Gene Timmons’ brief stint in an Albuquerque nursing home was supposed to make him stronger.

His family hoped he would live there for a few weeks, getting the physical therapy he needed to return home stronger and avoid repeat falls, said his son, Matthew Timmons, an Albuquerque resident.

Instead, Gene Timmons got sicker. When he went to the hospital after just a few days in the nursing home, doctors determined he was suffering from severe dehydration, pressure ulcers, sepsis and respiratory failure, said Caela Baker, an attorney representing the family.

Gene Timmons died in December at age 83 — seven days after leaving the nursing home.

“He was only there for a week before he was taken out and basically put on his deathbed,” his son said.

Stories like Timmons’ aren’t as unusual as you might hope, according to the latest safety and quality ratings from the U.S. Centers for Medicare and Medicaid Services. Inspectors hand out, on average, 9.3 health citations per nursing home across the U.S. In New Mexico, that figure nearly doubles to 17.8 health citations — the highest of any state in the country.

The New Mexican reviewed ratings for all 68 facilities in the state considered nursing homes by the Centers for Medicare and Medicaid Services. Nearly a quarter received one star out of a possible five from the agency’s rating system.

Eleven facilities were recently cited for abuse. And Casa Real — one of just two nursing homes currently in operation in Santa Fe — is unrated “due to a history of serious quality issues,” according to the federal agency’s website. The facility’s latest inspection yielded 29 health citations, well over New Mexico’s average of 17.8 and the national average of 9.3.

Several factors contribute to the poor quality of care available in the state, including profit-driven corporate structures and low reimbursement rates for care, said Angelina Flores-Montoya, deputy Cabinet secretary of the New Mexico Aging and Long-Term Services Department. Chief among those, though, is trouble recruiting and retaining staff.

“We have a nursing shortage in this country. That’s not specific to New Mexico; that’s across the U.S.,” Flores-Montoya said. “But New Mexico certainly faces that in more challenging ways in rural communities.”

To fix those problems, policymakers will have to strike a “balance of resident safety and quality of care with the realities of the long-term care workforce and Medicaid reimbursement,” department spokesperson Joey Long wrote in an email.

The state’s poor quality and safety ratings have led attorneys who represent plaintiffs in nursing home abuse and neglect cases to call on the Legislature to increase minimum staffing standards for nursing homes.

“What we need is some kind of state legislative mandate that makes staffing better at these places,” said Tyler Atkins, founding partner of an Albuquerque-based law firm that takes on nursing home abuse cases. “And yeah, it may affect the bottom line of the corporations operating them, but … they’re going to be in business. They just won’t make as much money by safely staffing these places.”

However, minimum staffing standards aren’t a “silver bullet” for better care as facilities struggle to recruit and retain qualified staff, especially in rural communities, argued Vicente Vargas, executive director of the New Mexico Health Care Association and New Mexico Center for Assisted Living, trade groups that represent long-term care and assisted living facility operators.

“Could it move the needle? Sure — at what cost? Is it less availability of beds? Is it closing down a facility?” he said.

Vargas added, “If we’re going to have that discussion, we need to have a more robust discussion about how we can find the workforce, how we can pay the workers, how we can ensure that they have a safe working environment.”

What are nursing homes?

Nursing homes are one step on a ladder of care options available to older adults, Flores-Montoya said. These include:

• Independent living, in which residents manage their own affairs but may use facility amenities for things like meals and entertainment.
• Assisted living, in which residents need help with daily, nonmedical tasks like bathing or preparing meals.
• Skilled nursing facilities, which are staffed with professionals 24/7 to provide medical care — like administering IV antibiotics or providing physical and occupational therapy — directly after a hospital stay.
• Nursing homes and long-term care facilities, which provide skilled nursing care for extended periods of time.
• Memory care, a type of specialized care for people with some form of dementia that can take the form of either assisted living or skilled nursing care.

Nursing home care is “appropriate when a person requires that 24-hour care” plus assistance with daily activities like feeding, bathing and toileting, Flores-Montoya said.

All of those types of care are becoming increasingly important as New Mexico baby boomers age. The state’s over-65 population grew nearly 40% between 2010 and 2019, outpacing the rest of the nation. That the trend is poised to continue: By 2030, New Mexico is projected to have the fourth-highest percentage of people over age 65 of any state in the nation, a demographic shift expected to have wide-reaching implications for the state’s healthcare system.

