There are families who have opened their homes in the neighborhood to care for the elderly in their community.  Then there are those who are "in the business" of operating a care home for the whoevers.  They build big homes, with multiple rooms for that purpose of providing for paying boarders needing personal care.  Abuse is a reality, unfortunately, a bad rap for those who are compassionate caregivers, but a fact.  So these care homes must be licensed, certified, inspected, and well trained in the business of personal health care. Maybe the DOH need more foot soldiers than high paid officers.