Nursing Home Abuse Statistics From Federal Inspections

When a nursing home breaks a federal rule, the inspector leaves behind a written finding called a citation. Each one also carries a severity level, showing how serious the problem was, ranging from no harm to residents facing immediate danger.

Three federal rules are most directly tied to abuse: protecting residents from abuse, reporting it on time, and responding to each report. These numbers cover about the last three inspection cycles, complaint visits included, and they come from the CMS citation records.

For context, the records include 418,947 health citations of all kinds. Among them, 22,564 involved residents who were harmed or in immediate danger; 9,248 of those reached the most serious level, immediate danger.

The federal nursing home rules give residents the right to live free of abuse, neglect, exploitation, and misuse of their property. The banned forms include verbal, mental, sexual, and physical abuse, along with physical punishment and isolating a resident against their will. The rule in this form dates to October 4, 2016.

CMS, the federal agency in charge of nursing homes, treats neglect and exploitation as forms of abuse too, as explained in a 2019 CMS memo.

The rules also set limits on hiring. No home may hire someone a court has found guilty of abusing, neglecting, exploiting, or mistreating a resident, or of taking a resident's belongings. It also may not hire anyone who has such a finding on their state's nurse aide registry.

The federal abuse rule names sexual abuse directly, listing it among the kinds of abuse that every resident must be kept free from. Within the federal inspection data, it is grouped with physical and mental abuse under one rule, so it is not tallied separately.

Sexual abuse is covered by the same federal rule, but these figures do not show how many citations involved sexual abuse. To learn what happened at a particular home, open its inspection report, which describes what the inspector found.

These federal figures do not break out memory care units on their own. The same abuse rules cover every nursing home resident, people living with dementia included.

Two parts of this rule matter most for residents who are unable to speak up for themselves. They have the right to live free of physical restraints, and free of drugs used as restraints, unless these are required to treat a medical symptom. A home must never use restraints to punish a resident or to make the staff's work easier.

A separate federal rule also restricts the use of mood- and behavior-altering drugs. That rule drew 4,901 citations across 4,104 homes, based on the CMS citation records.

The federal rule lays out strict time frames for telling officials such as the state survey agency and, where state law permits, adult protective services.

Suspected crimes have to go to law enforcement as well. During an investigation, the home has to keep residents safe from any further possible abuse. Its policies must also make clear that no one will be punished for speaking up.

CMS places an abuse icon, a warning symbol, on a home's federal profile after inspectors cite the home for abuse. CMS began using it in October 2019, and 1,429 homes carry it today, based on the CMS provider file.

As set out in the CMS memo, there are two ways a home can receive the icon:

• The home was cited for abuse that caused harm, on its most recent standard survey or on a complaint visit within the past 12 months.
• The home was cited for abuse that could have caused harm, and it had also been cited on the prior inspection, or on a complaint visit 12 to 24 months earlier.

Homes in Oregon carry a disclaimer. Oregon's state agency referred potential abuse cases to Adult Protective Services rather than handling the investigations itself under CMS rules, which means certain abuse findings might not show up on the federal site. The disclaimer directs readers to Oregon's Adult Protective Services website to check for abuse findings.

Special Focus Facilities are homes placed in the CMS program for the worst-performing homes in the country. Right now 87 homes are in the program, and another 440 are listed as possible picks.

A 2025 report by the federal Inspector General looked at the years 2013 through 2022 and found that close to two-thirds of these homes got better enough to graduate from the program. Soon afterward, the same kinds of quality problems showed up again. The report found the program depends too heavily on fines that do not make homes change how they operate. Homes that kept up their gains were better staffed.

The report also noted that a small number of owners control many low-quality homes, but CMS does not take ownership into account in the program. CMS agreed with just one of the three recommendations. The recommendations on ownership, and on consequences besides fines, were closed without ever being put into practice.

Fines appear across the wider records as well. Altogether, 6,510 homes carry at least one fine on record, and those fines total $454,984,026, based on the CMS penalty records.

In an emergency, call 911. If it isn't life-threatening, you can report it to Adult Protective Services in your state, call the Eldercare Locator, or call the National Elder Fraud Hotline. You can look up any home's inspection record by name, city or ZIP with our search, or compare two or three homes side by side.