Remember, unlike hospitals, which may be for-profit institutions or may be non-profit institutions, nursing homes are almost ALWAYS for profit institutions.

Sometimes run by individuals with not a lot of cash flow, who are very conscious of cost containment. They have to meet state health standards regarding RN's per patient, personell per patient, but that doesn't mean the personel are all that well trained.

As it is, hospitals are in a budget crunch also, and also are practicing cost containment measures, using the minimum amount and price of staff they can get by with.

In any hosptal/extended care/nursing home situation, prudence requires that someone keep track of the patient's care to see that it's done correctly. Hate to sound like a cynic, but I've seen some horror shows, heard of more.
Bob