The aspect of getting old we all fear most is not death. It is disability to a degree that makes nursing home care necessary.

As a society, we are judged by the manner in which we treat our most vulnerable citizens – the very young and the very old. By that standard, we have set the bar relatively low.

Governor O’Malley recently signed into law legislation to determine if there is a link between nursing home ownership and the quality of care they provide. Such ownership ranges from small nonprofits to giant corporations with worldwide holdings, known as private equity firms.

Beginning in 2000, these huge private equity firms began buying nursing homes. The Carlyle Group, a private equity firm, paid $6 billion in December 2007 to purchase HCR Manor Care nursing homes.

Of Maryland’s 233 nursing homes, HCR Manor Care owns 14.

This year, two Maryland nursing homes, Manor Care Rossville, owned by the Carlyle Group, and the Waldorf Center, owned by Formation Capital, were placed on the national federal watch list. This means that instead of one yearly inspection, these homes will have to undergo two yearly inspections and be subject to possible penalties.

According to a Service Employer International Union – SEIU – study, buyouts of two other nursing homes in the State have led to violation of state and federal law and paved the way for the creation of new business structures that limit the nursing home’s liability and make it more difficult to track how federal Medicaid and Medicare funds are spent. Stephen Lerner, a spokesperson for SEIU, said, "Private equity (ownership of nursing homes) is corporate greed on steroids – how that melds with
patient care is hard for us to figure out."

According to Wendy Kronmiller, director of the State Office of Quality Care, a task force with membership that includes representatives from nursing homes and consumer groups will examine and analyze data to see if there is a ling between ownership and quality of care.

Charlene Harrington, a professor at the University of California, referring to the Maryland task forced study, stated, "I am not sure they need to do another study." Professor Harrington asserted that national studies, with which she is familiar, reveal that for-profit nursing homes operate with lower cost and less staff than nonprofit nursing homes, which operate with larger staff and provide higher quality care.

Voices for Quality Care has been urging Congress to pass legislation requiring more transparency in nursing home ownership. The Group has noted a Nursing Home in Southern Maryland that has a high number of state and federal violations.

It is difficult to determine how ownership of some nursing homes are structured and who is responsible for what. Tracing corporate responsibility through layers of limited liability corporations is like pealing an onion. According to Jason Frank, Chairman of the Elder Law section of the Maryland State Bar Association, these complicated structures make it hard for nursing home residents to identify who to sue for poor care.

We owe our seniors who must seek nursing home care a better deal. As I see it, the further away nursing home ownership and liability get, the more likely it is that the quality of care will suffer. We cannot depend on huge corporate entities with worldwide holdings to be too concerned with nursing home quality of care. These businesses are concerned with profit, many times to the exclusion of what has to be done or not done to turn that profit. At the very least, Maryland has the responsibility to nursing home residents to pin down who the owner is and where the ultimate responsibility for care rests.

For the fourth time in the past 15 years, the General Assembly approved legislation to create a state commission to study and provide an assessment of the death penalty’s merits and costs.

In 1993, the Governor’s Commission on the Death Penalty concluded that racial disparity in the death penalty was "a legitimate concern." In 1996, the Governor’s Task Force on the Fair Imposition of Capital Punishment concluded that the racial disparity in the death penalty "remains a cause of concern" can requires further study.

In 2000, a University of Maryland study was approved by the General Assembly. It concluded, in 2003, that the race of the offender did not have a significant impact on the process, but that the jurisdiction where the murder was prosecuted was relevant because some county State’s Attorneys asked for the death penalty more frequently.

In January 2008, an Abell Foundation study revealed that the cost of the death penalty has been $186 million, at least three times greater than the state would have spent to imprison for life those convicted of first degree murder.

Ever since the death penalty was reinstated in 1978, opponents of the penalty have been trying and failing to repeal it. Failure to repeal the death penalty often resulted in the creation of another commission to do another death penalty study. That is what happened during the recent 2008 session. Frankly, I think the death penalty has been studied and studied beyond a reasonable degree.

This newest study is modeled after the New Jersey study group and will include legislators, state officials, religious leaders, a prosecutor, public defender, police chief, correctional guard, a family member of a murder victim and a former prisoner who was later exonerated of the crime for which he served time. Obviously, the composition of this group is heavily weighted toward abolishing the death penalty. The New Jersey study led to that state abolishing the death penalty last year.

At the center of the latest effort to abolish the death penalty is the question of lethal injections. Lawyers for inmates have contended that the fatal doses of three drugs used in lethal injections, if administered improperly, can cause a painful death. In April, the U. S. Supreme Court ruled 7-3 that lethal injection executions do not violate the Fifth Amendment, which protects against cruel and unusual punishment.

The Supreme Court’s decision has no direct impact on Maryland’s current de facto death penalty moratorium. The moratorium has been in effect since 2006 when the State’s highest court ruled that the state’s procedures for lethal injections had not been properly administered. For executions to resume, Governor O’Malley would have to issue new regulations. He has resisted taking this step.

Marylanders are almost evenly divided on the death penalty. According to a January 2008 poll, 48% of Marylanders believe that the appropriate penalty for first degree murder is life in prison without possibility of parole, while 42% believe that the death penalty for first degree murder is more appropriate. Whether one is for or against the death penalty, most people believe that the matter has been mired down in one study after another.

Since the death penalty was reinstated in 1978, Maryland has executed 5 murderers. Today, five inmates are on death row.

The truth of the matter is that it can take up to 20 years before a murderer sentenced to death is actually executed. The vast majority of death penalty sentences are eventually reversed in the long and expensive appeals process. The sad fact is that the death penalty is cruel and unusual punishment for victims’ families. These families are forced to endure years of trials and legal procedures which replay the murder of their loved one and almost never end in the murder’s execution.

Richard Dieter, executive director of the Death Penalty Information Center, said, "if there is any deterrent effect to the death penalty, there isn’t one if there aren’t any executions." I couldn’t agree more.