New study LTCCC finds a persistent “accountability gap” in nursing home oversight. Read the alert

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Nursing Home Oversight and Enforcement

Federal law gives nursing home residents strong protections, but they only matter when violations are found, harm is recognized, and consequences follow. LTCCC’s studies, guides, and data help residents, families, ombudsmen, and advocates hold nursing homes and regulators accountable.

Featured study · September 2026

A national examination of how states and CMS enforce nursing home standards

LTCCC’s newest national study finds a steep decline in fines and widespread classification of violations as “no harm” in the years after the pandemic.

↓55%

fewer fines in 2024 than 2022

94%

of deficiencies cited below actual harm

90%

of homes below expected staffing

Explore the study & state data Full report (PDF)

New in 2026 Changes to nursing home inspections

Risk-Based Surveys (RBS)

CMS is changing how state inspectors survey nursing homes. Learn what the risk-based survey process means for residents, families, and ombudsmen, and how to make sure problems are still found and fixed.

Learn about RBS

Research

Reports & studies

LTCCC’s analyses of federal data on how well states and CMS identify violations and hold nursing homes accountable.

Study2026 The Accountability Gap National examination of oversight and enforcement, 2022–2024, with section reports and state-by-state data. Explore the study → Report2021 Broken Promises: An Assessment of Nursing Home Oversight State, regional, and federal survey and enforcement data, with maps, tables, and recommendations. Read the report → Report2023 “They Make You Pay”: How Fear of Retaliation Silences Residents Why many residents don’t report poor care, and what that means for oversight. Read the report →

Know the system

Guides & webinars

Plain-language explainers on what regulators are required to do, and how to use that knowledge to advocate.

Guide A Guide to Nursing Home Oversight & Enforcement What to expect from state agencies, from inspection requirements to action on abuse and neglect complaints. Read the guide → Guide2026 Understanding & Responding to the Accountability Gap Practical steps for residents, families, and ombudsmen. Download PDF → Guide A Guide to Essential Nursing Home Quality Standards The federal minimum standards every resident is entitled to. Read the guide → Topic2026 Risk-Based Surveys (RBS) What CMS’s new risk-based inspection process means for residents, families, and ombudsmen, with LTCCC’s resources and updates. Learn about RBS → Guide2026 Helping Ombudsmen Respond to CMS’s Risk-Based Surveys How ombudsmen can respond to changes in the inspection process. Read the alert → Webinar2026 The Accountability Gap: Oversight in the Post-Pandemic Era Richard Mollot and Hayley Cronquist walk through the findings. Watch & get slides → Webinar2021 Broken Promises: An Assessment of Federal Data on Nursing Home Oversight Eric Goldwein presents the findings and LTCCC’s recommendations to improve enforcement. Watch & get slides →

Data center

Oversight & enforcement data

Look up citations, penalties, staffing, and ratings for nursing homes in your state, updated from federal data.

Data2022–2024 Accountability Gap State Data Downloadable state files on surveys, citations, fines, staffing, and more. Download data → Data Nursing Home Citations & Penalties Health deficiency citations, fines, and payment denials by facility and state. Explore citations & penalties → DataQuarterly Nursing Home Staffing Data Facility and state staffing levels from federal payroll-based data. View staffing data → Data Provider Ratings & Info Five-star ratings, ownership type, and other key facility details. View ratings → Data State Pages Staffing, ratings, and other nursing home information for your state. Find your state →

Follow the money

Financial transparency & ownership

Complex ownership and related-party arrangements make it harder to hold operators accountable for public funds.

Study2025 U.S. Nursing Home Finances: Spending, Profitability, and Capital Structure How nursing homes spend public money, including payments to related parties. Read the alert → Statement CMS’s Suspension of Ownership Disclosure Revalidation Why delaying ownership disclosure undercuts accountability. Read the statement → Comments2023 Comments to CMS on Ownership Transparency (ACA 6101) LTCCC’s recommendations for more complete public ownership information. Read the comments → Policy brief2025 Nursing Home Funding Adequacy in New York No more funding without real reform and accountability. Read the brief → Slides2022 Nursing Home Transparency Webinar State reforms and recommendations for financial transparency. Download slides (PDF) →

Take action

Policy, alerts & advocacy

LTCCC’s positions on federal oversight policy, and tools for reporting and fighting poor care.

Alert2026 CMS’s Risk-Based Survey Policy Puts Residents at Risk Why streamlined inspections weaken protections for residents. Read the alert → Policy brief2026 Standards Without Enforcement Senior Care Policy Brief on the study and recent enforcement news. Read the brief → Newsletter Elder Justice Newsletter Real “no harm” deficiencies from across the country. You decide. Read the newsletter → Comments Comments & Statements LTCCC’s comments to CMS and statements on oversight policy. View all → Get help Abuse, Neglect & Crime Reporting Center How and where to report abuse, neglect, or a crime in a nursing home. Report a problem →

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