By Steve Moran

I originally titled this article “Bulls#$&.”

I am guessing my title for this article, and maybe even the whole article itself, will not make it through my own editing process, but I am so frustrated about a series of email conversations I had today with a reader.

I know this industry is not perfect, that it has real challenges. That failures happen that should not. I also know bad things happen because humans are imperfect. I am often a critic but always with the goal of finding better ways to serve residents and team members.

On a regular basis I hear from this reader — someone who works in the industry and is always critical and only critical. I try to always respond in a way that is as honest and helpful as I can.

Particularly in the world we live in, being critical is so, so easy.

Today’s Dialog

Today’s dialog set me off (triggered me, but I hate that word) in a way almost never happens. Here it is, with names and some details changed to protect the reader’s identity. I have also added some additional commentary.

The thing I hate most about the conversation is that it represents the knee-jerk thinking of the general public, and that kind of thinking is unhelpful. Worse than that, it is harmful to residents and team members.

Note: Here is my point of view on federal guidelines, which factors into this conversation.



You are totally wrong about no need for federal guidelines. I’ve worked skilled and assisted and believe me AL needs regulations!

People are too sick for AL but prefer the apartment style living and the companies want to keep up census !

And staffing – absolutely needs requirements! Starting with activities!


How have federal nursing home regulations made things better? Given the amount of regulations that impact nursing homes they should all be wonderful places. They are not. Given a choice, most people would feel better and safer in assisted living than nursing homes in spite of the fact that nursing homes are way more regulated.


The new regulations in nursing homes increase staffing. CNAs cannot care for 8 -10 residents each which was allowed!

Call bells missed etc. Sadly the new regulations don’t increase activity staffing which can be one person for 200 residents! No quality of life with that ratio.

I see AL where residents are in overheated rooms, where people clearly with memory problems are in non-memory care rooms!

Residents who are sick are not having food delivered to their rooms.

Lots of problems in AL that feds need to resolve and regulate!


What evidence do you have that it would fix those problems?

You are telling me that if you had to go into senior living you would rather go into a nursing home than assisted living?


I’m saying AL needs regulations to keep residents safe. I was in an AL as a vendor when a resident was “missing.” Fortunately for him it was warm outside when he was found at a bus stop! No one knew he was gone from breakfast until lunch!

I worked in nursing where state surveys check regularly every year spending a week with a team of three checking right down to electric plugs!

I plan to have home care forever! I know how bad AL and nursing home life is from no meal choices to showers twice a week.

Endless boredom due to bingo, trivia and group focused dumbing down activities due to limited staff and funds!

At this point I am super frustrated. I have made some arguments and asked some questions. She ignores them because … well, actually, I don’t know why. Perhaps because she is unwilling to rethink her comments.

You are probably thinking I should have stopped digging my hole right now … and maybe you are right. 


So fundamentally you and I have very different beliefs.

  1. You believe that having more regulation will force bad actors to behave better.
  2. I believe we need regulation but that at some point regulation becomes more detrimental than helpful.

I do think there are some states where the regulation and enforcement needs substantial improvement.

I see no evidence that massive regulation of nursing homes has made them substantially safer and a better place to live out one’s last years.

I do know that in the nursing home world the cost of providing care has been substantially increased because of all that regulation.

I do know that nursing homes have a difficult time innovating because of massive regulation.

Finally, I believe that family members have some obligation to figure out which communities are good and which are not.

Again I am looking for someone to demonstrate that nursing homes have gotten better, less expensive or safer because of federal regulation. 

Once again, no response to any of my points. But here is what triggered turning this into an article:


Our difference is

I’ve worked in both AL and Nursing Homes for over 18 years doing activities. I’ve traveled to over 35 states and three times to Canada visiting communities and speaking with workers and residents.

What she is telling me is two things:

  1. She is unwilling to address my questions and ideas.
  2. She is right, and I am wrong, because her life experience means she has to be right and any other opinion is wrong.

Who cares, except this is a common way of thinking, and it hurts our industry, and it hurts people. And it is even worse when it comes from within the industry.

As a postscript, I came across this article about a highly regulated nursing home that did massive damage to residents and team members. I think it is at least possible that if they had been less regulated and better compensated, this would not have happened: “A Missouri Nursing Home Shut Down Suddenly. A New Report Offers Insight Into the Ensuing Confusion.”