The national advocacy group Families for Better Care gave Pennsylvania's nursing homes an F, but not everyone agrees with the state's grade.
Families for Better Care says 95% of Pennsylvania's nursing homes were cited for deficiencies. The state's facilities were ranked 46th nationally, sinking 14 spots since the last report in 2014.
The nonprofit says residents struggle to get direct care from staff.
The state says Gov. Tom Wolf continues to urge lawmakers to establish safe staffing levels. This year, the state began monthly reports on its nursing homes.
Health officials say in April, there were 541 inspections of 369 nursing homes, plus 312 complaint investigations. Civil penalties totaled more than $200,000.