DEPARTMENT OF HEALTH &. HUMAN SERVICES

SEP 18 2008

Office of Inspector General

Washington, D.C. 20201

TO:

FROM:

SUBJECT:

Kerry Weems

Acting Administrator

Centers for Medicare & Medicaid Services

Daniel R. Levinson

Inspector General

Memorandum Report: "Trends in Nursing Home Deficiencies and

Complaints," OEI-02-08-00140

This memorandum report describes the nature and extent of nursing home deficiencies

and complaints in 2007 and identifies trends from 2005 to 2007. This study is part ofthe

Office ofInspector General's (GIG) continuing commitment to addressing the quality of

care in nursing homes. It builds on OIG's prior work by analyzing the most recent data

available on nursing home deficiencies and complaints.

In each ofthe past 3 years, over 91 percent of nursing homes surveyed were cited for

deficiencies and a greater percentage of for-profit nursing homes were cited for

deficiencies than not-for-profit and government nursing homes. During those same

years, the most common deficiency categories cited were quality of care, resident

assessment, and quality of life. Additionally, 17 percent ofnursing homes surveyed in

2007 were cited for actual harm or immediate jeopardy deficiencies, and 3.6 percent were

cited for substandard quality-of-care deficiencies-a slight increase since 2005. Lastly,

the number ofsubstantiated complaints decreased nearly 3 percent since 2005.

BACKGROUND

Survey and Certification Process

All nursing homes that participate in Medicare and/or Medicaid must be certified as

meeting certain Federal requirements.! The Centers for Medicare & Medicaid Services

(CMS) contracts with States to perform nursing home surveys before nursing homes may

be certified. States must conduct these standard surveys at least every 15 months, and the

Statewide average interval between surveys must be 12 months or less. 2 Surveys are

I Title XVIII (Parts A and B) and XIX of the Social Security Act.

1 42 CFR §§ 488.308(a) and (b).

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unannounced and may be conducted at any hour on any day.3 Surveys assess medical, 

nursing, and rehabilitative care; dietary and nutrition services; activities and social 

participation; and sanitation, infection control, and the physical environment.4 

Surveyors collect data from different sources. They conduct a medical record review 

based on a case-mix stratified sample of nursing facility residents.5 They also review 

plans of care to determine their adequacy, audit residents’ assessments, and review 

compliance with legal requirements concerning residents’ rights.6 In addition, surveyors 

observe facility operations and interview residents, family members, and staff to 

determine whether facilities are providing appropriate care.7 

CMS provides guidance on long term care facility survey procedures and protocols 

through its “State Operations Manual.” The Manual describes the intent of the 

regulations pertaining to nursing homes as well as the process for determining whether 

deficiencies have occurred and how to categorize them. Updates to the Manual are 

issued periodically. 

Deficiencies. When a nursing home fails to meet one or more of the Federal 

requirements, surveyors cite a deficiency. There are 190 possible deficiencies, which fall 

into the categories listed in the box below. 

Deficiency Categories 

Resident rights Physician services 

Admission, transfer, and discharge rights Rehabilitative services 

Resident behavior and facility practices Dental services 

Quality of life Pharmacy services 

Resident assessment Infection control 

Quality of care Physical environment 

Nursing services Administration 

Dietary services Laboratory and radiology services 

Sources: 42 CFR § 483, subpart B; CMS “State Operations Manual,” Appendix PP. 

Surveyors also decide the scope and severity of the deficiency based on a matrix that uses 

the letters “A” through “L.” See Figure 1 on the next page. The scope of the deficiency 

measures the number of residents potentially or actually affected by the deficiency. The 

scope rating has three different levels: isolated, pattern, and widespread. Isolated 

deficiencies occur when one or a very limited number of residents or staff are affected or 

the situation exists only occasionally. Pattern deficiencies occur when more than a very 

limited number of residents or staff are affected or the situation occurs repeatedly. 

Finally, widespread deficiencies occur when the situation is pervasive throughout the 

facility or potentially affects a large portion of the nursing home’s residents.8 

3 42 CFR § 488.307(a); CMS, “State Operations Manual,” Pub. No. 100-07, ch. 7, § 7207B2, p. 34. 

4

 42 CFR § 488.305(a)(2).
 5

 42 CFR § 488.305(a)(1).
 6

 42 CFR §§ 488.305(a)(3) and (4). 

7

 42 CFR § 488.110(f). 

8

 CMS, “State Operations Manual,” Pub. No. 100-07, App. P, pp. 93–94. 

