There are good ones out there but you have to pay big money for them.
I recently called one and they wanted a $99K entrance fee and you had to prove the person being admitted to the facility has at least $450K worth of assets (not including any homes) as a financial qualifier. This is a top rate facility with good care, one of the best in the state but people unable to afford such places have to deal with whatever their health insurance, Medicare, and Medicaid will approve.
Just dealing with the staff at the facilities is emotionally and mentally exhausting and for me it makes me angry to know my family has limited options. Some staff do care and if you can make bonds with those who do you'll get better service. But mostly, for the lower quality facilities, these are systemic problems embedded in the structure of the facility. And they'll always have full beds because they're cheaper. The DON at my mother's facility said outright to my family and I that she didn't care what Medicare.gov ranked her facility and if we wanted better treatment we should go somewhere else. You have to ride these people so hard just to do basic care. Not to mention the lower quality facilities are the most dismal and depressing places to be in. The people there sit in their wheelchairs or laying in their beds looking hopeless, they smell, they don't eat their food, so much going wrong. It's so obvious many of them have lost their spirit and are waiting to die. Very non-responsive and passive.
My family and I just have to joke about it to keep from completely tanking. We get crème de la crème of the worst facility!
Thank God, my mother isn't there permanently. In a twisted way, I'm happy that I've been exposed to this so I can know what decisions to make for myself and my loved ones if this should happen again. I really think I've found a passion in elder care. Nobody wants to deal with the ugliness of end-of-life care. It's a serious reality check.