Sidney Health Center Extended Care

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

Therapy staffing: this home’s payroll records show 0.01 therapist hours per resident per day in 2026Q1 — more than 1% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 3% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 93 beds and averages 41.7 residents a day — about 45% occupied, or roughly 51 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 4.26 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.00 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.74 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 3.90 hrs/resident/day on weekends vs 4.41 on weekdays — 12% thinner on weekends. RN hours go from 1.16 to 0.62 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 55% is about the same as the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

22 citations, most serious first. The 12 most serious are shown; the remaining 10 are one tap away and print in full.

• Immediate jeopardy · K2025-12-04 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — pattern
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to implement an effective fall prevention program; failed to follow the established fall policy and failed to identify and address the direct root causes of resident falls with and without major injury. Additionally, the facility did not ensure staff received updated fall-prevention training or education on newly implemented fall prevention interventions. These failures negatively affected 4 (#s 4, 7, 9, and 46) residents out of 5 residents sampled for falls with injuries, to include: - Resident #4 experienced a fall on 9/8/25 and sustained a rib fracture;- Resident #7 experienced multiple falls, with three individual falls on 2/13/25, 6/17/25, and 11/13/25, where she sustained injuries to include head lacerations and bruising. - Resident #9 experienced a fall on 11/23/25, sustaining an S5 sacral fracture and orbital hematoma;- Resident #46 experienced a fall on 8/30/25, sustaining a head laceration. On 12/3/2025 at 4:05 p.m., the facility…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · G2024-10-10 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
  Provide safe and appropriate respiratory care for a resident when needed.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to provide a resident with necessary respiratory care and services in accordance with professional standards of practice and the resident's physicians orders, which caused the residents to have insufficient oxygen saturations for 2 (#1 and #10) of 14 sampled residents. Findings include: a. During an interview on 10/8/24 at 11:35 a.m., staff member M said resident #1 had been in the tub room without her oxygen on when the resident turned blue and was not responding. Staff member M applied oxygen to resident #1, assessed the resident, and called the physician for orders. Staff member M was unable to remember the exact date this incident occurred. Staff member M said the CNA scheduled to care for resident #1 was new. Staff member M said she did was unaware if the CNA had been educated to know which residents were on oxygen. During an interview on 10/8/24 at 2:56 p.m., NF2 said someone from the facility called him and said, We made a mistake and took resident #1 to the dining room for breakfast without her oxygen. NF2 could not…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2025-12-04 · tag F0812 — failed to store, cook, and serve food safely — widespread
  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation, interview, and record review, the facility failed to ensure food was held at safe temperatures in the steam table1. The failure placed all residents who are served food from the steam table at risk for foodborne illness. Findings include:During an initial observation of the facility's dining room on 12/1/25 at 5:45 p.m., staff member G was observed in the dining room talking with a resident who was seated at a table. A steam table was observed, which contained trays with stuffed peppers, chicken strips, and soup. All trays were uncovered, and the lids were set off to the side of the steam table.During an observation and interview on 12/1/25 at 5:50 p.m., with staff member A, staff member G was prompted to check the holding temperatures of all foods in the steam table. Staff member G checked the temperature of one stuffed pepper on the top layer and reported the temperature at 127 degrees (Fahrenheit). Staff member G checked the chicken strips last and reported a temperature of 131 degrees (Fahrenheit). Staff member G stated that the recommended intervention if…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2025-12-04 · tag F0868 — widespread
  Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to ensure the Medical Director participated in the Quality Assurance and Performance Improvement meetings, in order to meet the minimum requirements for the meeting attendees and frequency. This failure could affect any resident when or if a care system was effectively addressed or corrected for a deficient practice. Refer to F689 Accidents and Hazards, with an Immediate Jeopardy cited related to falls; F880, Infection Control; F883 Influenza Vaccines; and F887 Covid-19 vaccines, all system failures related to direct care. Findings include:During an interview on 12/3/25 at 8:31 a.m., staff member A stated that sign-in attendance sheets were not used to track attendees who participated in the QAPI meetings. Attendance was noted on the meeting minutes with the word present listed by the names of the attendees who were at each meeting. Staff member A stated the Medical Director was a member of the QAPI team but did not attend meetings regularly. Staff member A stated the medical director was provided with the meeting minutes and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2025-12-04 · tag F0880 — failed to prevent and control infections — widespread
