{
  "dataset_name": "US nursing home inspection figures by state",
  "description": "Per state or territory: certified nursing homes, harm on two or more inspections, the same requirement at harm level twice, fines, staffing medians, the complaint share of harm-level citations, Special Focus Facilities and recent ownership changes.",
  "file": "/data/downloads/nursing-home-state-profiles.csv",
  "rows": 54,
  "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 G or worse on two or more survey dates."
    },
    {
      "name": "repeat_harm_pct",
      "description": "repeat_harm_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "same_requirement_repeat_homes",
      "description": "Homes cited at G or worse under one requirement on two or more survey dates."
    },
    {
      "name": "same_requirement_repeat_pct",
      "description": "same_requirement_repeat_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "fined_homes",
      "description": "Homes with at least one fine."
    },
    {
      "name": "fined_pct",
      "description": "fined_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "median_fine_usd",
      "description": "Median total fine over fined homes, US dollars. EMPTY below 10 homes or where none is fined."
    },
    {
      "name": "median_total_nurse_hprd",
      "description": "Median total nurse hours per resident day over reporting homes. EMPTY below 10 homes."
    },
    {
      "name": "median_nurse_turnover_pct",
      "description": "Median nurse turnover over reporting homes. EMPTY below 10 homes."
    },
    {
      "name": "harm_citations",
      "description": "Harm-level (G or worse) citations at the state's homes."
    },
    {
      "name": "harm_citations_from_complaints",
      "description": "Of those, citations written on a complaint investigation."
    },
    {
      "name": "harm_complaint_pct",
      "description": "harm_citations_from_complaints ÷ harm_citations. EMPTY below 10 homes or 10 citations."
    },
    {
      "name": "special_focus_facilities",
      "description": "Homes CMS lists as a Special Focus Facility."
    },
    {
      "name": "special_focus_candidates",
      "description": "Homes CMS lists as a Special Focus Facility candidate."
    },
    {
      "name": "abuse_icon_homes",
      "description": "Homes carrying CMS's abuse icon."
    },
    {
      "name": "ownership_changed_12_months",
      "description": "Homes CMS flags as having changed ownership in the last 12 months."
    },
    {
      "name": "chain_homes",
      "description": "Homes in this state that CMS lists as part of a chain, counted in this state. EMPTY on the United States row: chains are counted within a state, so these do not add up to a national figure."
    },
    {
      "name": "repeat_harm_rank",
      "description": "Where the state ranks by repeat_harm_pct, 1 = highest, among the states and territories with at least 10 certified homes. EMPTY below that floor and on the United States row."
    },
    {
      "name": "state_page",
      "description": "The page these figures are on. EMPTY where no page is published because the state has too few homes."
    }
  ],
  "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": "54 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": {
    "profiles": "\nWITH harm AS (\n  SELECT ccn, deficiency_prefix, deficiency_tag, survey_date\n  FROM care.nh_health_citations WHERE scope_severity = ANY(%(harm)s)\n), repeat_any AS (\n  SELECT ccn FROM harm GROUP BY ccn HAVING count(DISTINCT survey_date) >= 2\n), repeat_same AS (\n  SELECT DISTINCT ccn FROM harm GROUP BY ccn, deficiency_prefix, deficiency_tag HAVING count(DISTINCT survey_date) >= 2\n), f AS (\n  SELECT ccn, state, fines_count, fines_total_usd, total_nurse_hprd, nurse_turnover_pct, special_focus_status, ownership_changed_12_months,\n         abuse_icon,\n         coalesce(split_part(ownership_type, ' - ', 1), 'not published') AS ownership,\n         CASE WHEN chain_id IS NULL THEN 0 WHEN chain_facility_count IS NULL THEN 9\n              WHEN chain_facility_count < 10 THEN 1 WHEN chain_facility_count < 50 THEN 2 ELSE 3 END AS chain_band\n  FROM care.nh_facilities\n)\nSELECT GROUPING(f.state), GROUPING(f.ownership), GROUPING(f.chain_band), f.state, f.ownership, f.chain_band,\n       count(*), count(rs.ccn), count(ra.ccn), count(*) FILTER (WHERE f.fines_count > 0),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.total_nurse_hprd), count(f.total_nurse_hprd),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.nurse_turnover_pct), count(f.nurse_turnover_pct),\n       count(*) FILTER (WHERE f.special_focus_status = 'SFF'), count(*) FILTER (WHERE f.special_focus_status = 'SFF Candidate'),\n       count(*) FILTER (WHERE f.ownership_changed_12_months), count(*) FILTER (WHERE f.abuse_icon),\n       percentile_cont(0.5) WITHIN GROUP (ORDER BY f.fines_total_usd) FILTER (WHERE f.fines_count > 0)\nFROM f LEFT JOIN repeat_same rs ON rs.ccn = f.ccn LEFT JOIN repeat_any ra ON ra.ccn = f.ccn\nGROUP BY GROUPING SETS ((), (f.ownership), (f.chain_band), (f.state), (f.state, f.ownership))\n",
    "complaints": "\nSELECT GROUPING(f.state), f.state, count(*), count(*) FILTER (WHERE h.is_complaint)\nFROM care.nh_health_citations h JOIN care.nh_facilities f ON f.ccn = h.ccn\nWHERE h.scope_severity = ANY(%(harm)s)\nGROUP BY GROUPING SETS ((), (f.state))\n"
  },
  "sources": [
    {
      "source_key": "cms_nh_citation_codes",
      "dataset_title": "CMS Care Compare - Nursing Home Citation Code Look-up",
      "publisher": "Centers for Medicare & Medicaid Services (CMS) Provider Data Catalog",
      "dataset_id": "NH_CitationDescriptions_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 Citation Code Look-up” (dataset NH_CitationDescriptions_Aug2026.csv), loaded 2026-09-14"
    },
    {
      "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 Citation Code Look-up” (dataset NH_CitationDescriptions_Aug2026.csv), loaded 2026-09-14; 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 CMS's provider file, aggregated to its state."
  ],
  "does_not_contain": [
    "Any individual home or chain.",
    "A comparison between states: inspectors differ from state to state."
  ]
}