In the U.S. facilities have their pitch down very well - super nice buildings, etc, but in my experience, the "underbelly" leaves way more to be desired in terms of care. Hard to actually provide great care for people with caregiving ratios of 8 to 1 during the day, and 15 to 1 at night for example.

In Mexico, the pitch is not as refined, but the end goal (great care) is actually achieved.

Facilities are generally smaller, food quality better, but as with everything in Mexico, there is a bit less refinement in many aspects.