Traction Law Group

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At Traction Law Group, we understand that finding the right lawyer can be a daunting task. Our dedicated attorneys work hard to provide our clients with fast and responsive legal representation. With a focus on nursing home negligence, funeral home negligence, and medical malpractice, we have the knowledge and skills to handle even the most complex cases. We believe in working closely with our cli

ents to understand their needs and goals, and we take pride in our efforts to help achieve the best possible outcomes.

05/27/2026

In one peer-reviewed study of residents with advanced dementia in 22 Boston-area nursing homes, about 37 percent received at least one medication considered potentially inappropriate for their condition. That does not mean every nursing home resident faces that exact rate. It is a serious warning sign about medication oversight.

The study is Tjia and colleagues, "Daily Medication Use in Nursing Home Residents with Advanced Dementia," published in the Journal of the American Geriatrics Society. The researchers followed 323 residents with advanced dementia across 22 Boston-area nursing homes prospectively for 18 months. They reviewed each resident's medication record against established criteria for medications considered "never appropriate" in advanced dementia, meaning drugs whose burdens outweigh their benefits given the resident's prognosis and condition. The findings: residents were prescribed an average of 5.9 daily medications, and 37.5 percent received at least one medication considered never appropriate in advanced dementia. The most common inappropriate prescriptions were acetylcholinesterase inhibitors and lipid-lowering agents. Twenty-eight percent of residents took antipsychotics daily.

That last finding deserves attention. Federal regulations, including 42 CFR § 483.10 and § 483.25, prohibit the use of any drug as a chemical restraint imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. Antipsychotics, in particular, carry FDA black box warnings for increased mortality in elderly patients with dementia-related psychosis. When an antipsychotic shows up on a chart, the question for families is whether the medication is treating a documented medical symptom or quieting a resident the facility finds difficult to manage.

Here is what families can do. First, if you are the resident or the resident's authorized representative, ask for a complete medication list and the documented reason each drug is being administered. Under 42 CFR § 483.10, residents and their legal representatives have the right to access clinical records within 24 hours, excluding weekends and holidays.

Second, if your parent or loved one suddenly seems sedated, withdrawn, or "not themselves," ask the care team whether anything has changed in the medication regimen. Sudden behavioral changes after admission or after a transition in care are worth investigating.

Third, do not assume a medication is appropriate just because it appears on a chart. Ask what it is, what risk it carries, and whether it is still necessary. Some medications appropriate for one stage of a condition become inappropriate as the condition progresses.

If you have questions about the list, inquire with your loved one's medical care provider. Ideally, ask for a formal medication review.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/26/2026

A son sits in a nursing home conference room in Illinois. His father has fallen twice. The administrator tells him, "We're doing our best, we're just short staffed today." That is technically true. It is also true on every other day.

The Long Term Care Community Coalition, or LTCCC, is the long-running advocacy organization that publishes quarterly analyses of nursing home staffing using federal Payroll-Based Journal data. The Payroll-Based Journal, or PBJ, is the system through which nursing homes are required to submit auditable staffing information based on actual payroll records. LTCCC compares each facility's reported staffing to an expected level based on the facility's own assessment of resident acuity. The methodology is evidence-based and uses each facility's own evaluation of what its residents need.

The Q3 2025 alert, released March 5, 2026, documents the national picture. Only two places in the entire United States meet expected nursing home staffing levels. Alaska, at approximately 21.1 percent above expected. Oregon, at approximately 0.9 percent above expected. That is the entire list.

Illinois ranked at approximately -37.9 percent, the largest negative deviation of any state. Texas at approximately -31 percent. Missouri at approximately -30 percent. Georgia at approximately -30 percent. Puerto Rico, the worst, at approximately -39.9 percent.

The national figures are even starker. 9 out of 10 U.S. nursing homes fall below expected staffing levels. The average facility is approximately 24 percent short staffed every single day. Approximately 1.14 million Americans live in facilities that fail to provide the staffing expected to meet their basic clinical needs.

The expected staffing levels are not external benchmarks set by an advocacy group. They are based on each facility's own assessment of its residents' acuity. The shortfall reflects facilities not meeting the staffing levels they themselves have identified as necessary.

That son's father is one of the 1.14 million.

If your loved one's nursing home is "just short staffed today," and every other facility in the state is also short staffed every day, at what point does that stop being an explanation and start being an admission?

You can pull staffing data on any Medicare- or Medicaid-certified facility at medicare.gov/care-compare. LTCCC publishes facility-level expected versus actual staffing comparisons at nursinghome411.org.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal advice.

05/18/2026

A peer-reviewed study in JAMA Health Forum tracked what happens after a private equity firm buys a nursing home. Emergency room visits for residents went up 11 percent compared to other for-profit facilities. Hospitalizations for conditions that good nursing home care is supposed to prevent went up 8.7 percent. Quarterly costs per resident went up almost 4 percent.