“In the next five years, 1 in 4 New Mexicans will be over the age of 65,” state Aging and Long-Term Services Cabinet Secretary Emily Kaltenbach said. “That’s quite alarming, and we still have a long way to go to build the infrastructure and to support the providers to care for those individuals.

One critical caveat to long-term nursing home care, Flores-Montoya said: It’s not typically covered by Medicare. The insurance program for older adults covers short stays in skilled nursing facilities, usually in the aftermath of an injury or illness. But long-term care is primarily paid for by Medicaid, the public insurance program for low-income people.

Nursing home operators have long argued Medicaid reimbursement rates aren’t sufficient to cover the cost of care. A 2024 report from the U.S. Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation found Medicaid reimbursement rates covered about 82 cents of every dollar of costs nursing homes incurred by caring for Medicaid patients.

Those tight resources limit the revenue available for nursing homes to increase pay for workers or provide training, Vargas said. His organization, he said, would “strongly support” specialized behavioral health training for nursing staff, as they care for an increasing number of patients struggling with dementia or behavioral health conditions.

“Medicaid rates just don’t cover it,” he said.

Insurance doesn’t cover independent or assisted living for older adults at all, leaving families to pay for those facilities — where rent can cost $10,000 per month or more — from their savings, if they have any.

“Most people are shocked to learn that Medicare does not provide long-term care services in nursing facilities,” Kaltenbach said. “And so, unfortunately, many of our older New Mexicans get to a certain age and realize that they don’t have the funds to support a very expensive service.”

Staffing standards

Providing a skilled nursing level of care is demanding work, Vargas said. It’s a high-stakes environment in which staff — particularly certified nursing assistants and certified medication aides, who Vargas called the “backbone” of nursing facilities — are responsible for residents’ health and safety.

Nursing homes are highly regulated. The state Health Care Authority Division of Health Improvement is responsible for determining compliance with state licensure regulations and for conducting certification and compliance surveys at nursing homes on behalf of the U.S. Centers for Medicare and Medicaid Services.

The federal agency tracks and publishes nursing homes’ performance on a series of safety, quality and staffing measures, ranging from rates of pressure ulcers and urinary tract infections to resident emergency room visits. When facilities don’t meet those standards, they can be written up for health and safety violations.

“These measures are stringent,” Vargas said. “They’re not easy to achieve, nor should they be easy to achieve. This is high-stakes care.”

Safe staffing is one part of nursing home regulations. The Centers for Medicare and Medicaid Services monitors several staffing measures, including the care available to each resident per day and turnover rates among staff, nurses and administrators.

But state — rather than federal — standards guide nursing home staffing levels. Though federal law requires all facilities provide enough staff to safely care for residents, there aren’t any nationwide standards dictating safe staffing.

The Biden administration in April 2024 considered minimum staffing requirements for long-term care facilities, with the goal of reducing the number of residents receiving unsafe and low-quality care. The rule would have mandated at least 3.48 hours of nursing care per patient per day, including at least 0.55 hours of registered nurse care and 2.45 hours of direct nurse aide care.

The Trump administration scrapped the minimum staffing proposal in December 2025. New Mexico Attorney General Raúl Torrez and fellow Democratic attorneys general from 17 other states decried the move as likely to worsen the quality of care available in nursing homes, while nursing home operators largely welcomed the change.

New Mexico has its own standards for appropriate staffing in long-term care facilities, though they’re lower than the ones considered under the Biden administration. State regulations require each facility have a member of nursing staff on-site at all times and set a minimum staffing level of 2½ hours per patient per day. For a facility with 100 patients, that’s roughly equivalent to one nursing department employee for every nine to 10 patients.

“There shall be sufficient nursing service personnel assigned to care for the specific needs of each resident on each tour of duty,” state regulations note. “Those personnel shall be briefed on the condition and appropriate care of each resident prior to beginning hands-on care of residents.”

Increasing staffing

Without sufficient staff — or with overburdened and unqualified staff — nursing home residents can get hurt, said Jennifer Foote, a partner at an Albuquerque-based law firm that specializes in nursing home abuse litigation.

Citations from the Centers for Medicare and Medicaid Services are replete with examples of staffing issues.

