Aging services in Maryland are highly regulated compared to other states making it difficult to start or expand services. Existing providers find that compliance in the current regulatory environment is costly — and even more costly if they fail to comply. In reacting to a few poor performers in senior living, Maryland has made regulatory compliance a priority over caring for people. In skilled care, for example, nurses spend an inordinate amount of time documenting the care they provide to avoid fines and citations. This does little to improve the quality of services or add value to the consumer. I agree that providers should be regulated and held accountable. However, when compliance takes priority over providing hands-on care, the regulations have become a detriment to the people they are meant to protect. These regulations also come with costs not fully reimbursed by Medicare or Medicaid.