In the early 1980s, the Reagan administration slashed funding for nursing home inspections by half and began trying to relax or repeal many of the regulations governing nursing homes, on the grounds that they unnecessarily burdened the operators. Administration officials even proposed outsourcing the inspections, which are carried out by state health or human services agencies under contracts with the federal government, to a private accrediting agency. Holder and NCCNHR pushed back hard, and helped prevent the most damaging cutbacks.
At the same time, Holder lobbied hard to build support for what ultimately became the Nursing Home Reform Act, which Congress passed in 1987. That law not only laid out what services homes were required to provide but also established nationwide standards for nursing homes.
In addition, the law created a nursing home residents' bill of rights, which not only protected residents from abuse and neglect, but also guaranteed their right to have their medical, physical, psychological and social needs met. The bill of rights also provided patients with access to their own care plans, and the opportunity to file grievances without fear of reprisal or discrimination.
After passage of the reform law, Holder continued to press hard to protect the rights of nursing home residents. In the 1990s, she and NCCNHR campaigned to reduce the use of physical restraints for mentally confused patients, enlisting the support of progressive nursing home operators who already had cut back on the practice.
Holder retired from NCCNHR in 2002 and returned to Oklahoma to be a caregiver for her own mother. Her organization, now known as The National Consumer Voice for Quality Long-Term Care, continues Holder's work.
In the 2004 Oklahoman interview, Holder envisioned eventually converting all nursing homes into nonprofit organizations to take away the incentive to cut costs for the sake of profits, adding that she wanted to see them pay higher wages to ensure the best care. She also expressed the hope that more space inside them could be allotted to areas where families could visit the residents and participate with them in activities. Encouraging that level of family involvement, she pointed out, would also create another safeguard against abuses.
“I visited a nursing home in Belgium that provided a small auditorium for plays and performances for the residents and members of the community,“ she said. “There was a cafe with sidewalk tables for outdoor dining and a playground open to all children. One atrium was filled with birds. There is no better insurance against a facility smelling of urine than inviting the public to walk through your facility on the way to a play in the auditorium.“