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The severity rating measures the extent of the health and safety risk to residents. The 

most serious level, immediate jeopardy, occurs in “a situation in which the provider’s 

noncompliance with one or more of the requirements of participation has caused, or is 

likely to cause, serious injury, harm, impairment or death to a resident.”9 Immediate 

jeopardy requires the nursing home to take immediate corrective action. The three levels 

of deficiencies that are not immediate jeopardy are: (1) actual harm that is not immediate 

jeopardy; (2) no actual harm with a potential for more than minimal harm, but not 

immediate jeopardy; and (3) no actual harm with a potential for minimal harm.10 

Figure 1: Scope and Severity Matrix for Nursing Home Deficiencies Severity of the Deficiency 

Scope of the Deficiency 

Isolated Pattern Widespread 

Immediate jeopardy to 

resident health or safety J K L 

Actual harm that is not 

immediate jeopardy G H I 

No actual harm with a 

potential for more than 

minimal harm, but not 

immediate jeopardy 

D E F 

No actual harm with 

potential for minimal harm A B C 

Note: Shading indicates substandard quality of care for the categories of quality of care, 

quality of life, and resident behavior and facility practices. 

The scope and severity of the deficiency are primary factors in determining the 

appropriate corrective action to be taken.11 Corrective actions include termination of 

participation in Medicare and Medicaid, civil money penalties, State monitoring, transfer 

of residents, and closure of the facility, among other remedies.12 

Substandard Quality of Care. Substandard quality of care exists when a facility has one 

or more deficiencies at the more serious scope and severity levels within certain 

categories. The scope and severity levels of substandard quality of care are shown in the 

shaded area of Figure 1 above. The categories related to substandard quality of care are 

quality of care, quality of life, and resident behavior and facility practices. A brief 

description of these categories is provided in the box on the next page. 

9

 42 CFR § 488.301.

10 42 CFR § 488.404(b)(1). 

11 42 CFR § 488.404(b). 

12 42 CFR § 488.406(a). 

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If a nursing home is found to have 

The Three Deficiency Categories Related provided substandard quality of care,

to Substandard Quality of Care surveyors must conduct an extended 

Quality of Care: Includes, among other issues, survey within 14 days. An extended

appropriate treatment to prevent and treat pressure sores survey includes a review of the policies and urinary tract infections and resident freedom from 

unnecessary drugs and significant medication errors. and procedures related to such substandard 

quality of care as well as an examination Quality of Life: Includes, among other issues, care that 

maintains or enhances dignity; the provision of social of staffing, training, and a larger sample of 

services to attain the highest practicable well-being of each residents’ assessments.13 Substandard resident; and a safe, clean, comfortable, and homelike 

environment. quality of care requires specific corrective 

actions such as a directed plan of Resident Behavior and Facility Practices: Includes, 

among other issues, freedom from physical or chemical correction, temporary management 

restraints for purposes of discipline and convenience and change, or termination of the provider freedom from abuse, corporal punishment, and involuntary 

seclusion. agreement. 

Complaints. Surveyors also investigate complaints. Complaints may be made by 

nursing home residents, family members, and facility employees, among others, and may 

be either verbal or written.14 State survey agencies must review all allegations. 

Depending on the outcome of the review, the survey agency may conduct a standard or 

abbreviated standard survey to investigate the allegation.15 These allegations are either 

substantiated or unsubstantiated during the survey. A substantiated allegation results in 

the citation of a deficiency.16 Surveyors may also cite additional deficiencies during this 

process. Complaints are grouped into the categories listed in the box below.17

Complaint Categories 

Resident abuse Proficiency testing 

Resident neglect Falsification of records/reports 

Resident rights Unqualified personnel 

Patient dumping Quality control 

Environment Specimen handling 

Care or services Diagnostic discrepancy/erroneous test results 

Dietary Fraud/false billing 

Misuse of funds/property Fatality/transfusion fatality 

Certification/unauthorized testing Other 

 Source: CMS Form 562. 

13 42 CFR § 488.310.
 14 CMS, “State Operations Manual,” Pub. No. 100-07, ch. 5, § 5010, pp. 7–8. 15 42 CFR § 488.308(e)(2).
 16 CMS Form 562. 

17 These categories are also used for hospitals. Some categories, such as patient dumping, are not relevant
 

to nursing homes. 

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Related Work 

In 2003, OIG published a report entitled “Nursing Home Deficiency Trends and Survey 

and Certification Process Consistency.” This report found that the percentage of nursing 

homes with deficiencies, the total number of deficiencies, and the average number of 

deficiencies per nursing home increased between 1998 and 2001. In addition, there was 

wide variation among States in the percentage of nursing homes with deficiencies and the 

average number of deficiencies per home. OIG found that this variability was due at least 

in part to differences in the survey process among States. Factors contributing to these 

differences included inconsistent survey focus, unclear Federal guidelines on citing 

deficiencies, and the lack of a common review process for draft survey reports. 

