As a Political Science professor at Villanova University, he dealt with plenty of bureaucracy and research data.
So Dr. Justin Green is not surprised, to get lots of questions from fellow seniors at East Knoxville's O'Connor Senior Center, on how to choose a nursing home, or to receive better care.
"People in a nursing home like that are very unwilling to tell you exactly how they feel because they're afraid if they say the wrong things--their treatment will suffer accordingly," he says.
"What you need to know is what the caregivers know rather than the feelings of those getting care."
The American Association of Retired Persons maintains that a "knowledge gap" may explain why Tennessee's nursing homes and care centers, often rate so poorly in surveys.
Its 49-page report, "Quality of Care and Litigation in Tennessee Nursing Homes, suggests that caregivers would face fewer lawsuits
if their facilties hired more staff.
"When your staffing is well below standards that are set for the nation, it seems pretty obvious that the staffing aspect should be looked at carefully," says Bill Schall, AARP's Knoxville representative,.
Such conclusions would seem to dovetail with the 5-star rating scale of the Centers for Medicare-Medicaid Services, a measuring stick
for patients and their families to judge quality of care.
Except that a number of East Tennessee's nursing homes and care centers rated average for quality of care, notched barely-passing or failing grades for staffing levels and training.
Should quantity of staff be the sole, or primary measure, of quality?
"We don't know that it's accurate, says AARP's Schall
"But there are a number of measures they have in there."
"It's very important, and their attitude is important too, " says Frances Rio, who conducted a prolonged search for the right assisted-living facility, after her husband was diagnosed with Alzheimer's.
Dr. Green advises surprise visits
"Follow (staffers) around to see what they do for the residents, and see how the patients react to their care," he says.
"What you see, rather than what they say, matters more."
"When I went in (to the place chosen) I knew I would be comfortable there, " says Frances Rio.
"It wasn't the cheapest place, but I could see he was so pleased with it."