The JAMA Health Forum study is Braun and colleagues, Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents, published in 2021. The researchers compared long-stay residents in private equity-acquired nursing homes to residents in other for-profit facilities. After PE acquisition, residents experienced an 11.1 percent increase in emergency department visits for ambulatory-care-sensitive conditions, an 8.7 percent increase in hospitalizations for those same conditions, and a 3.9 percent increase in quarterly Medicare costs per resident.

A second study, Gupta and colleagues, originally circulated as NBER Working Paper 28474 and later published in the Review of Financial Studies, used Medicare records covering more than seven million patients. The researchers documented that PE acquisition was associated with declines in frontline caregiver hours and an approximately 50 percent increase in antipsychotic medication use. They also estimated a local average treatment effect of approximately 11 percent on mortality.

The disclosure problem makes all of this harder for families. CMS has required facility-level disclosure of private equity and real estate investment trust ownership since 2024, but compliance is incomplete. A 2025 KFF issue brief found that fewer than 100 nursing facilities nationwide self-report private equity ownership, while academic researchers and industry analysts estimate the real number is several thousand. Families looking at Care Compare may not see who actually owns the facility their loved one is in.

None of this means every PE-owned facility is failing residents. It does mean that the financial structure of ownership has documented consequences for staffing decisions, hospitalizations, and medication use.

The corporate owner makes the cut. The aides absorb it. The residents pay for it. The family of the resident may never know who is actually running the building. The staffing decision lives at the top of the ownership stack. The harm lives at the bottom.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/15/2026

Federal law sets one minimum for registered nurse coverage in every nursing home: 8 hours a day. Not 8 hours of whoever is available. A registered nurse. Every single day.

The federal RN coverage minimum comes from 42 CFR § 483.35(b)(1), which requires nursing homes participating in Medicare and Medicaid to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. The 2024 staffing rule briefly contemplated a 24/7 RN requirement, but the 2024 rule was vacated by federal courts and formally repealed by HHS in December 2025. The 8-hour-per-day floor reverted to being the operative federal standard effective February 2, 2026.

In May 2025, the HHS Office of Inspector General issued a report titled CMS Use of Staffing Data To Inform State Oversight of Nursing Homes. The report documented something striking. CMS sends state survey agencies information about nursing homes that appear to violate federal staffing requirements, but the data CMS shares is limited. Specifically, CMS flags facilities that reported zero RN hours on a given day, but not facilities that reported only a few hours of RN coverage well below the 8-hour minimum. The OIG recommended that CMS expand its data-sharing to include facilities that appeared to violate the 8-hour minimum more broadly. CMS did not concur.

The practical effect is an accountability gap. A facility that reports one hour of RN coverage on a given day is technically below the federal minimum, but the OIG found that CMS is not flagging that data for state inspectors. The state surveyors who would conduct enforcement do not get the information that would let them target inspections at the facilities most likely to be running short on the floor.

The nurses showing up to those shifts are not the problem. They are working the schedule ownership built. A registered nurse cannot be in two places at once. She cannot cover a shift she was not scheduled for. The decision about how many RN hours appear on the floor each day is an operational choice made by the people who own and run the facility.

When a resident suffers harm on a day the facility was running below the federal minimum, the question is not whether the aide did her job. The question is why ownership chose to run that building without a registered nurse.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/13/2026

A 2025 systematic review found that when private equity firms own nursing homes, residents face higher mortality rates. The pattern held across study after study.

Private equity firms buy nursing homes with borrowed money. The debt has to be paid back. That structure creates pressure to cut costs, and in a nursing home, the biggest cost is staff. The mechanism is well-documented across more than a decade of research.

Research by Atul Gupta and colleagues at the University of Chicago, published in the Review of Financial Studies in 2024, found that private equity acquisition of nursing homes was associated with decreased resident mobility and an approximately 10 to 11 percent increase in short-term mortality. The Gupta study examined Medicare patient records covering more than 7 million patients across 12,400 for-profit skilled nursing facilities, of which roughly 1,674 had been acquired by private equity firms between 2000 and 2017.

A 2025 systematic review by Orewa and colleagues, published in Health Policy in November 2025, compiled the qualifying peer-reviewed research on this question. The reviewers identified 12 studies meeting their inclusion criteria, published between 2000 and 2024. The conclusion: private equity ownership was consistently linked to higher numbers of deficiency citations, increased hospitalization rates, and higher mortality. Staffing changes suggested an increased reliance on lower-skilled staff. Initial financial gains for PE owners were typically followed by long-term financial challenges due to high debt and lease obligations.

