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 Jan Plotczyk September 10, 2025
 At Shore Progress’s monthly meeting last week, the tension between national politics and local opportunity was on full display. With President Donald Trump escalating his attacks on offshore wind, representatives from US Wind and the Oceantic Network made their case directly to members gathered in Salisbury. From the outset, the presenters stressed the scale of what’s coming to the Eastern Shore. “This project is the equivalent of building two nuclear power plants off our coast,” US Wind representative Dave Wilson said, pointing to plans for 114 turbines and four offshore substations. Together, he said, the project will generate two net gigawatts of clean energy, enough to power approximately 26% of the homes in Maryland. The presentation walked members through the timeline: a four-phase buildout beginning in the southeast corner of the lease area, with each phase, including its own export cable, routed through Indian River Bay into the regional grid at the Indian River Power Plant in Delaware. Environmental safeguards on display Slides showed how US Wind plans to minimize negative effects on wildlife. The company will use an aircraft detection lighting system to keep turbines dark until a low-flying aircraft approaches, reducing night-sky light pollution. Marine protections include bubble curtains to dampen noise during pile driving, visual and acoustic monitoring for whales, and strict shutdown zones if animals enter construction areas. Lights will be on less than 1% of the time in any given year, underscoring their view that offshore wind can coexist with migratory birds, commercial fishing, and marine transit. Economic promise for the Shore The discussion turned quickly to what the project means locally. US Wind pledged hundreds of jobs for the Shore, with commitments to use union labor and partner with minority, women, and veteran-owned businesses. Officials noted that the Lower Shore Workforce Alliance has already received $700,000 from Maryland Works for Wind to build training programs, while community colleges are adjusting trade curricula to educate the next generation of turbine technicians. A planned operations and maintenance facility in West Ocean City will house technicians and crew transfer vessels, bringing steady employment and infrastructure investment to the harbor. A national fight with local stakes The meeting didn’t shy away from politics. Several members noted Trump’s repeated attempts to derail offshore wind projects including his latest push to revoke US Wind’s federal permit. US Wind officials acknowledged that such lawsuits could delay progress but insisted that the project’s federal approvals are on solid ground. “This is the Eastern Shore's moment,” Shore Progress Chair Jared Schablein said, referring to a slide that showed more than $815 million in offshore wind investments statewide. “The question is whether politics will slow us down, or whether we keep building for the Shore’s future.” The presentation had a clear message: Offshore wind is not just about clean power, but also about jobs, investment, and opportunity for Eastern Shore families. Jan Plotczyk spent 25 years as a survey and education statistician with the federal government, at the Census Bureau and the National Center for Education Statistics. She retired to Rock Hall.
By Gren Whitman September 10, 2025
Standing at the Legacy at Twin Rivers apartment community in Howard County, Maryland Gov. Wes Moore signed an executive order aimed at addressing his state’s deepening housing crisis. Titled Housing Starts Here, his order is designed to accelerate construction of affordable homes and cut through what Moore called years of “no and slow” decision-making in state housing policy. Maryland is facing a shortage of at least 96,000 housing units, according to state estimates, a gap that officials say has driven up prices, pushed families out of the state, and stifled economic growth. “Building pathways to wealth for Marylanders, creating jobs, attracting new businesses and residents, growing our economy, and securing our future all start with housing,” Moore said at the signing. “We need to be the state of yes and now.” Five guiding principles The executive order lays out five core priorities for state housing policy: Use state land for housing . Agencies must identify surplus properties and land near transit stations that can be converted into new housing developments. Cut red tape. State permitting processes will be streamlined, with new rules allowing third-party reviewers to accelerate approvals. Strengthen partnerships. A new State Housing Ombudsman will serve as a liaison to help coordinate projects between state agencies, local governments, and developers. Set clear goals. By January 2026, the state will publish housing production targets for each county and update them every five years. Incentivize affordable housing. Jurisdictions that meet housing targets or pass pro-housing policies will be recognized with new Maryland Housing Leadership Awards, making them more competitive for state funding. Speed as the priority State officials said the new framework is focused on cutting delays that can hold back projects for years. By digitizing applications, engaging multiple agencies simultaneously, and allowing outside reviewers, the state aims to expedite project completion while upholding environmental and community standards. What could this mean for us on the Eastern Shore? Moore acknowledged that housing affordability consistently ranks as Marylanders’ No. 1 concern. For young people in particular, high costs and long commutes are major reasons they leave the state. The order seeks to reverse that trend, tying housing growth to job creation and transit access. On the Eastern Shore , where rental availability and starter homes are limited, Moore’s order could open opportunities for mixed-use, transit-oriented projects on state-owned land, as well as accelerate approval for affordable housing initiatives backed by nonprofits and local developers. What comes next The Department of Housing and Community Development will publish the state’s first set of production targets by Jan. 1, 2026, followed by annual progress reports starting in 2027. Agencies have until March 2026 to implement many of the new permitting and funding acceleration rules. Moore framed the executive order as a generational investment. “Making housing more affordable is not just about building shelter, it’s about building a legacy,” he said.
