Think welfare programs are overly tolerant of fraudsters? Wait until you see how kind they are to low-quality providers. Consider the Ensign Group. As the largest owner of federally certified nursing home facilities, it gets most of its revenue from the government. Taxpayers aren’t getting much from that arrangement. A recent investigation by the investment firm Hunterbrook shows that these programs are failing to protect vulnerable elderly residents from chronic, sometimes deadly neglect at nursing homes.One ventilator-dependent Ensign resident died after becoming unable to breathe and pounding the wall for a nurse who never came. The family is suing Ensign for wrongful death. Another Ensign resident suffocated after a bed rail pinned and suspended them upside down. By the time staff arrived, the resident was “completely purple and black” with early signs of rigor mortis.
An Ensign facility was found to have allowed maggots to infest a living resident. Another allowed ants to overrun a nonverbal resident with Alzheimer’s disease. “They crawled on her face, neck, legs, and swollen-shut eyes,” investigators report. “They left bites all over her body.” An Ensign resident complained of “persistent hygiene and medical failures,” “wet paper towels in place of toilet paper,” “recurring infections,” and another resident who “cried and screamed after going a day without food, without being changed, left in a soaking wheelchair.”Ensign executives literally extol “customer second” as a core corporate value. It is no coincidence that a company that derives most of its revenue from the government explicitly tells employees to put their welfare ahead of customers.But the problem isn’t Ensign, at least in particular. Medicare and Medicaid spend more than $400 billion annually on long-term care services and supports. That’s 60% of all long-term care spending and more than $80,000 per recipient. The real problem is that government cannot discipline low-quality providers, and it cannot promote market competition. When government develops and implements quality controls for care, providers are almost always the most vocal — and powerful — people in the room. And they wield that power to protect their revenues. Typically, that means ensuring that low-quality providers can keep drawing government subsidies. People walk inside the assisted living facility at the Toby and Leon Cooperman Sinai Residences on July 4, 2025, in Boca Raton, Florida. (AP Photo/Rebecca Blackwell)