These are not editorial conclusions. They are measured outcomes from studies applying research methodology to federal data and patient records. The pattern is consistent enough across study designs that a 2023 systematic review in The BMJ, examining private equity ownership across multiple healthcare sectors and 55 studies, characterized the impacts on quality of care as ranging from mixed to harmful.

When you place a loved one in a nursing home, the ownership structure of that facility is a matter of public record through CMS. Care Compare at medicare.gov/care-compare publishes ownership data, including whether a facility has been acquired by private equity, though disclosure compliance is incomplete. State survey agencies maintain additional ownership records.

None of this means every private equity-owned nursing home is failing residents. It does mean the financial structure of ownership has documented consequences for staffing, hospitalizations, and resident outcomes, and that those consequences are knowable.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

Would it help if I also turn each of these into a one-line “headline hook” you can use at the top of each description for better scroll-stopping?

05/12/2026

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Right now, approximately 88 nursing homes in America are on a federal government watch list, officially identified as the worst-performing facilities in the country. CMS publishes the list every single month. Most families have never heard of it.

The program is called the Special Focus Facility, or SFF, program. CMS runs it. The criteria are public. To qualify as an SFF, a nursing home must have a documented pattern of serious deficiencies over a period of about three years. SFFs typically have roughly twice as many deficiencies as the average nursing home, more frequent serious deficiencies that cause actual harm to residents, and a "yo-yo" compliance history where improvements after one inspection are followed by regression by the next. CMS calls this pattern persistent quality failure.

Each state has a designated number of SFF slots, and the program caps the total active SFFs at approximately 88 nationwide. CMS publishes the list publicly, updated roughly every month, on its Special Focus Facility program page at cms.gov.

There is also a second list. CMS calls them SFF candidates. These are facilities that meet the same quality criteria that would qualify them for the program but have not yet been selected, primarily because each state has a fixed number of SFF slots. CMS publishes the candidate list alongside the active SFF list. The candidate list typically contains five candidates for each SFF slot, which means several hundred facilities nationwide are formally flagged as having the same compliance pattern as the worst-performing facilities. Most families do not know the candidate list exists.

Being on either list does not mean a facility closes. Many continue accepting new residents throughout their time on the SFF list and during the time they appear on the candidate list. The program subjects active SFFs to standard health inspections at least once every six months, roughly twice as often as a typical facility, and to progressive enforcement until the facility either graduates or is terminated from Medicare and Medicaid.

In January 2026, CMS revised the SFF selection criteria to give greater weight to a facility's prevalence of resident falls when state agencies choose which candidates to advance into active SFF status. That change followed the September 2025 HHS Inspector General report documenting that nursing homes failed to report 43 percent of falls involving major injury and hospitalization among Medicare-enrolled residents.

The most useful action for families is to check the current SFF and candidate lists for the facility you are considering. The lists are at cms.gov under the Special Focus Facility program. If a facility appears on either, that is information you would want before signing an admission agreement.

A public, monthly-updated list of the worst performers in American long-term care. Most families do not know to look for it.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/05/2026

Here is a nursing home statistic families almost never hear about.

In a recent staffing report, 35 percent of facilities reported zero medical director time.

Zero.

Every nursing home is supposed to have a designated medical director. Under federal regulations, the medical director is responsible for implementing resident care policies and coordinating medical care in the facility.

When a facility has serious problems, falls, infections, pressure wounds, medication issues, hospital transfers, families should not only ask: Where was the nurse?

They should also ask: Where was the clinical oversight? Who was reviewing patterns? Who was looking at repeated injuries? Who was asking why residents kept declining?

Nursing home neglect is not always one bad moment. Sometimes it is a system that nobody is properly supervising.

If a facility reports zero medical director time, families deserve to know what clinical oversight actually exists.

Follow us for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/04/2026

The federal government just repealed a nursing home staffing rule that was supposed to set a national floor for care.

The 2024 rule, finalized by the Centers for Medicare and Medicaid Services, would have required nursing homes participating in Medicare and Medicaid to provide a minimum of 3.48 total nursing hours per resident per day. That included specific minimums for two staffing categories: at least 0.55 hours per resident per day from a registered nurse and at least 2.45 hours per resident per day from a nurse aide. The rule also required each facility to have a registered nurse onsite 24 hours a day, 7 days a week.

The rule faced immediate legal and political opposition. Federal courts in the Northern Districts of Texas and Iowa vacated parts of the rule in 2024. In July 2025, Public Law 119-21 prohibited CMS from implementing or enforcing the minimum staffing standards until at least September 30, 2034. On December 2, 2025, HHS published an interim final rule formally repealing the 3.48 hours-per-resident-day standard, the RN and nurse aide minimums, and the 24/7 RN requirement.

