Nursing Home Care: The Unseen Crisis

Muriel Cole • January 3, 2023


With more than 1.3 million Americans now in nursing homes, 70% of us over age 65 will need long-term care. By 2050, up to 30 million people will require it, according to Zippia.com, a career information center.

 

The people that make up these numbers are not at our borders, they’re not in our schools, they’re not out marching. They’re faceless. Unless we work in a nursing facility, we forget they exist. The quality of care is decreasing at an alarming rate.

 

Did we hear anything about this crisis from the recent crop of candidates?

 

As the National Consumer Voice for Quality Long-Term Care notes, “chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the covid-19 pandemic.” The high number of patients per staff leads to a poor quality and quantity of care. The guidelines set by the Centers for Medicare and Medicaid Services (CMS) call for 4.1 hours of nursing care per patient per day. In 2019, only one-third of nursing homes in the United States reached that level.

 

The American Association of Retired Persons faults the nursing home industry for blocking changes to minimum staffing requirements.

 

Of the 15,000 nursing homes in the U.S., 69% are for-profit. Industry lobbying groups object to what they call "over-regulation" and argue they are more regulated than the nuclear power industry.

 

A Washington Post story quotes Kelly Bagby, vice-president of AARP Foundation Litigation, as saying, “shortchanging the direct-care workforce primarily made up of women and people of color with low pay, poor training, and insufficient numbers is a tempting way for nursing homes to boost the bottom line.”

 

The Medicare web site notes that, on average, a nursing home administrator stays little more than a year. A quarter of certified nursing assistants rely on Medicaid and 64% do not have paid sick leave. Registered nurses working in long-term care are paid 7% less than those in hospitals.

 

In 2023, CMS is expected to issue minimum staffing standards, and the industry is expected to continue to fight these standards. Consumer Voice calls conditions in nursing homes “a crisis.” Its surveys show that nursing homes, on average, experience a 52% turnover of nursing staff annually. Numerous studies have shown that nursing turnover is related to poor pay, lack of benefits, high workloads, inadequate training, poor management, and lack of career advancement.

 

High turnover means poorer health outcomes for nursing home residents. A recent study directly connects high turnover with poor care. A review of federal data shows that nursing homes with higher turnover have higher instances of resident abuse, poorer Medicare ratings, and greater numbers of substantiated resident complaints.

 

A White House Fact Sheet issued in February 2022 noted that “private equity firms have been buying up struggling nursing homes, and research shows that private equity-owned nursing homes tend to have significantly worse outcomes for residents. Private equity firms’ investment in nursing homes has ballooned from $5 billion in 2000 to more than $100 billion in 2018.”

 

In November 2022, the Office of Inspector General for the U.S. Department of Health and Human Services released a report documenting the failure of a 10-year effort to reduce the inappropriate use of medications in nursing homes to sedate residents. Of those staying over 100 days, 80% were given these drugs. There was a direct correlation between the use of these drugs and staffing levels. The report noted that illegal drugging was being used to offset the need for care and adequate staffing.

 

Where is the public outrage?

 

 

Muriel Cole is Co-Chair of the Kent County Commission on Aging and was, for ten years, a volunteer long-term care ombudsman for Upper Shore Aging, Inc.

 

