Nursing homes cited for the same harm twice
14.6% of the 14,690 Medicare-certified nursing homes in the United States were cited for harming a resident, or putting one in immediate jeopardy, under the same federal requirement on two or more separate inspections. At for-profit homes the share was 16.0%; at non-profit homes, 9.9%.
CMS publishes every citation, each with the federal requirement it was written under. Its files do not flag whether a home was cited for the same requirement at harm level again, which can separate a single incident from a problem that recurred. This page counts it for every certified home, and splits it by who owns the homes and how many homes their chain runs. It is not evidence that ownership causes harm; the limits below say why.
of 14,690 certified homes were cited at harm level under the same requirement on two or more survey dates (2,147 homes)
of 10,877 for-profit homes, against 9.9% of 2,868 non-profit homes
of the 22,914 harm-level citations in the file are marked as found on a complaint investigation
homes were cited at harm level twice or more under F-0689: “Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.”
The same harm cited again, by who owns the home
Ownership type as CMS's provider file records it, grouped by its first part. “Harm on 2+ inspections” is any requirement; “same requirement twice” is one requirement at harm level on two or more survey dates.
| Ownership | Certified homes | Same requirement twice | Harm on 2+ inspections | Fined | Median nurse hours per resident day | Median nurse turnover |
|---|---|---|---|---|---|---|
| For profit | 10,877 | 16.0% | 29.2% | 47.0% | 3.58 | 46.3% |
| Non profit | 2,868 | 9.9% | 19.9% | 35.4% | 4.23 | 40.2% |
| Government | 945 | 13.0% | 27.3% | 40.4% | 4.00 | 42.1% |
Fined means at least one fine in CMS's penalties file, which covers 19 Aug 2023 to 29 Jul 2026. Staffing medians are over the homes that report them. No share is printed for a group of fewer than 10 homes.
Independent homes and chains
Whether CMS lists the home as part of a chain, and the number of homes CMS lists for that chain nationally.
| Chain | Certified homes | Same requirement twice | Harm on 2+ inspections | Fined | Median nurse hours per resident day | Median nurse turnover |
|---|---|---|---|---|---|---|
| Independent (no chain) | 4,574 | 12.5% | 23.1% | 39.9% | 4.04 | 42.4% |
| Chain of fewer than 10 homes | 1,953 | 17.8% | 29.1% | 45.9% | 3.76 | 44.8% |
| Chain of 10–49 homes | 4,937 | 15.4% | 29.4% | 46.0% | 3.60 | 46.7% |
| Chain of 50 or more homes | 3,226 | 14.4% | 28.9% | 47.2% | 3.49 | 45.2% |
The requirements most often cited at harm level twice
Homes cited at G or worse under the requirement on two or more separate survey dates. The wording is CMS's own, from its citation code list.
| Requirement | What it requires (CMS wording) | Homes |
|---|---|---|
| F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | 1,444 |
| F-0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | 517 |
| F-0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | 280 |
| F-0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | 261 |
| F-0760 | Ensure that residents are free from significant medication errors. | 50 |
| F-0692 | Provide enough food/fluids to maintain a resident's health. | 47 |
| F-0697 | Provide safe, appropriate pain management for a resident who requires such services. | 45 |
| F-0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | 44 |
| F-0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | 22 |
| F-0835 | Administer the facility in a manner that enables it to use its resources effectively and efficiently. | 18 |
How this was computed
- Every row of CMS's nursing home provider, health deficiency and penalty files is loaded and reconciled against the publisher's own row count.
- A citation is “harm level” when its scope and severity letter is G, H, I, J, K or L, as defined in the CMS State Operations Manual, Appendix PP.
- A home counts as “same requirement twice” when harm-level citations under one deficiency prefix and tag fall on two or more different survey dates. Two citations on one date are one inspection.
- Ownership is the first part of CMS's ownership type (For profit, Non profit, Government). Chain membership and chain size are CMS's own fields in the provider file.
- Shares are counts of homes over counts of homes. Nothing is weighted, modelled or adjusted.