What was not repealed matters too. The repeal reinstated the prior federal policy on RN coverage, which still requires nursing homes to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week, and to designate an RN to serve as director of nursing on a full-time basis. That is a meaningful floor, but it is far below the 24/7 standard the 2024 rule contemplated. The facility assessment requirement also remains in place. Each facility is still required to evaluate its residents and staff based on assessed needs.

The practical issue for families is that without a strong numerical floor, staffing decisions are largely returned to the facility. Reasonable people can debate whether one federal rule was the right way to solve the long-term care staffing crisis. The deeper issue is that when there is no strong staffing floor, the burden of evaluating staffing adequacy shifts back to families.

Families have to ask the questions the federal rule would have answered automatically. How many CNAs are actually working tonight? Is there an RN in the building between 11 p.m. and 7 a.m.? Who responds if my loved one falls at 2 a.m.? How long does it take to answer call lights? Does the facility's assessed staffing match its actual staffing? You can pull staffing data on any Medicare- or Medicaid-certified facility at medicare.gov/care-compare. The Long Term Care Community Coalition publishes facility-level expected versus actual staffing comparisons at nursinghome411.org.
Even after the repeal, nursing homes remain subject to other federal requirements, state licensing rules, and common-law duties to provide reasonable care. When facilities fall short of those obligations and a resident is harmed, families may have legal claims regardless of what numerical staffing rule does or does not exist at the federal level.

The resident does not experience policy. The resident experiences whether someone is there when they need help. In nursing homes, that can be the difference between safe care and serious harm.

Follow Traction Law Group for more nursing home information most people never know about.

This is general information, not legal or medical advice.

05/01/2026

Most families think a nursing home is something that happens to somebody else. Until there is a fall. Or a stroke. Or dementia gets worse. Or Mom goes to the hospital and suddenly cannot safely come home.

Here is the reality. The federal government says someone turning 65 today has almost a 70 percent chance of needing some type of long-term care services or support during the rest of their life.

That does not mean 70 percent of people end up in a nursing home. A lot of long-term care happens at home. The chance of needing facility care is still very real. Federal data indicate roughly 35 percent of people use nursing facilities at some point.

An HHS-backed lifetime-risk study found that 15 percent of older adults spend more than two years in a nursing home.

This is not a rare problem. It is a normal part of aging that most families are completely unprepared for.

That matters because when families wait until there is a crisis, they are choosing a facility under pressure. They look at the star rating. They skim the brochure. They trust the tour.

Before you ever need a nursing home, you should know how to check staffing, inspections, ownership, complaints, falls, and pressure wound history.

The best time to learn how nursing homes work is not the day the hospital says, "We need to discharge your loved one tomorrow."

It is before your family is forced to choose.

Follow us for more nursing home information most people never know about.

This is general information, not legal or medical advice.

04/30/2026

"Sorry, we're short-staffed" is not an explanation families should just accept.

In a nursing home, staffing is care.

It is who answers the call light. Who helps someone to the bathroom. Who turns a resident to prevent pressure wounds. Who notices confusion, dehydration, infection, or a fall risk before it becomes a crisis.

A new LTCCC report analyzing federal staffing data found that 9 out of 10 U.S. nursing homes fell below their expected staffing levels in Q2 of 2025. The average facility was 25 percent short-staffed on a daily basis. On weekends, the gap was even worse, averaging 31 percent.

That matters because nursing homes do not get to say "we were busy" after someone gets hurt. They are supposed to staff based on what their residents actually need.

Even CMS has said staffing is one of the vital components of a nursing home's ability to provide quality care.

When a resident falls, develops a pressure sore, becomes dehydrated, or is left waiting for help, one of the first questions should be whether the facility was staffed to meet the needs of the people living there.

Short staffing is not just a workplace problem. In a nursing home, short staffing can become neglect.

Follow us for more nursing home information most people never know about.

This is general information, not legal or medical advice.

04/29/2026

That nursing home with the "low fall rate"? You may want to look twice.

A new report from the HHS Office of Inspector General found that nursing homes failed to report 43 percent of falls involving major injury and hospitalization among Medicare-enrolled residents.

Here is the part families really need to understand. Those fall rates you see on Medicare's Care Compare website are based on information the nursing homes report themselves.

If a facility fails to report serious falls, its public numbers can look better than reality.

The OIG found that nursing homes with the lowest fall rates on Care Compare were actually the least likely to report the falls the government reviewed.

A "low fall rate" may not always mean residents are safer. It may mean the facility is better at not reporting.

When you are choosing a nursing home, do not just look at the rating. Ask about hospitalizations. Ask about fall prevention. Ask what happens after a resident falls.

The number on the website may not tell the whole story.

Follow us for more nursing home information most people never know about.

This is general information, not legal or medical advice.

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