As a physician I have worked in a facility that had a sorted reputation. My thought was those patients deserved to have access to good care and I wanted to provide that for them. However having access to me meant nothing if orders were not followed, meds were not given, and basic care wasnt given. In no way am I blaming the staff b/c for the most part the staff was dedicated to doing their best. But how can you do your best when 2 or 3 CNAs are  expected to cover 60 bedbound total care patients? How can patients get their best care when basic FUNCTIONAL equipment is not provided by corporate b/c they have found a cheaper yet totally unsuitable solution? What about when its 85 degrees in the building b/c the HVAC unit is inefficient and there's no one to clear food trays so the trays sit and gnats and flies are everywhere? How about  when we have to beg corporate for COVID & flu testing in the midst of a flu pandemic? How do they get good care when you've burnt out all of the good staff and they get replaced with staff who are unsuitable to be working (depressed, inefficient, unknowledgable and likely wouldn't be tolerated anywhere else but beggers cant be picky).  I'd watch State come in and just would be STUNNED at how these facilities would walk away from survey with little to no penalties or very minimal changes. And just when something terrible happens and you think that corporate will finally be held accountable....the facility is sold to another for-profit entity who gives promises of change but finds a way to deliver less, charge more, and continue to drain the life out of the patients AND the staff. So what needs to be done? #1 Mandatory staffing ratios. The majority of states have one. Why is Virginia exempt? #2 Do not allow for-profit or private equity firms to own LTC (nursing homes), ALFs (assisted living), or SNFs (Skilled nursing facilities). The very nature of those businesses is to purchase a business, extract all value from it, and then sell when there's nothing valuable left.  Every dollar they extract is suffering heaped upon a person who trusted them to care for them. They do not belong in any facet of healthcare. #3 Non-medical people should NOT be making medical decisions. If your degree is in Economics, then don't refuse when the medical staff is telling you  wound care or a certain treatment for a patient is needed.  Everyone knows they need it except corporate and for some reason their word overrides all medical authority. #4 Pay these folks better. Being a nurse, CNA, med tech, patient care tech is an incredibly difficult job. They are the ones lifting, changing, feeding, cleaning, dispensing meds, entertaining, and consoling patients (and families). They are also first in line for abuse from patients ,families, and the facility itself. They are invaluable to the facility but often treated by corporate as an afterthought.  #5 Every single time an infraction is found there should be monetary penalties. Those penalties should be bigger with repeat infractions. Make it un-profitable to give crappy care. Then maybe investors would look elsewhere to make money. Too many chances are given and the wrong people keep getting blamed for what is a systems level problem.