Washington, D.C. — More than a fourth of nursing homes across the country have reported at least one serious deficiency this year, according to a new KFF analysis released Thursday. About 5% of those deficiencies reached the level of actual harm or immediate jeopardy to residents — a category that includes risks of injury, impairment, or death.
That translates to roughly 6,700 health deficiencies serious enough to threaten resident safety. Most were isolated incidents rather than widespread problems, the report found.
Staffing shortages tied to worse safety records
KFF researchers pulled the data from CMS’s Nursing Home Care Compare database. They found that about 93% of health deficiencies in the most recent inspection cycle were classified as having the potential to cause harm but did not result in actual injury. The remaining share — the 5% flagged as actual harm or immediate jeopardy — represents the most severe citations CMS can issue.
The report also draws a clear line between staffing and safety. Nursing homes with lower staffing levels were more likely to receive serious deficiencies than facilities with better staffing ratios. Widespread deficiencies, which signal a pattern of problems rather than one-off incidents, were also tied to lower staffing.
Inspection gaps are adding to the pressure
The analysis arrives at a delicate moment for the industry. CMS is already overhauling how it inspects nursing homes, with a new risk-based model set to take effect in September that would fast-track surveys for high performers and free up resources for troubled facilities.
Despite the shift in federal strategy, basic inspection delays persist. About 87% of nursing homes received a standard survey within the last 15 months, but some facilities have gone more than two years without an inspection. Complaint surveys played a significant role in catching problems, accounting for roughly a quarter of all deficiencies found in the most recent cycle.
The findings come as federal oversight is changing under the Trump administration. CMS has repealed the Biden-era staffing mandate, is leaning more heavily on complaint-based inspections, and has delayed reporting requirements for nursing home ownership. The agency also warned that fewer federal validation inspections will happen because of the 2025 government shutdown.
KFF noted that adequate staffing is closely linked to fewer serious safety violations and better overall quality of care. The finding underscores the tension between Washington’s push for deregulation and the reality on the ground in facilities caring for the nation’s most vulnerable residents.
