Medilodge of Livingston, where Catlin lived, and four other nursing homes in the Medilodge chain — all given a below-average health inspection rating by Medicare, and three having been cited specifically for infection control deficiencies — were among the 21 facilities to sign up for the plan. Several scrambled to obtain ventilators to meet any demand.

They were responding to the incentive, as nursing homes have done for years. Covid-19 just shifted that incentive, and Medilodge moved quickly to take advantage. In the context of a system in which government money largely supports for-profit nursing home enterprises, it made sense.

Federal money, through the Medicare and Medicaid systems, has long shaped the nursing home business — and in ways that left it completely vulnerable when the viral pandemic arrived in March.

For years, extra money has gone to pay for extra services, encouraging some nursing home owners to game the