LARA licenses nursing homes and many of their employees.

State and federal governments fund and heavily regulate nursing homes.

Nursing homes are inspected by the state, using state and federal standards.

Reports are filed.

AND YET - many nursing homes are dangerously understaffed and inmates residents suffer neglect.

An MLive report links the annual federal report; the remainder of the article is behind paywall.

Following is a longer report centered on COVID. 

https://www.mlive.com/news/2023/07/these-are-the-worst-nursing-homes-in-michigan-according-to-the-federal-government.html

These are the worst nursing homes in Michigan, according to the federal government

Updated: Jul. 31, 2023, 8:20 a.m.| Published: Jul. 30, 2023, 8:40 a.m.
Matthew Miller | mmiller@mlive.com

The patient was found with dried vomit on her face. She had a history of respiratory problems and chronic obstructive pulmonary disease. She should have been using oxygen.

The nurse treating her at Villa at Parkridge didn’t give her oxygen, according to a report on the 2021 incident from the federal Centers for Medicare & Medicaid Services. Instead, she called 911.

The long form Detroit News reports their FOIA findings of specific complaints filed against Michigan nursing homes during COVID.

Due to length, I quote here only the beginning and omit the photos, screen shots, and audio.

Michigan nursing home complaints reveal deadly chaos in pandemic’s early days

Craig Mauger  |   Published8:44 PM EDT May. 4, 2023Updated10:59 AM EDT May. 11, 2023

Riverview— Michigan nursing homes repeatedly failed early in the pandemic to isolate patients with COVID-19, provide minimum levels of care and disclose infections when they occurred, according to documents obtained by The Detroit News and made public for the first time.

The records — 167 COVID-19 and staffing-related complaints included in more than 200 overall complaints released by the federal government nearly three years after The News first requested them — point to a litany of concerns about nursing home conditions inside dozens of facilities across Michigan. One nurse in Ludington reported working with a 101-degree fever because there was no one to fill her spot. Another employee at a nursing center in Detroit said patients with COVID-19 had been "left to themselves." Others said facilities with ongoing outbreaks were bringing in new patients despite the danger.

According to the documents, the problems largely occurred amid a shortage of personal protective equipment for staff at nursing homes and sometimes hospitals, as well as a short supply of COVID-19 tests.

The documents raise further questions about staffing levels and orders imposed by Gov. Gretchen Whitmer's administration at the height of the pandemic. The policies became one of the most debated aspects of the Democratic governor's COVID-19 response, with Republicans contending more residents with the virus should have been cared for in entirely separate facilities to stem the spread. Members of Whitmer's administration said that idea wasn't feasible.

Previously, little has been known about what happened inside the buildings when COVID-19 infections were initially claiming residents' lives.

Whitmer's emergency directives relied on nursing homes themselves to safeguard patients with the virus, provide personal protective equipment for their employees and track cases within their buildings.

Drawing controversy, the orders established a system for treating elderly individuals with COVID-19 in existing nursing homes, requiring residents with the virus to be cared for in dedicated units of their current facilities or transferred to others with proper space and equipment. The administration used the strategy despite a nursing home lobbyist suggesting in March 2020 state officials use empty facilities as quarantine centers to "avoid widespread infection."

In October 2020, the governor and lawmakers provided protections for the nursing homes to limit families' ability to sue them if their missteps led to someone's death.

The legal immunity law came despite the state's Bureau of Community and Health Systems receiving the 167 complaints about nursing homes' handling of COVID-19 or staffing from April 6, 2020, through May 31, 2020, amounting to three complaints each day. One of them was filed by William Woods, 55, of Taylor, whose mother, Johnnie Woods, died inside the Rivergate Terrace nursing home in Riverview on April 19, 2020.

"This is the hardest thing ever that I'm going through," said William Woods, sitting on the couch in his living room with tears in his eyes. "Because in my heart, my mom is not at peace because her killers are still out there, doing the same thing, not getting charged, not being found guilty of what they did.

"If they had the staff members there, my mom would have lived."

Johnnie Woods was 79 when she died April 19, 2020, of respiratory failure, without having tested positive for the virus, William Woods said. That's despite the fact her roommate had COVID-19 and was eventually hospitalized, he said.

Her son argues that a lack of staffing and medical assistance contributed to her body's failure and others' deaths. William Woods said he was inside Rivergate Terrace in April 2020 to stay with his mom during her final days and said he saw residents struggling to feed themselves with no employees around to help them.

...

[Quote/]

https://www.detroitnews.com/in-depth/news/politics/michigan/2023/05/04/michigan-nursing-home-complaints-reveal-deadly-chaos-early-in-pandemic/70084711007/

What's missing from this picture?

Local ownership.

I suggest that with decades of rising state and federal control plus "warehousing" (larger facilities with more residents), the local supportive framework of institutions faded away.

Everyone understands the need, but without a modicum of control, nursing homes are a hot mess no one wants to touch.

Once extremely active, the high-school volunteers, church committees, guilds, boards, and other volunteer organizations have been intimidated, overruled, cut out of the picture, made to feel unwanted - call it what you will.