C. STATUS OF THE NATION''S NURSING HOMESIn 1996, nursing roughly 10,000 of the home 15,000 nursing homes inspected by state surveyors had deficiencies.(50) The federal government actually collected ratings or imposed only 2% of nursing the monetary fines or penalties recommended by the states.(51) State inspectors recommended that the federal government bar 5,458 nursing homes from receiving money for new admissions, of which the government home enforced only 156 proposals.(52) Surveyors suggested special staff inservices for 3,039 nursing homes; HCFA imposed this remedy on only 103.53 States proposed 2,935 facilities for fines; ratings HCFA fined 228 and gave a 35% discount to the facilities that did not appeal the fine.(54) When confronted with this lack of enforcement, HCFA nursing officials explained that nursing homes "`have a right'' to correct problems before penalties are imposed."(55)

Recently, home the conflict between reimbursement and quality care received national ratings attention.(3) Vencor, the U.S.''s second largest nursing home chain, attempted to terminate its Medicaid contracts and evict all its Medicaid residents.(4) Executives explained that the contract terminations and resident evictions were strategies to make room for higher paying private pay residents.(5) Faced with state, and potentially federal, fines,(6) as well as a district court injunction and public outrage over the patient dumping, the company quickly abandoned its policy and apologized.(7) The attempted resident evictions quickly prompted new legislation nursing less than a year later, which forbids facilities from evicting Medicaid patients based solely on payment status. Although the strategy resulted home in a public relations disaster, the company claims that ratings the real "bad guy" is the government because what the government pays "is not adequate to cover the cost for what [the company] believe[s] is the proper care for a patient."(8) This statement reflects providers'' frustration with current government payment levels and expected standards nursing and home of care throughout ratings the nation.

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