Federal records show that nearly 6,500 nursing homes — about 40 percent — have been cited at least once for a serious violation since 2013. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores. Medicare has fined two-thirds of those nursing homes.

However, new penalty guidelines discourage regulators from levying fines in some situations, even when negligence has resulted in a resident's death. The shift in the Medicare program’s penalty protocols was, of course, requested by the nursing home industry. The American Health Care Association, the industry's main trade group, has complained that under the regulations put in place by Obama, inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.

Trump’s change in policy aligns with his promise to reduce bureaucracy, regulation and government intervention in business. The new guidelines will likely result in lower fines for many facilities. Some, like Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), feel that cutting back on unnecessary regulation will allow providers to spend more time caring for their patients, instead of “spending time complying with regulations that get in the way of caring for their patients and doesn't increase the quality of care they provide.”

But advocates for nursing home residents say the revised penalties are weakening a valuable patient safety tool. They believe that relaxing penalties threatens to undo progress at deterring wrongdoing.

Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation, assess a fine for each day that a nursing home was in violation, or it can deny payments for new admissions. The average fine in recent years has been $33,453, but records show that 531 nursing homes accumulated combined federal fines above $100,000.

With the new changes, there is now a maximum per-instance fine of $20,965. This means that some nursing homes could be sheltered from high fines, even for horrendous mistakes.

In September 2016, for example, health inspectors faulted an Illinois nursing home for failing to monitor and treat the wound of a patient whose implanted pain pump gradually slipped over eight days and protruded from her abdomen. The negligent care ultimately resulted in the patient's death.

CMS fined the nursing home $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties "modest" given the appalling care. The fines were issued before the new guidelines took effect, but now, if CMS had issued a one-time fine, the maximum would have been less than $21,000.

In November, the Trump administration also exempted nursing homes that violate eight new safety rules from penalties for 18 months.

Sources: money.cnn.com, nytimes.com