Survey Deficiencies
KFF reported on deficiencies in nursing homes. As concerns nursing home quality of care way heavily on the millions of Americans with a loved one in a nursing home, the Kaiser Family Foundation took a look at the nursing home inspection process.
The nursing home survey and certification process is a federal-state partnership designed to ensure that nursing homes comply with health and safety standards. In order to receive federal funding from the Medicare or Medicaid programs, nursing homes must meet conditions of participation, which include complying with health and safety standards.
To enforce the conditions of participation, CMS partners with state agencies to conduct unannounced, on-site nursing home inspections, also known as standard surveys.
These surveys identify “deficiencies” in nursing homes, which are defined as a nursing home’s failure to meet a federal requirement for participation in Medicare or Medicaid.
While CMS primarily relies on states to accurately collect information on deficiencies, the agency also conducts on-site “validation inspections” in nursing homes to verify the accuracy of state inspections.
Federal law requires that all nursing homes must receive a standard inspection, also called a survey, at least once every nine to fifteen months. In practice, however, some states may not inspect all facilities within this time frame. While state agencies generally conduct standard surveys at least once every 15 months, staffing shortages and relaxed oversight can lead to delays.
Recent data shows that while a majority (87%) of nursing homes received at least one standard survey in the last 15 months (between March 2025 and May 2026), only ten percent of nursing homes received a standard survey between January 2024 and February 2025, and the remaining three percent of nursing homes have not had a standard survey since prior to January 2024.
The last survey cycle cited 137,000 deficiencies. 5% of these caused, or were likely to cause, serious injury, harm, impairment, or death to a resident.
While the vast majority of nursing home deficiencies did not cause actual harm to residents, it is still worth noting that around 28% of nursing homes in total reported at least one of these deficiencies in 2026.
These deficiencies are classified as Level 3 and 4 deficiencies, and they include the following examples:
“Facility failed to ensure a resident’s bedside rail was raised up while the resident was in bed. This failure resulted in the resident falling out of bed and sustaining a fracture through the right femur.”
“Facility failed to ensure a cognitively impaired resident was fed with nectar thick liquid, liquid thickened with an agent for a nectar like consistency, to prevent aspiration (accidental breathing in of fluid or food into the lungs).”
93% nursing home deficiencies cited in the last survey cycle were of level 2 severity. These did not cause actual harm to residents but had the potential to do so. Examples of this type follow:
“Facility failed to ensure resident to resident altercations were thoroughly investigated and reviewed for abuse investigations. This failure placed the residents at risk for repeated incidents, unidentified abuse, and inappropriate corrective actions.”
“Facility staff failed to ensure residents were free from accidents by failing to properly educate staff on how to operate a Hoyer lift, and by failing to maintain supervision of residents from the locked dementia unit.”
Unsurprisingly, KFF’s analysis noted that nursing homes with low staffing levels have more severe level 3 or 4 deficiencies.
32% and 27% of low staffed facilities had level 3 and 4 deficiencies respectively, while only 18% and 10% of higher staffed facilities had deficiencies of level 3 and 4 types respectively.
Recently, federal oversight of nursing homes has gotten looser.
Under the Trump administration, the nursing home staffing minimum was rescinded, inspections triggered by complaints are prioritized over routine inspections, and the deadline to report detailed ownership information has been suspended.
If KFF’s recent analysis paints a bleak picture of the level of nursing home deficiencies, relaxing inspection rules will simply make nursing home care quality worse, not better.