Re “State acts on nursing homes’’ (Page A1, Feb. 11): Hopefully, as the headline says, the state will act. Having consulted and provided clinical services in some of these facilities, I can substantiate the need for a clearly delineated process for reporting complaints up the chain of supervisors and managers that is enforced and rewarded.

Compliance training, related to standards of quality care, was provided within the facilities in which I have worked. However, merely completing the online training was viewed as the essential goal. In my experience, in-house supervisors did not sufficiently emphasize personal responsibility in implementing the training. Rather, it seemed that this was only a process for the corporate entity to satisfy state requirements as an ethic for so-called good practice, not an ethic to embrace within the facility itself.

Violations of in-house compliance standards may occur in some cases because of the absence of supervisory vigilance, or because clinical providers may not diligently report violations, thinking they might be ignored or might suffer retribution for reporting them. Such reporting also may suffer because of the unrealistic productivity that is expected of clinical and rehabilitation personnel, as set by companies that contract with these facilities. Instead of focusing primarily on how many billable hours a clinician is able to deliver in a given work day, there should be greater focus on delivering patient-centered, quality care.

David L. Maxwell, Marshfield

The writer is a professor emeritus in the department of communication sciences and disorders at Emerson College.