I work with many patients in skilled nursing facilities specifically in hospice. If there are issues we try and go to staff, alert the family and in some cases adult protective services is called as mandated reporters. However the issue is that the skilled nursing facility will then penalize the hospice company for reporting them (even though it is the law) and refuse to referral patients to that hospice company OR BAN that RN or medical social worker from going to that building (even if you report anonymously SNFs will just assume or guess). These skilled nursing facilities have too much power and not enough oversight.