. The average family finds it too great a burden, and many families are simply not equipped to provide the healthcare and psychological support their aging relatives require.
Families unable to provide for their elderly at home have little choice but to turn to care facilities such as nursing homes. But nursing homes have severe problems that, in too many cases, cause actual harm to the senior citizens who reside in them. While the federal government attempts to track and resolve those problems, elected officials are not always successful in those efforts, as the literature reviewed here demonstrates.
Financial Instability in the Nursing Home Industry
In a United States Senate special committee hearing held on September 5, 2000, it was noted that nursing homes were struggling not only to provide adequate care for the elderly but also to remain financially solvent. An article in AHA News (Baisden, 2000) reported that five of the nation's ten largest nursing home chains had filed for bankruptcy between 1999 and 2000.
If there were plenty of patients to fill the beds in those nursing homes, why were so many nursing home companies losing money? According to nursing home administrators who testified at the hearing, part of the blame lay in the fact that federal subsidies for nursing home facilities had been cut back. In 1997, Congress passed — and President Bill Clinton signed — the Balanced Budget Act, which tightened budgets across the federal bureaucracy.
That said, Senator Chuck Grassley of Iowa, the Republican chairman of the Special Committee on Aging, stated that he was "not convinced" that nursing home companies "need more money" (Baisden, 2000). If patients have "access to adequate nursing home care," Grassley argued, then the taxpayer money directed to nursing home chains "is adequate as it is."
Grassley also pointed out that nursing homes in America were at that time receiving upwards of $39 million annually from Medicare and Medicaid, and that some of the financial difficulties facing nursing home corporations were self-inflicted — the result of "business decisions based on the belief that Medicare payments would continue to increase." Those payments had not increased. Grassley noted that a study was underway by the U.S. Government Accountability Office to determine what could be done to improve nursing care in America, both from a human comfort perspective and a financial one.
Works Cited
Baisden, Harry. "Senate Panel Proves Nursing Home Failures." AHA News 36.36 (2000): p. 7.
Government Accountability Office. "Report to the Ranking Minority Member, Committee on Finance, U.S. Senate: Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents." Retrieved September 2, 2007, from
Lee, Christopher. "Arizona Veterans' Services Director Quits Amid Scandal." The Washington Post. 28 March 2007, p. A6.
Missouri Coalition for Quality Care. "Missouri Long-term Care Facility Notices of Non-Compliance." Retrieved September 3, 2007, from
O'Connor, Phillip. "Missouri Governor Wants Web Site for Nursing Home Violations." St. Louis Post-Dispatch. 27 October 2002. Retrieved September 3, 2007, from http://www.stltoday.com.
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