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The Nursing Home Reform Act (NHRA) was adopted and implemented to improve the quality of care that residents receive in nursing homes by having state inspection agencies issue deficiencies for substandard care. Yet, there is a great deal of variation in the average number of deficiencies cited by state inspectors. The goals of this study are twofold: 1) to identify the impact of political factors on the variation in deficiencies and nursing home compliance, and 2) to provide the Health Care Financing Administration (HCFA) with a strategic planning model that will help to improve its ability to oversee state implementation of the NHRA. Political party control of the governorship and legislative houses accounted for significant amounts of variance in deficiencies.

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