The Upper Payment Limit (UPL) program was established to support city and county-operated nursing homes by providing enhanced Medicaid payments for nursing home residents residing in those homes. Although the program was created with good intentions, over time concerns have arisen that some cities, counties, and states exploit loopholes to redirect these enhanced payments, originally intended for residents, toward unrelated purposes. In Utah, the UPL program has come under intense scrutiny in the past year. Advocates revealed that several city and county-run hospitals had acquired licenses for nearly two-thirds of all nursing homes in the state, more beds than there are residents in their areas. These hospitals then contracted private companies to operate these facilities. Investigative reports uncovered that funds meant for patient care were frequently diverted to unrelated projects, such as community health centers. A recent report by the Auditor General revealed that out of nearly $1 billion in UPL payments made between 2016 and 2024, only 49% were actually used by nursing homes. The remaining funds were diverted away, often to management fees and other unrelated initiatives. Further analysis indicated that care in UPL program facilities often declined compared to non-UPL program homes. Barry Toone, a Utah attorney, has been at the forefront of efforts to expose the flaws in Utah's UPL program. In this episode, Barry joins Sam Brooks to discuss how entities participating in the UPL program have benefited from UPL payments, often at the expense of nursing home residents. Together, they examine the program's failures and explore potential solutions. They also highlight the urgent need for greater transparency and accountability among nursing home owners and operators regarding the use of taxpayer dollars.

Good food is something we all look forward to, something that tastes good, nourishes us, connects us to culture and community, and that we enjoy sharing with friends and family. That doesn’t change when someone moves into a long term care facility. In fact, food often matters more to people living in long-term care. At its best, food supports nutrition and health, triggers positive memories, and provides moments of comfort and connection. However, we know this isn't always the case. In fact, poor food is often one of the top complaints that residents share with Ombudsmen representatives and family members. When Consumer Voice conducted a survey of over 450 residents last year, two thirds of respondents said that their food usually doesn't look or smell appealing. In this episode, we’re joined by Vanessa Emm, the Operations Director for the National Association of Activities Professionals (NAAP) who has worked in the long-term care field for over 20 years. We are also joined by Summer Nancollas, a Culinary Director at a Senior Living Community in Nevada. Join us as we talk about why food plays such a central role in residents’ well being, what gets in the way of good meals in long term care, and the best practices that facilities can use to create dining experiences that truly honor residents’ needs, preferences, and dignity.

When the Biden Administration announced its intent to implement a minimum staffing standard, the nursing home industry immediately responded with cries that a standard would result in closures, loss of money to nursing homes, and that the standards could not be met. These arguments, although unsupported by evidence, were effective and resulted in the current administration rescinding the staffing rule in March. Now, a new research paper shows that the implementation of state staffing standards over the years did not result in facility closures, paid for themselves, did not impact profit margins, and increased staffing levels. Join Consumer Voice’s Sam Brooks who talks with Dr. Rachel Werner, one of the authors of the study, as they discuss the new paper and what it means for policymakers considering the implementation of staffing standards. Guest: Dr. Rachel Werner, Physician and Economist

This episode explores the Essential Caregivers Act of 2025 and the lessons learned from the COVID 19 visitation bans in long term care. Our discussion examines how isolation harms residents, why essential caregivers are irreplaceable, and how this legislation aims to protect resident rights during future emergencies. It’s a conversation about dignity, safety, and ensuring that no one in long term care is ever left without the people who know and love them most. Guests: Irma Rappaport, National Advocate, Caregivers for Compromise, Connecticut Virtual Family Council; and Amy Badini, Connecticut Caregivers for Compromise, Essential Caregivers Coalition, Connecticut Virtual Family Council

