This study assessed nursing home oversight and enforcement of minimum standards in the three year period following the COVID-19 public health emergency (2022-2024). Findings are based on federal data on (1) state and national citations, (2) quality measures, and (3) staffing.
In addition to the study, this page provides searchable data reports (to view and evaluate individual state performance), and other resources that can be useful for improving accountability for compliance with federal standards for nursing home care.
Explore the Findings
Explore each section of the study, including section reports, downloadable data, and background briefs.
Start with an overview of the study, why nursing home oversight and enforcement matter, and how the federal survey and enforcement system is intended to protect residents.
Read the introduction (PDF)Explore how frequently nursing homes were surveyed across the country and how state survey activity changed from 2022–2024.
Read the section report (PDF)See how often nursing homes were cited for failing to meet federal requirements and how those deficiencies were classified by scope and severity.
Read the section report (PDF)Health deficiency citation rates by state (Excel) Health deficiencies by scope & severity (Excel)
Examine the use of financial penalties for nursing home violations, including how the frequency of fines changed during the study period.
Read the section report (PDF)Nursing home fines by state (Excel)
Explore nursing home compliance with infection prevention and control requirements and how infection-control deficiencies were cited and classified.
Read the section report (PDF)
Infection control citations by state (Excel)
Examine nursing home staffing in relation to resident needs and how frequently facilities were cited for failing to meet federal staffing requirements.
Read the section report (PDF)Sufficient staffing citations by state (Excel) Expected vs. reported staffing by state (Excel)
Explore the prevalence of pressure ulcers in nursing homes and how frequently facilities were cited for failures related to pressure-ulcer prevention and treatment.
Read the section report (PDF)Pressure ulcer citations by state (Excel) Pressure ulcer rates & citations by state (Excel) Residents with unhealed pressure ulcers (Excel)
Examine the use of antipsychotic medications in nursing homes and enforcement of federal protections against unnecessary and inappropriate psychotropic drug use.
Read the section report (PDF)Antipsychotic drugging rates by state (Excel)
Explore enforcement of federal protections intended to safeguard nursing home residents’ rights, dignity, choice, and autonomy.
Read the section report (PDF)Resident rights citations by state (Excel)
Read LTCCC’s conclusions on what the findings reveal about nursing home oversight, enforcement, and accountability in the post-COVID era.
Read the conclusion (PDF) Key Findings
Snapshot of some of the study’s findings.
64.8%
of nursing homes received a standard survey in 2024.
94%
of cited health deficiencies were classified below actual harm.
↓ 55%
fewer nursing home fines were issued in 2024 than in 2022.
90%
of nursing homes were below expected staffing in 2024.
↓ 65%
decline in infection-control citations classified at actual harm or immediate jeopardy.
~3 per 100
pressure-ulcer citations for every 100 residents reported with a pressure ulcer.
99.5%
of psychotropic medication violations were classified below actual harm.
45%
resident-rights citations increased, while findings of actual harm declined.