Since 2013, nearly 6,500 US nursing homes – four in ten – have been cited at least once for a serious violation, with two-thirds fined by the Federal Government according to The New York Times.

The fines are not small. The average in recent years is $33,453, but 531 nursing homes have been fined over $100,000.

However under the Trump administration changes, some nursing homes could be protected from fines above the new maximum per-instance fine of $20,965, even for serious transgressions.

The new guidelines discourage regulators issuing fines in some situations, even when a resident has died. The changes will also result in lower fines for many facilities for common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.

In one case cited, a since-closed nursing home was fined $282,954 for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over an eight-day period and protruded from her abdomen, leading to her death.

Under the new fines, the home would have been fined less than $21,000.