Abstract
Skilled nursing facilities take care of some of the most medically fragile patients. Quality of care is the most pressing issue in Skilled nursing facilities and breaches in care include wrongful deaths, injuries and, in some cases, abuse. These facilities are regulated by both the federal government and their respective states. There is not a clear best practice for regulating skilled nursing facilities. Research to evaluate each state’s regulatory framework is lacking, in part, because there are no well recognized quality metrics. In order to effectively ensure skilled nursing facilities are providing quality care, best practices for compliance should be established. My research examines four states--Texas, Illinois, North Carolina, and Nevada--to understand how these states seek to compel skilled nursing facilities to deliver quality of care. My research entails interviews with staff working at regulatory agencies, fact finding using publicly available information, and review of regulatory requirements. I found that each state used varied tactics without a proven quality metric to determine their effectiveness. My final recommendation includes next steps to establish best practices for states seeking to implement and ultimately compel skilled nursing facilities to provide quality care.