The query the tables are built from:
WITH harm AS (
SELECT ccn, deficiency_prefix, deficiency_tag, survey_date
FROM care.nh_health_citations WHERE scope_severity = ANY(%(harm)s)
), repeat_any AS (
SELECT ccn FROM harm GROUP BY ccn HAVING count(DISTINCT survey_date) >= 2
), repeat_same AS (
SELECT DISTINCT ccn FROM harm GROUP BY ccn, deficiency_prefix, deficiency_tag HAVING count(DISTINCT survey_date) >= 2
), f AS (
SELECT ccn, state, fines_count, fines_total_usd, total_nurse_hprd, nurse_turnover_pct, special_focus_status, ownership_changed_12_months,
abuse_icon,
coalesce(split_part(ownership_type, ' - ', 1), 'not published') AS ownership,
CASE WHEN chain_id IS NULL THEN 0 WHEN chain_facility_count IS NULL THEN 9
WHEN chain_facility_count < 10 THEN 1 WHEN chain_facility_count < 50 THEN 2 ELSE 3 END AS chain_band
FROM care.nh_facilities
)
SELECT GROUPING(f.state), GROUPING(f.ownership), GROUPING(f.chain_band), f.state, f.ownership, f.chain_band,
count(*), count(rs.ccn), count(ra.ccn), count(*) FILTER (WHERE f.fines_count > 0),
percentile_cont(0.5) WITHIN GROUP (ORDER BY f.total_nurse_hprd), count(f.total_nurse_hprd),
percentile_cont(0.5) WITHIN GROUP (ORDER BY f.nurse_turnover_pct), count(f.nurse_turnover_pct),
count(*) FILTER (WHERE f.special_focus_status = 'SFF'), count(*) FILTER (WHERE f.special_focus_status = 'SFF Candidate'),
count(*) FILTER (WHERE f.ownership_changed_12_months), count(*) FILTER (WHERE f.abuse_icon),
percentile_cont(0.5) WITHIN GROUP (ORDER BY f.fines_total_usd) FILTER (WHERE f.fines_count > 0)
FROM f LEFT JOIN repeat_same rs ON rs.ccn = f.ccn LEFT JOIN repeat_any ra ON ra.ccn = f.ccn
GROUP BY GROUPING SETS ((), (f.ownership), (f.chain_band), (f.state), (f.state, f.ownership))Citation
CivicDelta, “US nursing homes cited twice for the same harm, by ownership and chain size”, computed from the CMS Care Compare nursing home files captured on the dates listed, surveys 23 Mar 2017 to 23 Jul 2026.
Retrieved from civicdelta.com/research/nursing-home-repeat-harm/. Figures are recomputed whenever the CMS files are reloaded.
Dataset: US nursing homes cited twice for the same harm, by ownership and chain size · spatial coverage United States · last rebuilt 2026-09-28.
The one-sentence finding: 14.6% of the 14,690 Medicare-certified nursing homes in the United States were cited for harming a resident, or putting one in immediate jeopardy, under the same federal requirement on two or more separate inspections. At for-profit homes the share was 16.0%; at non-profit homes, 9.9%.
The table behind this page is free to download: nursing-homes-same-harm-by-ownership-and-chain.csv.
Sources and capture dates| Dataset | Dataset ID | Captured |
|---|---|---|
| CMS Care Compare - Nursing Home Citation Code Look-up | NH_CitationDescriptions_Aug2026.csv | 2026-09-14 |
| CMS Care Compare - Nursing Home Health Deficiencies | NH_HealthCitations_Aug2026.csv | 2026-09-14 |
| CMS Care Compare - Nursing Home Penalties | NH_Penalties_Aug2026.csv | 2026-09-14 |
| CMS Care Compare - Nursing Home Provider Information | NH_ProviderInfo_Aug2026.csv | 2026-09-14 |
CMS Care Compare provider data. Nothing on this page is sampled.
What this does not tell you
- It is not causal. For-profit, non-profit and government homes differ in size, location, the residents they admit, how they are paid and which state inspects them. Any of those could produce the gap without ownership doing anything.
- It measures inspectors as much as homes. State survey agencies do not cite alike, and the mix of ownership types differs from state to state. Compare a home only with homes in its own state; the state pages do that.
- The same requirement is not the same incident. A requirement such as accident prevention covers many different events. Two citations under one tag mean the home failed that requirement at harm level twice, not that one event happened twice.
- It is a window. Only surveys from 23 Mar 2017 to 23 Jul 2026 are in the citation file, and a home that changed owners inside that window carries its whole record under its current ownership type.
- A citation is not a court finding. Homes dispute citations; the file records that a dispute is under way, not how it ended.
- It does not rank homes or chains. No home, owner or chain is named or scored here, and a chain's size says nothing about any one of its homes.
For a home you are actually considering, the Nursing Home Record shows its own repeat citations and fines against its state, and the free owner lookup shows the other homes its owners run.
Questions people ask
How common is it for a nursing home to be cited for the same harm twice?
Across all 14,690 Medicare-certified homes, 14.6% were cited at harm level (scope and severity G or worse) under the same federal requirement on two or more separate inspections, between 23 Mar 2017 and 23 Jul 2026.
Are for-profit nursing homes cited for repeat harm more often?
In CMS's files, yes: 16.0% of for-profit homes had the same requirement cited at harm level twice, against 9.9% of non-profit homes. That is a difference between groups of homes that differ in many ways, not proof that ownership causes it.
Which problem is most often cited again at harm level?
F-0689, which CMS describes as: “Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.” It was cited at harm level on two or more survey dates at 1,444 homes.
Do most serious citations come from complaints?
Of the 22,914 harm-level citations in the file, 72.5% were written on a complaint investigation, alone or alongside a scheduled inspection. A complaint investigation happens because someone reported a problem.
Can I download the numbers?
Yes. The table behind this page is at nursing-homes-same-harm-by-ownership-and-chain.csv, with its sources and SQL in a companion file, free to reuse with attribution.