Nursing Home Deficiencies By State

The Centers for Medicare and Medicaid Services monitor short-term rehabilitation and long-term care facilities to protect resident rights and prevent abuse and neglect. Well-defined deficiencies help them assess each facility’s situation, create corrective plans, and ensure the facilities improve their standard of care through enforcement actions. 

This article will define deficiencies, outline the most common ones, provide statistics on care standard violations, and explain how a care home lawyer can help you. 

What Are Nursing Home Deficiencies?

Nursing homes are legally responsible for maintaining professional standards of medical care, safety, and quality of life. State and federal regulations define these standards. When a facility fails to meet them, it’s considered a deficiency. This framework helps identify and address shortcomings in resident care and facility management.

The Impact of Deficiencies on Residents

Deficiencies in nursing homes can have serious consequences for residents, ranging from minor issues that affect dignity and comfort to severe problems that can result in serious injuries, abuse, or even death.

The impact of deficiencies on residents can include:

• Injuries – This bodily harm includes fractures, contusions, cuts, and burns, especially in cases of inadequate supervision.
• Illness – Poor sanitary conditions, a lack of infection control procedures, and understaffing sometimes lead to infections or worsen existing conditions.
• Psychological trauma – Neglect, abuse, and disregard for resident rights often result in fearfulness, anxiety, depression, isolation from social activities, and accelerated cognitive decline,  
• Neglect – Failure to hire enough staff, screen employees for abuse and neglect, and train existing employees can lead to malnutrition, poor ulcer care, poor hygiene, and an overall decline in well-being. 
• Abuse – Nursing homes must adhere to standards for preventing, reporting, and addressing abuse from residents, visitors, and staff members. When facilities fail to meet these standards, residents become vulnerable to various forms of mistreatment, including theft, exploitation, and physical, emotional, and sexual abuse.
• Death – In the most severe cases, deficiencies can cost a resident their life.

The Role of State and Federal Oversight

Federal and state agencies ensure compliance and conduct inspections to determine the quality of care in a facility. The Centers for Medicare & Medicaid Services (CMS) sets federal guidelines, while state surveyors oversee compliance with federal and state regulations. 

They also enforce these standards of care. In addition to regular inspections, they investigate complaints, create correction plans, impose fines, and, in some cases, revoke nursing home licenses.

Nursing Home Deficiencies: A National Overview

In the US, the percentage of nursing home facilities with serious deficiencies is disturbing, up to 26% in 2023. This rating illustrates how many elderly US citizens suffer from substandard care.

In this section, we’ll discuss common deficiencies, their severity classification, and the importance of transparency.

Common Types of Deficiencies

The data show that some deficiencies are more frequent, including administration, resident rights, and health deficiencies. Here are some common deficiencies that affect residents across the US: 

• Infection deficiencies  – One of the most prevalent and serious deficiencies is failing to implement an infection prevention and control program. These deficiencies are hazardous to elderly people, who are more vulnerable to communicable diseases.
• Accident and fall prevention – Failure to ensure the nursing home area is free from accident hazards and adequate supervision to prevent accidents has resulted in fractures, bruises, cuts, and accidental poisoning. 
• Medication errors – This deficiency refers to incorrect dosage or administration of drugs, including giving the wrong medicine to a resident or delayed administration. 
• Inadequate staffing  – Staffing is a significant issue in the US care system. These deficiencies include insufficient medical, sanitary, and kitchen staff, inadequate training and screening of employees, and failure to have an RN on each shift.
• Resident rights violations  – These are often violations of the right to a safe, clean, and homelike environment, the right to be treated with dignity, and the right to self-determination. 

The Severity of Deficiencies

Nursing home deficiencies are categorized by severity (level of harm) and scope (how many residents are or could have been affected). The scope ranges from isolated to patterned and widespread. Together, scope and severity determine enforcement actions and penalties. 

The rating system ranges from A to L:

• No harm with potential for minimal harm (A, B, C) – Minor violations without significant harm or risk. Agencies may still require corrective measures.
• No harm with potential for more than minimal harm (D, E, F) – More serious violations with the potential for actual harm. Facilities must take corrective action.
• Actual harm but not immediate jeopardy (G, H, I) – Deficiencies causing harm but not posing an immediate danger. The facility may receive a fine or penalty.
• Immediate jeopardy to resident health (L, K, J) – The most severe, indicating that residents are at risk of serious harm or death. This level requires immediate corrective action and may result in severe penalties or facility closure. 

Most recent serious deficiencies include failing to protect residents from abuse, lack of quality assessment groups, significant medication errors, and failure to prevent accidents.

