In October, 2014, the American departments of Justice and Health and Human Services, and state investigators, found a nursing home chain to be guilty of ‘egregious care’, that is, care that was substandard, and which seriously harmed residents. The company agreed to a $38 million settlement. It had no real choice, as it had fallen foul of an area of law called elder-justice. In some cases, misappropriation of state funds (not providing the service that the government is paying for), is treated as a federal crime, and can result in a prison sentence.

Assistant Attorney General Joyce Branda blamed Extendicare’s business model – a model that was driven more by profit and less by the quality of the care it provided: “Extendicare employed fewer skilled nurses than were needed to care for the very sick residents in those facilities and failed to properly train and supervise the staff it did have”.

Extendicare operates 146 skilled-nursing facilities across 11 states.

The investigation found:

Low staffing levels.

Improper catheter care.

Falls, fractures and head injuries unnoticed by staff.

Malnutrition, dehydration, pressure ulcers and infections.

Medicine improperly administered.


“Through this settlement, not only will the states and federal government be reimbursed for the millions that we believe was paid for inadequate care, but we will also make sure that residents living in every Extendicare skilled nursing facility across the country receive the quality care that they depend on and deserve,” Attorney General Mike DeWine commented.

Thank God nothing like this can happen in the UK. Proof of this is given in the mission statements of all our major (private equity owned, we take a 30% slice of the fee income), care companies. One has only to consider a statement by Four Seasons: “I would happily put my mother into my home”. That comment from one of our managers captures what quality is all about. It comes from having well trained, dedicated staff who really bring care into our homes’. We are so reassured.

So, all is well. There is not a need to inspect nursing home chains as groups, and to fine them £30 million if they are guilty of the fraudulent misuse of state funds.

Of course not, as many of the government’s business friends will wholeheartedly agree.

lenin nightingale 2014



  1. Thanks for an important, neglected question
    N Ireland = The Regulation and Quality Improvement Authority (RQIA –
    Scotland = Care Inspectorate care homes
    NHS Hospitals in Scotland= Healthcare Improvement Scotland
    Wales= Healthcare Inspectorate Wales
    All have slightly different roles. Complicates. Wales still has Community Health Councils..
    Regards Carol Dimon

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