In 1963, fire claimed more than 60 lives in an Indiana nursing home. The disaster initiated what became persistent congressional investigations of far more than fire safety: attention turned to the nature of nursing facilities, the quality of care, private ownership, public regulation, and methods of payment. Medicare and Medicaid programs, enacted in 1965, established the safety and performance of nursing homes as federal as well as state responsibilities. Later legislation carried forward the attempt to define the care-giving and residential characteristics of homes-with-nursing, evolving from typically small, mom-and-pop units into larger for-profit facilities grouped in chains. Nonprofit homes with community or religious sponsorship form a minority of the nursing home industry.
Few regulatory issues have been more vexatious than the attempt to secure the well-being, care, and safety of the frail residents. Again and again, widespread deficiencies have been found, testifying to regulatory inadequacies and refractory underlying conflicts, some