The Importance of Transparency and Public Access to Information

Deficiency data for nursing homes is available through online databases, such as Medicare’s Nursing Home Compare and state health department websites. On these websites, you can see inspection reports for each certified facility covering the last three years.

These databases empower families to choose which care facility to entrust with their loved one’s well-being. The CMS also has a 1-5 scoring system for nursing homes, letting you know how nursing homes compare to the average US facility.

State Analysis of Nursing Home Deficiencies

The average number of deficiencies in the US is 8.9 per certified nursing facility [1]. Most deficiencies are not caused by intentional caregiver errors or malicious intent. Instead, there are systemic issues such as staffing shortages and underfunding.

Overview of Deficiency Rates

When looking at the percentage of homes with at least one serious deficiency in the last three years, some states are doing worse than others [2]. Here are the numbers:

• Texas (49%)
• Rhode Island (46%)
• Minnesota (45%)
• Delaware (43%)
• New Mexico (41%)

According to CMS reports, the states that have paid the highest average fines in the same period are:

• Washington D.C. ($53,000)
• Vermont ($38,000)
• Illinois ($35,000)
• Delaware ($33,000)
• North Carolina ($31,000)

However, this rating doesn’t mean these states are the most hazardous for the elderly. Unfortunately, we cannot be sure as there are states with high percentages of nursing homes that are behind schedule on inspections. These are the five states with the highest share of nursing facilities that haven’t had a standard inspection in two or more years:

• Kentucky (75%)
• Alabama (67%)
• Maryland (67%)
• Idaho (53%)
• Tennessee (50%)

Most Common Health Deficiencies

The most common health deficiencies in the US are:

• F0884  – This deficiency reveals a failure to report COVID cases to the National Healthcare Safety Network in a timely and accurate manner, and it was the most cited deficiency in 2023.
• F0689 – The second most common deficiency is related to accident and prevention.
• F0880 – The third most common deficiency includes failing to implement an infection prevention and control plan.
• F0812 – Food must be procured from sources approved by federal, state, or local authorities and stored, prepared, and served according to standards. This deficiency means the facility failed to do one or more of these things properly.
• F0684 – This covers all quality of care deficiencies, such as failing to notify a physician of changes in condition or providing treatment according to the resident’s personal care plan. 

The Role of a Nursing Home Abuse Lawyer

A nursing home abuse and neglect lawyer can help families report abuse, file a complaint, or hold the nursing home accountable for its failure.

Holding Nursing Homes Accountable

Nursing home abuse lawyers have the expertise and experience to investigate potential abuse and neglect. Here is where a lawyer comes in:

• We can help you recognize abuse. If you’re unsure if you have a case, you can consult a lawyer for a free consultation.
• We can collect evidence, such as medical records and witness statements, to build a strong case. 
• We help families pursue legal action, potentially resulting in compensation, penalties, and even loss of certification for the negligent nursing facility.

Seeking Compensation for Damages

If a person you care about has suffered an injury or lost their life in a nursing facility, we can help you recover the following types of damages:

• Economic damages – This compensation can include medical expenses, therapy costs, funeral expenses, and property damage. 
• Non-economic damages – These are damages that are harder to quantify, such as pain and suffering.
• Punitive damages – These are rare but are awarded in some states for cases of gross negligence, where the behavior that led to the injury was particularly egregious or malicious.

The compensation amount depends on the severity of the case, with more extreme cases receiving higher amounts. In most cases, lawyers can negotiate a satisfactory amount with the nursing facility’s insurance company. However, when that doesn’t happen, we can take the nursing home to trial.

Advocating for Improved Care and Safety

Legal professionals play a vital role in pushing for systemic changes and improved standards of care within nursing homes to prevent future harm to residents. 

By representing clients in cases of abuse, neglect, or malpractice, lawyers hold facilities accountable for the harm they have caused. This claim not only brings justice to residents who have already been harmed but also helps protect other residents from suffering the same fate. 

In addition, lawsuits often result in financial penalties for the facility, forcing it to improve its practices and indirectly pushing other facilities to improve their standards of care. 

Finally, lawyers often work with legislators to strengthen laws protecting residents, advocating for stricter enforcement, better staffing, and increased transparency.

Reach Out to a Nursing Home Abuse Lawyer Today! 

If you’re concerned about deficiencies in a nursing home or suspect a loved one has suffered neglect or mistreatment, contact Nursing Home Law Center for a free consultation. Our experienced legal team is dedicated to protecting the rights of nursing home residents and holding negligent facilities accountable.

Together, we can ensure victims receive justice and compensation for the abuse and neglect they had to endure. 

Call us at (800) 926-7565 or fill out our contact form.

References: [1] State Health Facts, [2] ProPublica