{
  "dataset_name": "US nursing homes cited twice for the same harm, by ownership and chain size",
  "description": "US Medicare-certified nursing homes cited at harm level under the same federal requirement on two or more inspections, with harm on two or more inspections, fines and staffing medians, nationally and by ownership type and chain size.",
  "file": "/data/downloads/nursing-homes-same-harm-by-ownership-and-chain.csv",
  "rows": 56,
  "columns": [
    {
      "name": "group_level",
      "description": "One of national, ownership, chain or requirement."
    },
    {
      "name": "group",
      "description": "The ownership type as CMS records its first part, the chain band from CMS's chain fields, or the federal requirement code (prefix and tag) on a requirement row."
    },
    {
      "name": "certified_homes",
      "description": "Medicare-certified homes in the group."
    },
    {
      "name": "same_requirement_repeat_homes",
      "description": "Homes cited at scope/severity G or worse under one deficiency prefix and tag on two or more separate survey dates."
    },
    {
      "name": "same_requirement_repeat_pct",
      "description": "same_requirement_repeat_homes ÷ certified_homes. EMPTY for a group of fewer than 10 homes."
    },
    {
      "name": "repeat_harm_homes",
      "description": "Homes cited at G or worse on two or more separate survey dates, any requirement."
    },
    {
      "name": "repeat_harm_pct",
      "description": "repeat_harm_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "fined_homes",
      "description": "Homes with at least one fine in CMS's provider file."
    },
    {
      "name": "fined_pct",
      "description": "fined_homes ÷ certified_homes. EMPTY below 10 homes."
    },
    {
      "name": "median_total_nurse_hprd",
      "description": "Median total nurse hours per resident day over homes that report it. EMPTY where none report it or below the floor."
    },
    {
      "name": "nurse_hprd_reporting_homes",
      "description": "How many homes that median is built on."
    },
    {
      "name": "median_nurse_turnover_pct",
      "description": "Median nurse turnover over homes that report it. EMPTY where none report it or below the floor."
    },
    {
      "name": "nurse_turnover_reporting_homes",
      "description": "How many homes that median is built on."
    },
    {
      "name": "harm_citations",
      "description": "Harm-level (G or worse) citations in the file. NATIONAL ROW ONLY: citations are not split by ownership, chain band or requirement here."
    },
    {
      "name": "harm_citations_from_complaints",
      "description": "Of those, citations written on a complaint investigation. National row only."
    },
    {
      "name": "harm_complaint_pct",
      "description": "harm_citations_from_complaints ÷ harm_citations. National row only."
    }
  ],
  "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": "14,690 certified homes; 56 rows (national, ownership types, chain bands)",
    "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-repeat-harm/",
  "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"
  },
  "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, in exactly one ownership row and one chain row.",
    "A requirement row for each federal requirement the study names, counting homes cited at harm level under it twice or more."
  ],
  "does_not_contain": [
    "Any individual home, owner or chain name.",
    "Evidence that ownership causes harm. The groups differ in size, location, residents, payment and which state inspects them.",
    "The outcome of a disputed citation."
  ]
}