The findings described in Hoffner's series included: Extreme overcrowding, poor sanitary conditions, inedible food, over-reliance on restraints, and severe understaffing.
Hoffner noted that in some institutions, so many residents were forced to sleep in a single bed that the only way to get out was to climb over the footboard.
Quarters were so overcrowded that residents had to crawl over the footboards to get in and out of bed.