desired political result and may only fuel the mistrust which the agency staff already has of lawyers. Increased public knowledge of and interest in nursing home issues is the single most important strategy which nursing home resident advocates can undertake to improve nursing home conditions generally and state enforcement in particular. If the public demands quality of care in nursing homes and accountability of agency personnel, the battle is half won. Even with public support, obtaining an aggressive, rational, comprehensive and coordinated state nursing home enforcement policy is difficult to accomplish. Without such support, it is highly unlikely to occur. Finally, advocates must push governmental and private research agencies to undertake serious evaluations of the remedies discussed herein. Very few state enforcement agen cies have scientifically or even informally examined or evaluated the effectiveness of the intermediate sanctions to enforce quality of care with respect to individual facilities or the nursing home industry as a whole. While many state officials have formed impressions as to the utility of the approaches, these subjective and perhaps self-serving views often contrast sharply with those of nursing home resident advocates from legal services programs and senior citizens organizations. It may be difficult to design a valid survey which would investigate the effect of these enforcement approaches on nursing homes, residents and state agency employees, but some careful study of these issues is clearly warranted in order to assist state policymakers in drafting meaningful and appropriate nursing home enforcement programs. |