​Nursing homes in Pennsylvania were fined more frequently by the state's department of health in the first four months of 2017 than in the previous three years combined, according to a May 17, 2017, article in the Philadelphia Inquirer. The state has fined nursing facilities $796,750 in 2017, compared with a total of $639,500 from 2014 to 2016. The state has levied sanctions against 86 nursing facilities in 2017, compared with 72 in 2016 and 47 in 2014 and 2015 combined. Regulators implemented a more rigorous penalty system in response to criticisms that they had been too light on substandard care, the article said. One reason for higher fines is an increase in citing facilities for "immediate jeopardy" situations, which the Centers for Medicare and Medicaid Services defines as "a situation in which the facility's noncompliance with one or more requirements of participation has allowed, caused, or resulted in (or is likely to allow, cause, or result in) serious injury, harm, impairment, or death to a resident" and requires immediate correction. An example given in the article is when a resident who is at risk of choking is left alone during a meal. In October 2016, Pennsylvania's Secretary of Health announced his department would begin taking into account factors such as level of harm, how long it takes to fix a problem, and track record of compliance before fining a nursing facility. Since then, two of the three operators with the highest total of fines have ceased operating in Pennsylvania, the article said. The other facility, which is still operating in the state, was fined for two instances, one month apart, in which the same resident fell out of bed while being bathed by one nursing assistant, rather than the required two.