METHODOLOGY 

The information provided in this memorandum report is based on an analysis of data 

from CMS’s Online Survey and Certification Reporting System (OSCAR). OSCAR 

includes the results of all State nursing home surveys. It contains the most current survey 

and the three previous surveys for every nursing home that is certified for Medicare 

and/or Medicaid. 

To carry out our analysis, we identified all surveys conducted in 2005, 2006, and 2007 

that were included in OSCAR. If a nursing home had more than one survey in a 

particular year, we included only the most recent survey for that year. We also used 

OSCAR to identify for-profit, not-for-profit, and government nursing homes as well as 

nursing homes that were part of an organization that owned two or more facilities 

(hereafter referred to as “multifacility”) and those that were not (hereafter referred to as 

“single-facility”). 

We analyzed OSCAR data to determine the nature and extent of nursing home 

deficiencies and to identify trends. For each year, we determined the number of nursing 

homes surveyed, the percentage with at least one deficiency, and the average number of 

deficiencies per nursing home. In addition, we examined the scope and severity of 

deficiencies and determined the percentage of nursing homes that were cited for 

deficiencies considered substandard quality of care. We identified trends in these 

measures from 2005 to 2007. We also described instances in which there were 

differences of at least 1 percentage point among for-profit, not-for-profit, and government 

nursing homes and between multifacility and single-facility nursing homes. In all cases, 

the percentages cited were based on nursing homes that were surveyed. 

We also obtained complaint information for 2005, 2006, and 2007 from OSCAR. We 

analyzed this information to determine the nature and extent of complaints and to identify 

trends. A complaint may contain several allegations. For the purposes of this report, we 

refer to each allegation as a “complaint.” We determined the number of substantiated 

complaints and the number of nursing homes associated with these complaints. 

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This memorandum report describes the nature and extent of nursing home deficiencies 

and complaints in 2007 and identifies trends from 2005 to 2007. This review was not 

designed to provide explanations for changes in these measures. 

This review was conducted in accordance with the “Quality Standards for Inspections” 

issued by the President’s Council on Integrity and Efficiency and the Executive Council 

on Integrity and Efficiency. 

RESULTS 

In Each of the Past 3 Years, Over 91 Percent of Nursing Homes Surveyed Were 

Cited for Deficiencies 

In 2005, 2006, and 2007, more than 91 percent of nursing homes surveyed were cited for 

deficiencies. Although this percentage remained stable during this time, it has increased 

over the last decade. According to the 2003 OIG report, the percentage of nursing homes 

cited for deficiencies increased from 81 percent in 1998 to 89 percent in 2001.18 Table 1 

below shows the trends in deficiencies from 2005 to 2007. 

In the past 3 years, the average number of deficiencies per nursing home increased 

slightly. In 2007, nursing homes were cited for an average of 7.0 deficiencies per home, 

compared to 6.4 deficiencies in 2005. During this period, the total number of 

deficiencies rose by almost 10 percent, while the number of nursing homes surveyed 

decreased by 1 percent. 

Table 1: Trends in Deficiencies, 2005–2007 

2005 2006 2007 Percentage Change 

2005–2007 

Percentage of nursing homes with deficiencies 91.1% 91.8% 91.9% 0.9 %* 

Average number of deficiencies per nursing home 6.4 6.9 7.0 10.7%* 

Total number of deficiencies 95,624 102,487 104,665 9.5% 

Total number of nursing homes surveyed 15,046 14,954 14,872 -1.2% 

Source: OIG analysis of OSCAR data, 2008. 

*Percentage change may vary because of rounding. 

Deficiency rates varied widely among States. In 2007, the percentage of nursing homes 

surveyed with deficiencies ranged from 76 percent in Rhode Island to 100 percent in 

Alaska, the District of Columbia, Idaho, and Wyoming. The average number of 

deficiencies also varied among States, from 2.5 deficiencies per nursing home in 

Rhode Island to 14.4 in the District of Columbia. These ranges were similar for each of 

the past 3 years. See Appendixes A and B for the trends in deficiencies by State. 

A Greater Percentage of For-Profit Nursing Homes Were Cited for Deficiencies 

Than Not-for-Profit and Government Nursing Homes in Each of the Past 3 Years 

In 2007, 94 percent of for-profit nursing homes surveyed were cited for deficiencies, 

compared to 88 percent of not-for-profit and 91 percent of government nursing homes. 

18 OIG, “Nursing Home Deficiency Trends and Survey and Certification Process Consistency,” 

OEI-02-01-00600, March 2003, p. 7. 