In this episode, Yiqun Chen and Marcus Dillender join us to discuss their revealing study on how nursing homes respond to government inspections. They explain how facilities often make short-term changes—like boosting staff and discharging patients—just to look better during inspections, only to revert immediately afterward. Despite this gaming, inspection ratings still offer meaningful insights into resident outcomes. The conversation covers why some citations lead to real improvements while others don’t; how inspection ratings relate to mortality risk; and what policymakers can do to make oversight more effective and less predictable. This episode offers a candid look at the strengths and blind spots of government monitoring, and what it means for the future of elder care. Guests: Yiqun Chen & Marcus Dillender, economists and authors of the National Bureau of Economic Research (NBER) paper “Government Monitoring of Health Care Quality: Evidence from the Nursing Home Sector”

Join us for part two of a conversation with long-term care residents. In spring 2025, Consumer Voice conducted a nationwide survey of residents to learn what daily life is like in their facilities. The questions ranged from whether residents feel they are treated with dignity and respect to how appealing their meals are, and everything in between. In part two of this podcast, we discuss the survey results and explore key themes with the residents themselves, who serve on Consumer Voice’s Consumer Advisory Council. They share their thoughts and experiences on what it’s like to live in long-term care in 2025 and offer valuable advice on how they advocate for themselves and others.

In spring 2025, Consumer Voice conducted a nationwide survey of long-term care residents to learn what daily life is like in their facilities. The questions ranged from whether residents feel they are treated with dignity and respect to how appealing their meals are, and everything in between. In this two-part podcast, we discuss the survey results and explore key themes with the residents themselves, who serve on Consumer Voice’s Consumer Advisory Council. They share their thoughts and experiences on what it’s like to live in long-term care in 2025 and offer valuable advice on how they advocate for themselves and others. Guests: Maurice Miller, Ray DiFrancisco, Cindy Jones, Margarite Grootjes, and Jeanette Sullivan-Martinez

When something goes wrong in long-term care, do you know what to do? In this episode, we introduce Documenting Resident Concerns in Long-Term Care, a new resource created to help residents and families respond with confidence. From falls and pressure injuries to conflicts with staff, knowing what questions to ask and what details to document can be the key to real solutions. Lori Smetanka and Jocelyn Bogdan of Consumer Voice share practical strategies for gathering information and advocating effectively. This joint project from the National Consumer Voice for Quality Long-Term Care and the National Center on Elder Abuse (NCEA) offers a clear path to stronger advocacy and better care. Guests: Lori Smetanka, Consumer Voice Executive Director, and Jocelyn Bogdan, Consumer Voice Senior Policy Specialist

In this episode, we're joined by three advocates who have worked to raise the personal needs allowance (PNA) and improve the quality of life for nursing home residents in their states. The PNA is a small portion of income that Medicaid nursing home residents can keep each month to cover personal expenses such as clothing, snacks, cell phone bills, and other essentials that make life more comfortable. The federal minimum PNA has not been raised since 1987 and remains just $30 a month, less than one dollar a day. While states can set higher amounts, they currently range from $30 to $200 a month, leaving most residents with only $2 to $3 per day for discretionary spending. Join us as we hear from Bill Lamb, a lifelong advocate in North Carolina, along with resident advocates Ray DiFrancesco of New Jersey, and Jeanette Martinez of Connecticut, as they share their experiences raising the PNA in their states and their advice for others working toward the same goal.

When award-winning filmmaker Susie Singer Carter placed her mother, who was living with dementia, in a five-star nursing home in Los Angeles, she never expected to be dealing with substandard care, inadequate staffing, and chemical restraints. Horrified by what was happening, Susie connected with former federal prosecutor Rick Mountcastle, whose prosecution of Purdue Pharma was featured in the miniseries, Dopesick. Susie and Rick have collaborated on a new documentary, No Country for Old People, to raise awareness about failures in our long-term care system and spur action to promote quality and accountability. On the eve of the release of the documentary, join a conversation with Susie and Rick about what they've learned in this process and what you can do to help change the system. Guests: Guest: Susie Singer Carter, Writer and Director, and Rick Mountcastle, Former Federal Prosecutor