Investigators wrote up an Aztec nursing home after staff left a resident in a room with her deceased roommate for an hour and a half — something the nursing home’s assistant director of nursing admitted to investigators was not consistent with “best practice.” The inspection, conducted in June 2024, also found a history of physical and verbal abuse by one of the facility’s nursing assistants, who was later fired.

Staff in an Albuquerque nursing home performed CPR on a resident despite an advance directive on file instructing them not to resuscitate the woman, investigators found after a June 2025 survey.

A resident remained on the floor of his room in a Roswell nursing home for more than three hours after a fall, according to evidence collected during a February 2025 investigation. The federal agency’s report stated nobody checked on the man during that time, despite his cries for help.

That pattern of problems statewide has led Foote and other plaintiffs attorneys to call for legislation that would increase the state’s minimum staffing requirements.

“Safer staffing ratios could make a big difference, potentially,” Foote said. “I think New Mexico could do that legislatively and just say, ‘2½ hours isn’t enough. We need to have stronger staffing ratios.’ ”

However, New Mexico Health Care Association members worry requiring facilities to find more staff from an already depleted pool of workers might lead to disruptions in care.

“They have to reduce the availability of beds to communities and families in order to meet the staffing requirements. That’s their that’s a big concern,” Vargas said.

But, he added, “That does not mean we don’t support more staffing. … I can’t think of a facility that wouldn’t happily hire more people if the people were out there and the rates were such that we could offer incentives and pay that attracted folks to our industry.”

Vargas called for a more robust discussion around the state’s healthcare workforce, something he said the association would welcome.

“We can find a long-term plan on how we can address this — but long-term care wants to be part of the discussion,” he said.

Increasing the state’s minimum staffing requirements would require careful evaluation, Long said.

“ALTSD supports efforts that strengthen quality of care and resident safety while also considering the resources necessary for those standards to be met,” they wrote in an email.

‘Going to fail’

Atkins cautioned against placing too much blame on individual nursing home staff. Rather, he said, the corporate structure of many for-profit nursing homes incentivizes cutting costs — often by reducing staffing to the lowest possible level.

“The staff, they’re not the villains here. They are just not,” he said. “They’re put in this position where they are going to fail.”

In New Mexico, the vast majority of nursing homes are operated by for-profit companies, according to federal data.

Just two multistate long-term care companies, Opco Skilled Management and Genesis HealthCare, operate more than 60% of the 6,911 certified nursing home beds in the state. Genesis is currently undergoing financial restructuring bankruptcy proceedings in Texas, which will likely result in another private company taking over their operations in the state.

There are a handful of nonprofit nursing homes throughout New Mexico, as well as a few operated by state and tribal governments.

On average, for-profit nursing homes tend to have lower quality and safety ratings than nonprofit and public options, Flores-Montoya said. That holds true for Genesis’ facilities in the state, 33% of which received a one-star overall rating from the Centers for Medicare and Medicaid Services. That’s higher than the state average of 24%.

Since staffing represents a major cost to for-profit companies, Atkins said, that’s also the first place nursing home operators look to reduce their expenses.

“When nursing homes are treated as a business, then the operators kind of start viewing it as, ‘What’s the bottom line? How do we make more money?’ “ he said. “And from my experience … the No. 1 way to bump up the … profit margins is staffing.”

Vargas disputed this idea, arguing all nursing homes — regardless of ownership structure — have to abide by the same rules and regulations in New Mexico.

Unsavory operators in the state are “going to get cited,” he said.

“You’re going to get tagged. The state of New Mexico is going to intervene. You will probably not be in business very long. You will be regulated out of business — as well you should be.”

Matthew Timmons is pursing a negligence and wrongful death case against the Albuquerque nursing where his father received care shortly before his death. He placed the blame for his father’s death squarely on a nursing home system he argues incentivizes poor quality care.

“The whole world needs to know that there’s something going on here that’s being done on purpose. I think it’s criminal,” he said. “… I think that more people should know about it and talk about it.”

He added, “I would like to see the people who designed this business model go to prison — because this isn’t just about, ‘Oh, somebody accidentally screwed this up.’ … This looks like a business model to me.”

Margaret O’Hara reports on issues affecting healthy communities in New Mexico. Her work is funded by a grant from Anchorum Health Foundation. Anchorum will not have any role in editorial decisions. The New Mexican and its Public Service Journalism Fund retain full editorial control. Philanthropically funded stories by The New Mexican are made available to all readers without a paywall.

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