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to maintain adequate infection surveillance and documentation within the facility over a four-month period for the early identification and monitoring of infections and safe infection control practices. This failure increased the risk for all residents in the facility and staff, related to the transmission and prevention of infectious agents. Findings include:During an interview on 12/3/25 at 10:27 a.m., staff member A stated she was unable to locate infection surveillance logs for the period of February 2025 through June 2025. Staff member A stated she only had line lists for a norovirus and a COVID outbreak that were tracked earlier in 2025. During an interview on 12/3/25 at 2:41 p.m., staff member R stated she had started in the position in July 2025. Staff member R stated in September 2025 that she had updated many of the program components to bring the facility back into compliance with the Federal regulations. Staff member R stated she did not know how the facility was tracking infections before starting her role. Staff…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2025-12-04 · tag F0609 — failed to report abuse allegations — pattern
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on Interview and record review, the facility failed to submit a report to the State Survey Agency within the required timeframe for reportable events for 5 (#s 9, 25, 30, 39, and 46) of 10 residents sampled for facility-reported events. Findings include: 1. Review of a facility reported event, dated 11/23/25 at 7:05 p.m., showed resident #9 had an unwitnessed fall with injury. The resident was treated in the ER and released. Resident #9 had a CT scan of her head and pelvis. The results of her CT scan showed a fracture to S5 vertebrae. The facility submitted the initial report to the State Survey Agency on 11/24/25 at 11:05 p.m. The submission was outside the maximum two-hour reporting window for incidents that result in serious bodily injury. During an interview on 12/2/25 at 3:40 p.m., staff member B stated reports to the State Survey Agency should be filed as soon as possible after an incident occurred and within two hours if there was a serious injury. Staff member B stated she did not know why any incident would be reported late. 2. Review of a facility reported event,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-12-04 · tag F0610 — failed to investigate and act on abuse reports — pattern
  Respond appropriately to all alleged violations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on Interview and record review, the facility failed to complete a thorough investigation and comprehensive corrective action following facility-reported events for 3 (#s 9, 39, and 46) of 10 residents sampled for facility-reported events. Findings include:During an interview on 12/2/25 at 8:10 a.m., staff member A stated the facility provided all investigation files they had for the requested incidents, which included for #s 9, 39, and 46. Staff member A stated they may not have formal investigation files on some of the incidents due to the previous Interim Director of Nursing not maintaining files for investigations. Staff member A stated that for those events, the only documentation they had was a copy of the submission of the event to the State Survey Agency. 1. Review of a facility reported event, dated 11/23/25 at 7:05 p.m., showed resident #9 had an unwitnessed fall with injury. The resident was treated in the ER and released. Resident #9 had a CT scan of her head and pelvic area. The results of her CT scan showed a fracture of the S5 vertebrae. Due to the resident's…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2025-12-04 · tag F0657 — failed to keep the care plan current — pattern
  Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to update resident care plans based on individual resident needs for 4 (#s 4, 8, 9, and 25) of 19 sampled residents. This deficient practice placed residents at risk for injury, unmet needs, and decline in overall function and health. Findings include:1. Review of resident #4's comprehensive care plan showed an admission date of 4/8/25. The care plan showed the resident was at high risk for falls, and a care plan problem for falls was dated 4/11/25. The care plan included a long-term goal for minimizing the risk of the resident's falls and injuries. The interventions to prevent falls included: Keep call light within reach. Instruct [Resident #4] of safety measures. Fall assessment PRN. Remind [Resident #4] to change positions slowly. An additional intervention was started on 9/11/25, to show resident #4 had a recent fall when she slipped while getting up from the toilet, and the resident had a rib fracture. The staff placed gripper strips in front of the toilet. A review of resident #4's medical record showed there was no…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-12-04 