Common Sense for the Eastern Shore

By Friends of Megan Outten July 29, 2025
Megan Outten, a lifelong Wicomico County resident and former Salisbury City Councilwoman, officially announced her candidacy recently for Wicomico County Council, District 7. At 33, Outten brings the energy of a new generation combined with a proven record of public service and results-driven leadership. “I’m running because Wicomico deserves better,” Outten said. “Too often, our communities are expected to do more with less. We’re facing underfunded schools, limited economic opportunities, and years of neglected infrastructure. I believe Wicomico deserves leadership that listens, plans ahead, and delivers real, measurable results.” A Record of Action and A Vision for the Future On Salisbury’s City Council, Outten earned a reputation for her proactive, hands-on approach — working directly with residents to close infrastructure gaps, support first responders, and ensure everyday voices were heard. Now she’s bringing that same focus to the County Council, with priorities centered on affordability, public safety, and stronger, more resilient communities. Key Priorities for District 7: Fully fund public schools so every child has the opportunity to succeed. Fix aging infrastructure and county services through proactive investment. Keep Wicomico affordable with smarter planning and pathways to homeownership. Support first responders and safer neighborhoods through better tools, training, and prevention. Expand resources for seniors, youth, and underserved communities. Outten’s platform is rooted in real data and shaped by direct community engagement. With Wicomico now the fastest-growing school system on Maryland’s Eastern Shore — and 85% of students relying on extra resources — she points to the county’s lagging investment as a key area for action. “Strong schools lead to strong jobs, thriving industries, and healthier communities,” Outten said. “Our schools and infrastructure are at a tipping point. We need leadership that stops reacting after things break — and starts investing before they do.” A Commitment to Home and Service Born and raised in Wicomico, Megan Outten sees this campaign as a continuation of her lifelong service to her community. Her vision reflects what she’s hearing from neighbors across the county: a demand for fairness, opportunity, and accountability in local government. “Wicomico is my home; it’s where I grew up, built my life, and where I want to raise my family,” Outten said. “Our county is full of potential. We just need leaders who will listen, work hard, and get things done. That’s what I’ve always done, and that’s exactly what I’ll continue to do on the County Council.” Outten will be meeting with residents across District 7 in the months ahead and unveiling more details of her platform. For more information or to get involved, contact info@meganoutten.com
By John Christie July 29, 2025
Way back in 1935, the Supreme Court determined that independent agencies like the Consumer Product Safety Commission (CPSC), the National Labor Relations Board (NLRB) and the Merit Systems Protection Board (MSPB) do not violate the Constitution’s separation of powers. Humphrey’s Executor v. United States (1935). Congress provided that the CPSC, like the NLRB and MSPB, would operate as an independent agency — a multi-member, bipartisan commission whose members serve staggered terms and could be removed only “for neglect of duty or malfeasance in office but for no other cause.” Rejecting a claim that the removal restriction interferes with the “executive power,” the Humphrey’s Court held that Congress has the authority to “forbid their [members’] removal except for cause” when creating such “quasi-legislative or quasi-judicial” bodies. As a result, these agencies have operated as independent agencies for many decades under many different presidencies. Shortly after assuming office in his second term, Donald Trump began to fire, without cause, the Democratic members of several of these agencies. The lower courts determined to reinstate the discharged members pending the ultimate outcome of the litigation, relying on Humphrey’s , resulting in yet another emergency appeal to the Supreme Court by the administration. In the first such case, a majority of the Court allowed President Trump to discharge the Democratic members of the NLRB and the MSPB while the litigation over the legality of the discharges continued. Trump v. Wilcox (May 22, 2025). The majority claimed that they do not now decide whether Humphrey’s should be overruled because “that question is better left for resolution after full briefing and argument.” However, hinting that these agency members have “considerable” executive power and suggesting that “the Government” faces greater “risk of harm” from an order allowing a removed officer to continue exercising the executive power than a wrongfully removed officer faces from being unable to perform her statutory duty,” the majority gave the President the green light to proceed. Justice Kagan, joined by Justices Sotomayor and Jackson, dissented, asserting that Humphrey’s remains good law until overturned