Comments from the provider associations and the survey agency, and the language of the legislature, all differ in the emphasis that they place on the various components of the quality improvement programs. There were clearly additional regulations introduced to strengthen the survey agency's oversight and ability to sanction; at the same time, provisions were added for greater consumer advocacy and technical assistance.
The language in the proposed legislation stated that the bills were drafted because it had become clear to everyone that the nursing home industry needed significant reform to improve the quality of life for residents. The proposal was aimed at strengthening state regulations in areas where the applicable federal standard was not sufficient to protect the public health, safety or welfare of Maryland citizens. The proposal identifies areas that federal regulations either do not address or are deemed to be too weak. Federal regulations do not address the relocation of residents or appropriate procedures to minimize relocation trauma, nor do they address the posting of staffing ratios and staff assignments, which Maryland legislators wanted to see defined. Federal regulations for quality assurance were also seen as deficient, not going far enough in terms of defining the framework for an acceptable quality improvement program.
According to Carol Benner, the purpose of the nursing home reform was to "give [the state] effective tools to gain and sustain compliance in Maryland homes." She noted a need to change the culture of both surveyors and nursing facility staff to focus on quality and resident safety, as opposed to regulation and enforcement. She also stated that, "although the survey agency seems to be effective at removing poor performing nursing homes from the system, there is no evidence that the current survey process is effective at improving quality. In fact, little is known about what does improve quality in nursing homes. To improve quality, Maryland is trying a variety of efforts." In one presentation she stated, "We decided to do anything that worked to improve quality--the 'throw the spaghetti at the refrigerator and see what sticks' approach."