This book shares insights gained through 5 years of personal experience and research by the author about nursing homes and the government oversight system for nursing homes.

It is a substantive 380-page journalistic novel hybrid written by a retired former journalist and certified internal auditor, William J. Beerman, Sr.

The author intends the book to provide important information to the public and especially to those who might have a nursing home for themselves or a loved one in their current or future lives.

The book is named after William's mother, Mary Regina, who died after a short stay in a nursing home. After Mary Regina's death, William filed suit over the mistreatment his mother had suffered, and he began looking into how the government oversees nursing homes. What he found out was alarming.

This book presents in an easy-to-read, memoir-like framework, a three-part narrative: (1) the human-interest background story of Mary Regina and William, (2) details of Mary Regina's hospital and nursing home experiences, and (3) what William learned about government oversight of nursing homes.

The book covers state attorneys general lawsuits involving 65 nursing homes and more than 1 million patient-days of nursing home care. The investigations for the lawsuits elicited reports on nursing home operations from former employees who became confidential witnesses. The investigations looked not only at resident treatment, but at how the nursing homes interacted with oversight agencies, and with their parent corporations. Audits by state and federal auditors, and the work of a nursing home quality improvement task force, are also covered.

William reports, for example:

- Many nursing home administrators knew in advance when state inspectors were coming for "unannounced" inspections.

- The federal government's ratings for nursing homes do not consider the opinions of the people who live in them.

- State enforcement actions can vary wildly, from 171 a year under one governor, to two under another in the same state.

- Lawyers sometimes seem to be more successful at holding nursing homes accountable than do the agencies established for that purpose.

- Even when government lawyers allege that it was mathematically impossible for inadequate nursing home staffs to provide the required care, lawsuits might be thrown out of court based on legal technicalities.

- Keeping continent residents in diapers can be less expensive in terms of staff hours for nursing homes than it is to escort them to the bathroom.

- In recent years, the number of complaints about nursing homes has risen while the number of citations and enforcement actions has gone down.

- Nursing home operators contend that they are victims of excessive regulations and costly unfounded lawsuits, and that Medicaid's rates for nursing home care fall about $25 per patient-day, or collectively about $7 billion per year, below the cost of providing proper care.

- Residents are still in jeopardy; some of the same conditions are reported decade after decade.

William grew up in a dysfunctional family, as many of us do. He had a strained relationship with his mother, largely because of a ruthless 13-year scorched-earth divorce war that she waged against his father, who was a steelworker. As Mary Regina grew older, she lived in Pittsburgh, Pennsylvania, and William lived 1,775 miles away in Las Cruces, New Mexico.

When William's sister died young, he became his mother's sole surviving offspring. And after Mary Regina broke her hip, William traveled to Pittsburgh and spent 20 days standing by at her bedside in a skilled nursing home. He observed what happened on the day shifts and listened as Mary Regina told him what happened at night.

William's complaints about the nursing home to the state department of health were not handled satisfactorily, so he began researching