I am an MDS coordinator so, I guess, part of “management.” Even so, I have been working in LTC for a long time (as a charge nurse before I got my current job). I am lucky to work for a company that is not a publicly owned outfit (no investors demanding dividends) with an owner who lives locally and seems to value his reputation. I believe that that the for-profit model of LTC is a huge impediment to quality of care. Every dollar spent on more staff is a dollar not given to a shareholder. There are currently state standards for LTC staff (at least in my state and I think in most) but they are absurdly low. My facility does not count administrative nurses in the staffing figures, but that probably varies by state. As someone else said, quality care takes time and supplies. There are no substitutes for those things. My suggestions to improve care: standards for staffing should be tightened drastically and health care companies should be non-profit in all areas (acute, LTC and ALF.) Also Medicaid really should pay more; in most states Medicaid pays less than it costs to provide care. And, from the perspective of my own job - the previous poster with 2 MDS coordinators for 240 beds - yikes! Huge workload for those 2 unfortunates.