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Enforcement should include swift and meaningful penalties for substandard care.

States should fund sufficient quality monitors to inspect all providers at least annually. Complaints should be responded to promptly. Inspections should be unscheduled.

States should provide effective complaint systems with prompt resolution. The systems should have both an internal and an external appeal process through a neutral third party.

The federal government should increase funding and strengthen requirements for states to implement Long-Term Care Ombudsman programs.

Congress should make pre-dispute mandatory arbitration provisions in LTSS contracts unenforceable. 

The federal government and the states should not accept accreditation by private bodies in lieu of federal or state licensing, certification, or enforcement of standards.

States considering payments to LTSS providers based on improved quality outcomes should rely on data from pilot projects developed with strong consumer participation.

States should ensure that facility-specific survey results and other information regarding quality are made available to the public in a timely manner.

More federal funding should be provided to the Administration for Community Living to develop and implement its emergency management responsibilities on behalf of older peo

Federal and state policymakers should support unbiased assessment of palliative care needs as well as improved access to palliative care services regardless of setting (e.g., nursing facility, resi