When Carol Crow, a 60-year-old Alzheimer's patient, was found covered in bruises at her nursing home, administrators at the facility said she fell. Crow's family wasn't so sure.
"What I saw was horrendous," said Crow's daughter, Julie Glass. "No one should ever go through what my mother went through."
While the investigation into Crow's nursing home found that there was no wrongdoing, concerns like these are not uncommon. A government report released this week found extensive problems in America's nursing homes. According to the study, nearly one in five of the nearly 15,000 nursing homes examined were cited for violations that put patients in immediate harm in 2007. A total of 92 percent were cited for some type of deficiencies during each of the last three years.
From treating bed sores to preventing urinary tract infections, the quality of care in nursing homes was usually the focus of those deficiencies, the report found. Experts also found that on a typical day, far too many residents waited too long to get the help they needed.
Despite the report's findings, critics said just issuing "deficiency citations" won't change anything.
"Very few of these deficiencies ever result in a financial penalty," said Wes Bledsoe, founder of A Perfect Cause, a non-profit group that advocates for the reform in long-term care. "And if they do, they are not collected. The system has no teeth."
As a result, some states are taking actions into their own hands. In New York, for instance, the attorney general's office has made nursing home care a "major area of concern" in the state, setting up a hidden camera in a nursing home it suspected of abuse. In that case, the nurse pleaded guilty to neglect and to falsifying a patient's records to cover up the crime after cameras rolled as a 70-year-old dementia patient with bed sores was left for more than 76 hours without being turned or fed.
"It's a priority for me in this office because sometimes it's a double crime," New York State Attorney General Andrew Cuomo said. "First of all, it's a fraud against the taxpayer. In many cases, taxpayers are actually funding these organizations and these institutions and they're being defrauded. And secondly you are literally affecting the most vulnerable in our society. And that's our first priority -- to protect those people who literally can't protect themselves."
Some states have also passed laws to allow families to set up their own so-called "Granny Cams" in nursing homes, a move the nursing home industry has resisted. Those who oppose the cameras argue that it's hard enough to attract workers even without the threat of constant surveillance.
On Tuesday, the Department of Health and Human Services' Office of the Inspector General issued new voluntary guidelines to help nursing homes improve the quality of their care. According to HHS, the guidelines will address staffing issues, the management of medications and resident safety, among several other concerns.
"The new guidance reflects OIG's increased focus on quality of care for nursing home residents, as well as our longstanding commitment to safeguarding Medicare and Medicaid program funds and beneficiaries through fraud and abuse prevention efforts," said Inspector General Daniel R. Levinson in a Tuesday statement. "The guidance should serve as a valuable resource for the long-term care industry."
Cuomo called to re-direct focus on the quality of care the patient is receiving.
"We're not just paying for a warehouse, we're paying for a facility to care for people," Cuomo said.
This week's report also found that spending more money on a nursing home does not guarantee a better care. It revealed that for profit homes are actually more likely to have problems than facilities run by local governments or non-profits. Nearly 43 percent of nursing homes were found not to be up to par when it came to dietary services, the report also found.
ABC News' Kate Barrett and Brian Hartman contributed to this report.