Graduated Sanctions to Enforce Nursing-Home Standards

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Abstract
The nursing-home industry in the United States is, on paper, the most closely regulated sector of the health-care system. Owing in part to the dependency of many patients1 and their inability to exert the pressure of active consumers, in part to massive public financing, which pays about two thirds of the nation's $7.5 billion nursing-home bill,2 federal and state governments have felt acutely the burden of setting and assuring standards of adequate care in nursing homes. But the focus, for the most part, has been on the standards themselves rather than on enforcement powers. The Department is coming to believe . . .

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