Despite the cost--and opposition from nursing homes--staffing standards are gaining support from those traditionally supportive of the industry. In Arkansas, lawmakers are expected to vote in the next few weeks on a bill mandating that nursing homes hire more aides--and pay stiff penalties for understaffing. The measure's sponsor is State Senator John Brown, a conservative Republican who generally knocks government regulation in favor of "free enterprise." On a recent sunny afternoon Brown stands in a hallway of the state capitol in Little Rock, at the bottom of a marble staircase leading to the governor's office, and caucuses with patient advocates about how to pay for the increased staffing.

"We have to talk about where the money's going to come from," Brown says.

"How about profits?" suggests Virginia Vollmer, a member of Arkansas Advocates for Nursing Home Residents.

Brown surprises her by nodding in agreement. "But we've got to look behind their published numbers," he says. "Whether it's the way they report expenses or amortize interest, there are different accounting ploys that homes can use to make money. By and large they have a pretty good return. We're paying them hundreds of millions of dollars, but in too many cases they're endangering people rather than caring for them."

The advocates are encouraged, but they remain skeptical. "I don't know that any of the increased staffing will come out of the industry's pockets," says Jim Porter, whose mother died in a Beverly home in Little Rock last November. "It will probably all come out of the taxpayer's pocket. That's the shame of it." Like Senator Brown, Porter is hardly an antibusiness activist. The chairman of the Arkansas Entertainer's Hall of Fame and a Beverly investor, Porter called CEO David Banks personally after witnessing the inadequate care at his mother's nursing home. "I told him they weren't paying the salary they need to get and keep the help they need," Porter recalls. "He said he knew they were having problems and he'd get things in order. But he didn't."

Porter has a simple explanation for why care at Beverly and other nursing homes remains substandard. "Greed," he says. "They don't want to pay these nurse's aides more because it would be money out of their profits. It's as simple as that." He also has a simple idea of how to improve care: Return nursing homes to public control. Given the history of abuses at county homes and the current political climate, it's not a proposal that's likely to gain much ground. But it does suggest the depth of frustration with a privatized system that profits from pain--and the importance of remembering who ultimately pays the price.

"Perhaps nursing homes should be taken over by the state, county or city," Porter says. "Each one of them could be run for less by the government, because there wouldn't be an owner sitting there siphoning off hundreds of thousands of dollars. Imagine what kind of care we could provide with all those profits.

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