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to prevent abuse for 1 (#25) of 6 residents sampled for abuse. The failure resulted in a violation of the resident's right to be free of physical restraint and placed the resident at risk for serious harm. The facility identified the abuse, addressed and corrected the deficient practice before the survey; therefore, it was past non-compliance. Findings include:Review of a facility reported event, submitted to the State Survey Agency on 2/3/25 at 3:40 p.m., showed on 2/2/25 at 1:40 p.m., facility staff held resident #25 down for the purpose of administering an intramuscular medication due to resident #25's behaviors.During an interview on 12/3/25 at 8:35 a.m., staff member A stated that due to the serious nature of the incident, the staff members involved no longer worked at the facility. Staff member A stated a Performance Improvement Project (PIP) had been added to QAPI, including monitoring for further incidents of abuse and restraints. Staff member A stated no further abuse or use of restraints was identified, and the…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Past Non-Compliance
• Potential for harm · Dcited before2025-12-04 · tag F0883 — failed to offer flu and pneumonia vaccines — isolated
  Develop and implement policies and procedures for flu and pneumonia vaccinations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to ensure adequate documentation was completed and maintained for the education provided to the resident or their responsible party, related to the risks and benefits of the seasonal influenza vaccination, for 3 (#s 6, 7, and 13) of 5 residents sampled for vaccinations. Findings include:During an interview on 12/3/25 at 2:41 p.m., staff member R stated she had administered vaccinations to facility residents for seasonal influenza and COVID vaccinations. Staff member R stated there was a section in the electronic medical record for a resident's vaccination administration information to include education on the risks and benefits provided to residents or their responsible parties. Staff member R stated she needed to go back into the resident medical records to update that section to indicate the education was provided to the resident or responsible party. Staff member R stated there were a few other nurses who administered vaccinations, but she administered most of the seasonal vaccinations. Review of a facility document,…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-12-04 · tag F0887 — isolated
  Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review, the facility failed to ensure documentation was completed and maintained to show education was provided to the resident or their representative related to the risks and benefits of the COVID-19 vaccination, for 4 (#s 6, 7, 13, and 14) of 5 residents sampled for vaccinations. Findings include:During an interview on 12/3/25 at 2:41 p.m., staff member R stated she had administered Covid-19 vaccinations to facility residents. Staff member R stated there was a section in the electronic medical record for a resident's vaccination administration information to include education provided to the resident or their representative on the risks and benefits of the vaccine. Staff member R stated she needed to go back into the resident records to update that section showing the education was provided. Review of a facility document, that was untitled and undated, included a table of residents who consented or declined to receive the COVID-19 vaccination in October 2025. Resident #s 6, 7, 13, and 14 declined to receive COVID-19 vaccination in October 2025.A…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · F2024-10-10 · tag F0727 — failed to provide required RN coverage — widespread
  Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observations and interview, the facility failed to ensure a Director of Nursing (DON) was working full-time for 35 or more hours per week, in the facility. This failure increased the risk of negative outcomes for all residents in the facility related to nursing care and services, due to the lack of onsite oversight provided by the DON to ensure completion of all necessary resident cares and treatments in the facility. During this survey, harm was identified related to respiratiry care and services, which was identified to be a system concern, and affected 2 (#1 and #10) of those who were sampled for respiratory care. Findings include: During an interview on 10/8/24 at 4:15 p.m., staff member A stated the facility had been advertising for a permanent director of nursing but had been unable to hire anyone. Staff member A said the facility had hired a director of nursing through and interim agency, and part of the contract included her ability to work on site for two weeks, and then work remotely offsite for two weeks. It was identified the facility failed to provide residents…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

$60,401 in federal fines across 1 penalty. 1 Medicare payment denial on record.

• $60,401 — penalty dated 2025-12-04
• Medicare payment denial — starting 2026-01-06 for 15 days

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

CMS files one row per role, so the 48 rows in the source record cover these 27 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

1 organizational owner listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

What families pay in MT