{
  "dataset_name": "US nursing home repeat-harm, penalty and staffing shares by state",
  "description": "Every US state and territory: Medicare-certified nursing homes, the share cited for actual harm on one and on two or more separate inspections, the share fined, the median fine, and median nurse turnover and nurse hours per resident day.",
  "file": "/data/downloads/nursing-home-inspection-records-by-state.csv",
  "rows": 53,
  "columns": [
    {
      "name": "state",
      "description": "State or territory name."
    },
    {
      "name": "state_code",
      "description": "Two-letter postal code, as CMS writes it."
    },
    {
      "name": "certified_homes",
      "description": "Medicare-certified nursing homes in the provider file."
    },
    {
      "name": "repeat_harm_homes",
      "description": "Homes cited at scope/severity G or worse on two or more separate survey dates."
    },
    {
      "name": "repeat_harm_pct",
      "description": "repeat_harm_homes ÷ certified_homes. EMPTY for a state with fewer than 10 certified homes — the page prints no share there either."
    },
    {
      "name": "any_harm_homes",
      "description": "Homes cited at G or worse on at least one survey date."
    },
    {
      "name": "any_harm_pct",
      "description": "any_harm_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "fined_homes",
      "description": "Homes with at least one penalty in the penalties file."
    },
    {
      "name": "fined_pct",
      "description": "fined_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "median_fine_usd",
      "description": "Median total fine across FINED homes only, US dollars, no separators. Empty when no home in the state is fined."
    },
    {
      "name": "median_nurse_turnover_pct",
      "description": "Median of CMS's reported nurse turnover, over homes in the state that report it. EMPTY where none reports it — a home that reports nothing is left out of the median, never counted as zero."
    },
    {
      "name": "nurse_turnover_reporting_homes",
      "description": "How many homes that median is built on."
    },
    {
      "name": "median_total_nurse_hprd",
      "description": "Median total nurse hours per resident day, CMS's payroll-based figure. Empty where not published."
    },
    {
      "name": "abuse_icon_homes",
      "description": "Homes carrying CMS's own abuse icon. A count, not a share."
    },
    {
      "name": "above_sample_floor",
      "description": "yes when the state has at least 10 certified homes, in which case the shares and medians are printed; no when it has fewer, in which case every share and median column is empty and only the counts are published."
    }
  ],
  "missing_values": "An empty cell means the value is not published by the source, or that our sample floor suppresses it. It is never written as 0 — a zero in this file is a measured zero.",
  "coverage": {
    "records": "53 states and territories, 14,690 certified homes",
    "temporal": "2017-03-23/2026-07-23",
    "spatial": "United States"
  },
  "generated_on": "2026-09-28",
  "generated_by": "civicdelta.dataset_exports.write_exports",
  "mirrors_page": "/research/nursing-home-inspections-by-state/",
  "sql": {
    "states": "\nWITH h AS (\n  SELECT ccn, count(DISTINCT survey_date) AS surveys\n  FROM care.nh_health_citations WHERE scope_severity IN ('G','H','I','J','K','L') GROUP BY 1\n)\nSELECT f.state, count(*),\n       count(*) FILTER (WHERE h.surveys >= 1),\n       count(*) FILTER (WHERE h.surveys >= 2),\n       count(*) FILTER (WHERE f.fines_count > 0),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.fines_total_usd) FILTER (WHERE f.fines_count > 0),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.nurse_turnover_pct),\n       count(*) FILTER (WHERE f.nurse_turnover_pct IS NOT NULL),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.total_nurse_hprd),\n       count(*) FILTER (WHERE f.abuse_icon)\nFROM care.nh_facilities f LEFT JOIN h ON h.ccn = f.ccn\nGROUP BY 1 ORDER BY 1\n",
    "survey_window": "SELECT min(survey_date), max(survey_date) FROM care.nh_health_citations"
  },
  "sources": [
    {
      "source_key": "cms_nh_health_citations",
      "dataset_title": "CMS Care Compare - Nursing Home Health Deficiencies",
      "publisher": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog",
      "dataset_id": "NH_HealthCitations_Aug2026.csv",
      "dataset_page": "https://data.cms.gov/provider-data/topics/nursing-homes",
      "loaded_on": "2026-09-14",
      "terms_url": "https://data.cms.gov/provider-data/about",
      "terms_summary": "CMS Provider Data Catalog; US federal government data. Verify reuse terms before paid use.",
      "terms_verified_by_a_human_on": null,
      "attribution": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Health Deficiencies” (dataset NH_HealthCitations_Aug2026.csv), loaded 2026-09-14"
    },
    {
      "source_key": "cms_nh_penalties",
      "dataset_title": "CMS Care Compare - Nursing Home Penalties",
      "publisher": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog",
      "dataset_id": "NH_Penalties_Aug2026.csv",
      "dataset_page": "https://data.cms.gov/provider-data/topics/nursing-homes",
      "loaded_on": "2026-09-14",
      "terms_url": "https://data.cms.gov/provider-data/about",
      "terms_summary": "CMS Provider Data Catalog; US federal government data. Verify reuse terms before paid use.",
      "terms_verified_by_a_human_on": null,
      "attribution": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Penalties” (dataset NH_Penalties_Aug2026.csv), loaded 2026-09-14"
    },
    {
      "source_key": "cms_nh_provider_info",
      "dataset_title": "CMS Care Compare - Nursing Home Provider Information",
      "publisher": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog",
      "dataset_id": "NH_ProviderInfo_Aug2026.csv",
      "dataset_page": "https://data.cms.gov/provider-data/topics/nursing-homes",
      "loaded_on": "2026-09-14",
      "terms_url": "https://data.cms.gov/provider-data/about",
      "terms_summary": "CMS Provider Data Catalog; US federal government data. Verify reuse terms before paid use.",
      "terms_verified_by_a_human_on": null,
      "attribution": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Provider Information” (dataset NH_ProviderInfo_Aug2026.csv), loaded 2026-09-14"
    }
  ],
  "attribution": "Source: Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Health Deficiencies” (dataset NH_HealthCitations_Aug2026.csv), loaded 2026-09-14; Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Penalties” (dataset NH_Penalties_Aug2026.csv), loaded 2026-09-14; Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog, “CMS Care Compare - Nursing Home Provider Information” (dataset NH_ProviderInfo_Aug2026.csv), loaded 2026-09-14. Computed by CivicDelta.",
  "license_note": "Terms are the publisher's, at the terms_url above. Where terms_verified_by_a_human_on is null we have not yet had a person confirm them, and we do not assert a license on the publisher's behalf. CivicDelta's own computation over these files is free to reuse with the attribution line above.",
  "contains": [
    "Every Medicare-certified nursing home in the CMS provider file, aggregated to its state.",
    "Citations between the first and last survey dates in the loaded citation file — see coverage.temporal."
  ],
  "does_not_contain": [
    "Any individual home. This is a state aggregate; nothing here identifies a provider.",
    "A safety ranking. Surveys are run by state agencies that do not cite alike, so a high share can mean hard inspectors as easily as worse homes. Never compare a home in one state with a home in another using these figures.",
    "The outcome of a disputed citation. The files record that a dispute exists, not how it ended.",
    "CMS star ratings. These are the citations, not the stars."
  ]
}