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The enforcement system regulating nursing homes still allows too many nursing homes to get away with providing substandard care, Sen. Herbert Kohl (D-WI), chairman of the Senate Special Committee on Aging, said during a hearing Wednesday.

The hearing, which included testimony from the government, providers and others, addressed the state of nursing homes 20 years after the Nursing Home Reform Act or OBRA ’87. It came just a few weeks after a Government Accountability Office report found that federal oversight failed to improve care at some poor performing nursing homes.

Providers reiterated at the hearing that the survey and certification system has failed nursing homes. The system measures success not by quality of care but in terms of a tally of regulatory fines and violations, said Mary Ousley, past chair of the American Health Care Association.