Too many patients are receiving substandard care. Workers, particularly nurse's aides who provide the majority of direct care, suffer from low wages, lack of benefits, understaffing, inadequate training, and limited career opportunities. Families are often appalled at how their loved ones are treated. Owners and managers struggle with government reimbursements that do not allow higher pay or better treatment. Government is deeply implicated, since the majority of nursing home bills are paid by Medicaid or Medicare.
States vary widely in their strategies.
Massachusetts and California have made recent gains in upgrading care quality and professionalizing care. In Florida, with its large population of seniors, there is the beginning of a coalition of patients, families, and workers on behalf of better care, but Governor Jeb Bush's administration is more obstacle than ally. Government also regulates the conditions of care and subsidizes training programs for nursing assistants and other paraprofessionals. Though bits and pieces of this strategy are emerging in a few states, it is being blocked nationally by warped budgetary priorities and a failure of political imagination. This problem will only grow.