By Gren Whitman September 10, 2025
Sen. Angela Alsobrooks (D-Md.) has intensified her calls for Health and Human Services Secretary Robert F. Kennedy Jr. to step down, releasing a detailed report that she says proves his tenure has been a disaster for American families. The first senator to demand Kennedy’s resignation in May, Alsobrooks joined Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) in unveiling a 54-page report that chronicles what they describe as the “costly, chaotic, and corrupt” record of Kennedy’s first 203 days at the department. Released before Kennedy’s Senate hearing last week, the report outlines examples of alleged mismanagement for each day since he was sworn in on Feb. 13. “Robert Kennedy’s tenure as America’s chief health officer has been higher costs, more chaos, and boundless corruption,” Wyden said. “His actions are endangering children, leaving parents confused and scared, and forcing families and taxpayers to pay more for their health care.” Echoing that assessment, Alsobrooks cited testimony from scientists at the National Institutes of Health in Maryland who she says have watched critical cancer research grind to a halt under Kennedy’s leadership. “His actions are increasing Americans’ health care costs, causing chaos, and furthering the Trump administration’s endless stream of corruption,” she said. The report argues that Kennedy has: Driven up costs by backing the Trump administration’s budget plan, which Alsobrooks says strips health coverage from 15 million Americans while handing tax breaks to the wealthy and corporations. Created chaos by dismantling HHS programs, undermining research institutions, and promoting vaccine misinformation. Engaged in corruption by using the office to advance personal and family financial interests, particularly around limiting vaccine access. Public Citizen, a consumer advocacy group, praised Alsobrooks’ leadership. “President Trump and Senate Republicans made a grievous error when entrusting Kennedy with our nation’s health,” the group said in. “It is far past time that President Trump rectifies this error by firing Kennedy before more lives are unnecessarily put at risk.” Alsobrooks appeared on the Morning Joe TV show on to discuss the findings and to reiterate her demand that Kennedy resign or be removed. “This is about protecting families and protecting science,” she said. “Our nation’s health system cannot afford another day under Robert Kennedy’s reckless watch.” As a community organizer, journalist, administrator, project planner/manager, and consultant, Gren Whitman has led neighborhood, umbrella, public interest, and political committees and groups, and worked for civil rights and anti-war organizations.
