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Federal and state governments should monitor compliance with the Nursing Home Reform Act and other laws and regulations affecting nursing facilities.

States should require that all beds in a nursing facility be certified for Medicaid and Medicare as a condition for the facility’s participation in Medicaid.

States should require adequate numbers of appropriately trained staff to ensure a high quality of care.

Quality measures: Participant preferences and satisfaction should be used as key quality measures.

The Centers for Medicare & Medicaid Services, the states, and all other regulators should vigorously enforce all regulations in long-term services and supports (LTSS) facilities and home care w

The federal government and the states should provide incentives (including, but not limited to, grants and loans) for new, affordable models of LTSS.