From Chapter 17: Pushing, Pulling, and Just Standing Still
 Two-thirds of the nearly 17,000 nursing homes now in operation in the United States are for-profit facilities, close to 85 percent of which are owned by chains. They are bought and sold on the open market, traded as commodities like anything else on the stock market. Mama's nursing home had started out being privately and locally owned, but as a parade of out-of-state corporate owners took over, conditions seemed to steadily deteriorate despite each new owner's glowing promises. With each proprietor came major staff changes, not only at the bottom rungs where turnover was already excessive but at the supervisory and administrative levels as well. I repeatedly had the experience of investing many hours in meetings, long distance telephone calls, and letters with administrators and supervising nurses only to return in a couple of months and find that none of them worked there anymore. So I would have to start over with a whole new crew.
The owners of the nursing home my mother was in kept the grounds perfectly manicured and placed expensive furnishings in the lobby. They ordered that the walls, which were free of noticeable marks or chipping and which looked fine, be painted even though there weren't enough linens—a fundamental necessity for providing basic care—to go around. Owners invest in appearances because that is what reels in new residents and their families, and hence increases revenues. When corporate financiers lay out a budget for bed and bath linens, they neglect to calculate the cost of intangibles, like the demoralization of nurse aides who cannot do their jobs because the day's supply of towels, washcloths, and sheets has run out. Nor do they appear to consider the social cost of the exodus of good staff, who become too discouraged and frustrated to continue. Evidence further suggests that they do not calculate the cost of the loss of comfort and dignity when a helpless elder must lie on dirty sheets, do without a top sheet or blanket, or even lie in his or her own waste because the meager supply of linens is used up faster than the laundry workers can replace them.
I would be remiss not to acknowledge that not all profit-based nursing homes are fueled by greed and disregard for the well-being of residents and staff. Some non-profit facilities have the same problems and shortcomings as do their for-profit counterparts. The impoverished conditions of many nursing homes, when not a case of outright disregard, may be the result of lack of vision and sensitivity on the part of everyone from CEOs to the nursing home administrators who are in a position to make changes but who deny what is possible and turn their backs on the problems.
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