By CSES Staff September 10, 2025
Wicomico County leaders have announced plans to move forward with the federal government’s controversial 287(g) program, entering into an agreement with U.S. Immigration and Customs Enforcement (ICE) that would deputize local officers to serve immigration warrants inside the county jail. Under the model selected, known as the Warrant Service Officer program, specially trained deputies at the detention center would be allowed to serve civil immigration warrants on individuals already in custody. County Executive Julie Giordano and Sheriff Mike Lewis emphasized that deputies would not conduct street-level immigration enforcement. “Public safety is our top responsibility,” Giordano said. “The Warrant Service Officer program provides our sheriff’s office with the tools they need to address individuals already in custody who may pose a risk to our community at no additional cost to the county.” Lewis added that the program “gives our deputies the ability to safely and lawfully carry out their duties while ensuring that Wicomico County remains a secure place to live, work, and raise a family.” Community pushback The announcement drew swift opposition from civil rights and community organizations, including the ACLU of Maryland, the Wicomico NAACP, and local grassroots groups such as Crabs on the Shore, who have warned that the agreement will harm immigrant families, sow fear, and erode trust between residents and law enforcement. Opponents also criticized the process, arguing that the decision was rushed through without meaningful public input despite repeated calls for hearings. “This is being framed as an administrative detail, but it has huge consequences for our neighbors,” one advocate said. Concerns about cost and precedent Supporters of the WSO model have emphasized that the partnership comes “at no additional cost” to Wicomico taxpayers, but critics point out that other jurisdictions have found otherwise. Anne Arundel County canceled its own 287(g) agreement, citing high costs and community backlash. The Camden Police Department in Delaware withdrew from a similar partnership after public protests in May. Advocates note that the federal government does not fully reimburse counties for the time, training, and legal exposure associated with 287(g) programs, leaving local taxpayers to shoulder hidden expenses. First on Delmarva If finalized, Wicomico County would become the first government or police agency on the Delmarva Peninsula to formally enter into a 287(g) agreement with ICE. Supporters say that distinction demonstrates a commitment to accountability and public safety. Opponents warn it risks branding the county as hostile to immigrant communities that have long been central to the Shore’s workforce, particularly in poultry processing and agriculture. The county’s decision comes amid a broader national debate about local involvement in federal immigration enforcement, with critics warning that partnerships like 287(g) make communities less safe by discouraging victims and witnesses from coming forward. For now, the final agreement is pending federal approval. But with strong opposition already mobilized, the fight over Wicomico’s new partnership is likely only beginning.
By CSES Staff September 10, 2025
Wicomico County Republicans have moved forward with an agreement to join the federal 287(g) program, aligning the county with the U.S. Immigration and Customs Enforcement (ICE). County Executive Julie Giordano and Sheriff Mike Lewis are backing the program to train county officers at the detention center to help ICE identify non-citizens for deportation proceedings. The agreement has triggered strong pushback from immigrant advocates, civil rights groups, and community leaders who warn that this partnership will erode trust between residents and law enforcement, risk racial profiling, and allot local tax dollars to assist federal immigration enforcement. Yet amid the growing controversy, the Wicomico County Democratic Central Committee has issued no response to the ICE agreement, even as residents voice frustration that the Democratic establishment’s silence has ceded the conversation to Republicans. Moreover, the Central Committee has remained silent with regard to recent comments by Democratic Councilwoman April Jackson, who told the Washington Post that the poultry industry should reduce its reliance on immigrant workers. Jackson also said, “a lot of Americans aren’t employed because the Haitians are taking our jobs.” Jackson’s remarks have drawn widespread criticism from immigrant advocates. For many residents, the Democratic leadership’s silence is as much of a concern as the county government’s new partnership with ICE. As the county waits for federal approval of the 287(g) agreement, the absence of a Democratic counterweight has left immigrant families and community organizers to carry the opposition on their own.
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By Community Desk September 10, 2025
With speculation mounting that Delegate Sheree Sample-Hughes (D-37A) may run for County Executive for Wicomico County in 2026, the longtime Eastern Shore lawmaker will headline a Community Conversation in Dorchester County on Sept. 17 at 6 pm. Sponsored by the Eastern Shore Democrats, the event will give residents the opportunity to hear Sample-Hughes speak about local priorities — schools, public safety, health care access, and economic development in the mid-Shore. Sample-Hughes, former Speaker Pro Tem of the Maryland House of Delegates, has represented portions of Wicomico and Dorchester counties for more than a decade. Her record includes bipartisan work on district projects, as well as efforts to expand health services and invest in infrastructure. Although organizers emphasize that the Sept. 17 gathering is not a campaign event, the timing has fueled interest. Political observers note that any appearance by Sample-Hughes will be closely watched as Democrats weigh potential challengers for County Executive in the upcoming cycle. The forum will include remarks from the delegate, followed by a question-and-answer session. Seating is available first-come, first-served and residents from across the Shore are encouraged to attend. Key details What: Community Conversation with Del. Sheree Sample-Hughes When: Sept. 17, 6 pm Where: Dorchester County, venue to be announced by organizers. Format: Remarks followed by audience Q&A Before her election to the House of Delegates, Sample-Hughes served on the Wicomico County Council. Should she enter the county executive race, many believe she would be a serious challenger to Republican incumbent Julie Giordano.
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