New York — Nursing homes collected more safety citations in 2024 than they did two years earlier. The fines attached to them shrank anyway — and not by a little.
A report released last week by the Long Term Care Community Coalition, a New York-based resident advocacy group, found that nursing home fines dropped 56.5% between 2022 and 2024, even as cited deficiencies rose. Forty-nine states issued fewer fines in 2024 than they had two years before.
The group calls the pattern a “persistent accountability gap.” The numbers behind that phrase are stark.
Most Citations Never Reach “Actual Harm”
The report measured enforcement on a per-resident basis rather than per facility — a deliberate shift, meant to capture what residents actually experience instead of how many buildings got cited.
What it found: 94% of deficiencies cited nationwide from 2022 through 2024 were classified below the level of actual harm. Average fines per resident fell from $186 in 2022 to $153 in 2024.
Geography matters, too. Illinois led the country at $465 in fines per resident. Arizona sat at the bottom, at $35.
Where Enforcement Goes Quiet
The state-by-state variation is where the report gets pointed. In 2024, 30 states, the District of Columbia and Puerto Rico did not cite a single nursing home for understaffing at a level that harmed residents. Ten states never classified any antipsychotic drug deficiency as harmful or immediately dangerous across the entire three-year window.
Infection control tells a similar story. Tennessee flagged 11.3% of its infection-control deficiencies as causing harm or immediate jeopardy — while Alabama, Alaska, Maryland, Nevada and the District of Columbia cited none at those severity levels during the whole period.
What Watchdogs Want Changed
LTCCC wants stronger, more consistent, resident-centered oversight, and it argues the per-resident lens should become standard. Deficiencies on paper mean little, the group contends, if the consequences never reach the residents they’re meant to protect.
The stakes aren’t theoretical. The fines that do get issued face mounting resistance — one Maryland nursing home has a pending Supreme Court fight over CMS’s authority to impose penalties without a jury trial.
For operators, lighter enforcement may look like breathing room. For residents and their families, the report suggests, it reads like a system that has stopped flinching.
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