and forecloses both the President’s firings and the Court’s decision to award emergency relief.” Our emergency docket, while fit for some things, should not be used to “overrule or revise existing law.” Moreover, the dissenters contend that the majority’s effort to explain their decision “hardly rises to the occasion.” Maybe by saying that the Commissioners exercise “considerable” executive power, the majority is suggesting that Humphrey’s is no longer good law but if that is what the majority means, then it has foretold a “massive change” in the law and done so on the emergency docket, “with little time, scant briefing, and no argument.” And, the “greater risk of harm” in fact is that Congress provided for these discharged members to serve their full terms, protected from a President’s desire to substitute his political allies. More recently, in the latest shadow docket ruling in the administration’s favor, the same majority of the Court again permitted President Trump to fire, without cause, the Democratic members of another independent agency, this time the Consumer Product Safety Commission (CPSC). Trump v. Boyle (July 23, 2025). The same three justices dissented, once more objecting to the use of the Court’s emergency docket to destroy the independence of an independent agency as established by Congress. The CPSC, like the NLRB and MSPB, was designed to operate as “a classic independent agency.” In Congress’s view, that structure would better enable the CPSC to achieve its mission — ensuring the safety of consumer products, from toys to appliances — than would a single-party agency under the full control of a single President. “By allowing the President to remove Commissioners for no reason other than their party affiliation, the majority has negated Congress’s choice of agency bipartisanship and independence.” The dissenters also assert that the majority’s sole professed basis for the more recent order in Boyle was its prior order in Wilcox . But in their opinion, Wilcox itself was minimally explained. So, the dissenters claim, the majority rejects the design of Congress for a whole class of agencies by “layering nothing on nothing.” “Next time, though, the majority will have two (if still under-reasoned) orders to cite. Truly, this is ‘turtles all the way down.’” Rapanos v. United States (2006). * ***** *In Rapanos , in a footnote to his plurality opinion, former Supreme Court Justice Scalia explained that this allusion is to a classic story told in different forms and attributed to various authors. His favorite version: An Eastern guru affirms that the earth is supported on the back of a tiger. When asked what supports the tiger, he says it stands upon an elephant; and when asked what supports the elephant, he says it is a giant turtle. When asked, finally, what supports the giant turtle, he is briefly taken aback, but quickly replies "Ah, after that it is turtles all the way down." John Christie was for many years a senior partner in a large Washington, D.C. law firm. He specialized in anti-trust litigation and developed a keen interest in the U.S. Supreme Court about which he lectures and writes.
By Shore Progress, Progessive Maryland, Progressive Harford Co July 15, 2025
Marylanders will not forget this vote.
Protest against Trumpcare, 2017
By Jan Plotczyk July 9, 2025
More than 30,000 of our neighbors in Maryland’s first congressional district will lose their health insurance through the Affordable Care Act and Medicaid because of provisions in the GOP’s heartless tax cut and spending bill passed last week.
Farm in Dorchester Co.
By Michael Chameides, Barn Raiser May 21, 2025
Right now, Congress is working on a fast-track bill that would make historic cuts to basic needs programs in order to finance another round of tax breaks for the wealthy and big corporations.
By Catlin Nchako, Center on Budget and Policy Priorities May 21, 2025
The House Agriculture Committee recently voted, along party lines, to advance legislation that would cut as much as $300 million from the Supplemental Nutrition Assistance Program. SNAP is the nation’s most important anti-hunger program, helping more than 41 million people in the U.S. pay for food. With potential cuts this large, it helps to know who benefits from this program in Maryland, and who would lose this assistance. The Center on Budget and Policy Priorities compiled data on SNAP beneficiaries by congressional district, cited below, and produced the Maryland state datasheet , shown below. In Maryland, in 2023-24, 1 in 9 people lived in a household with SNAP benefits. In Maryland’s First Congressional District, in 2023-24: Almost 34,000 households used SNAP benefits. Of those households, 43% had at least one senior (over age 60). 29% of SNAP recipients were people of color. 15% were Black, non-Hispanic, higher than 11.8% nationally. 6% were Hispanic (19.4% nationally). There were 24,700 total veterans (ages 18-64). Of those, 2,200 lived in households that used SNAP benefits (9%). The CBPP SNAP datasheet for Maryland is below. See data from all the states and download factsheets here.
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