Everything is dictated at the corporate level. Fancy menu plans mean nothing. My mother has had a ruptured colon and needs a special diet. It is not provided. No one even inquires about it.
Medications are a real issue.
It is nearly impossible to speak to the physician and he is usually in a big hurry. Most of the time all the doctor does is follow charts regarding patient, does not even see them. Families must constantly stay on top of the situation. They do not even have an opportunity to be heard. If they are quite elderly and do not have a close family member advocating for them they are lost.