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See Figure 2 below. Since 2005, the percentages of for-profit nursing homes with 

deficiencies were between 3 and 6 points higher than the percentages of the other types of 

nursing homes with deficiencies. In each of the past 3 years, for-profit nursing homes 

made up 67 percent of the nursing homes surveyed, not-for-profit homes accounted for 

27 percent, and government-owned homes accounted for the remaining 6 percent. 

Figure 2: Percentage of Nursing Homes Surveyed With Deficiencies by Type of Ownership, 

2005–2007 

93.0 93.4 93.5 

86.8 

88.0 88.4 

89.9 90.2 90.5 

82 

84 

86 

88 

90 

92 

94 

96 

2005 2006 2007 

Percentage of Nursing Homes 

For-Profit Not-for-Profit Government 

Source: OIG analysis of OSCAR data, 2008. 

For-profit nursing homes also had a higher average number of deficiencies per home than 

the other types of nursing homes. In 2007, for-profit nursing homes averaged 

7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 

6.3, respectively. As Table 2 below shows, the averages for all types of nursing homes 

increased since 2005. 

In addition, a greater percentage of multifacility nursing homes were cited for 

deficiencies, compared to single-facility nursing homes. In 2007, 93 percent of 

multifacility nursing homes surveyed were cited for deficiencies, as opposed to 91 

percent of single-facility nursing homes. These numbers have not changed significantly 

since 2005. The average number of deficiencies was also higher for multifacility homes 

than for single-facility homes in each of the past 3 years. See Table 2 below. 

Table 2: Average Number of Deficiencies per Nursing Home Surveyed 

by Type of Home, 2005–2007 

For-profit 7.0 7.4 7.6 9.8% 

Not-for-profit 5.1 5.6 5.7 13.1% 

Government 5.5 6.0 6.3 14.1% 

 Type of Nursing Home 2005 2006 2007 Percentage Change* 

Multifacility 6.6 7.2 7.3 10.9% 

Single-facility 6.1 6.5 6.7 10.4% 

 Source: OIG analysis of OSCAR data, 2008. 

 *Percentage change may vary because of rounding. 

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The Most Common Deficiency Categories Cited in Each of the Past 3 Years Were 

Quality of Care, Resident Assessment, and Quality of Life 

The most common deficiency categories cited in 2005, 2006, and 2007 were quality of 

care, resident assessment, and quality of life. As shown in bold in Table 3 below, almost 

74 percent of nursing homes surveyed were cited for quality-of-care deficiencies in 2007. 

The most common quality-of-care deficiencies involved accident hazards; providing care 

for residents’ highest practicable physical, mental, and psychosocial well-being; and 

urinary incontinence. About 58 percent of nursing homes were cited for resident 

assessment deficiencies. The most common resident assessment deficiencies involved 

services meeting professional quality standards, comprehensive care plans, and service 

provision by qualified persons. Over 43 percent of nursing homes were cited for qualityof-life deficiencies. The most common quality-of-life deficiencies involved 

housekeeping and maintenance services, dignity, and accommodation of needs. In 

addition, almost 43 percent of nursing homes were cited for deficiencies in the dietary 

services category. 

Table 3: Percentage of Nursing Homes Surveyed That Received at Least One Deficiency 

by Category, 2005–2007 

Deficiency Category 2005 2006 2007 

Percentage-Point 

Difference, 

2005–2007* 

Quality of care 70.6 71.5 73.6 3.1 

Resident assessment 54.4 58.0 58.2 3.8 

Quality of life 43.1 45.6 43.3 0.2 

Dietary services 43.1 44.4 42.9 -0.2 

Resident rights 33.4 34.5 34.3 0.9 

Administrative services 28.9 31.5 30.7 1.9 

Pharmacy services 23.8 25.3 28.8 5.0 

Infection control 26.3 28.7 28.4 2.1 

Resident behavior and facility practices 26.4 26.7 27.4 1.0 

Physical environment 22.9 23.7 23.8 0.9 

Laboratory and radiology services 6.9 7.9 9.1 2.2 

Nursing services 4.2 5.3 6.9 2.7 

Physician services 4.6 5.4 5.7 1.1 

Admission, transfer, discharge rights 1.6 1.6 1.7 0.1 

Rehabilitative services 1.3 1.5 1.4 0.2 

Dental services 1.2 1.4 1.4 0.2 

 Source: OIG analysis of OSCAR data, 2008. 

*Percentage-point difference may vary because of rounding. 

The 2003 OIG report found that the most common deficiency categories cited in 2001 

were also quality of care, resident assessment, quality of life, and dietary services, in the 

same descending order.19 During that year, 68 percent of nursing homes were cited for 

19 OIG, “Nursing Home Deficiency Trends and Survey and Certification Process Consistency,” 

OEI-02-01-00600, March 2003, p. 9. 

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quality-of-care deficiencies, 50 percent were cited for resident assessment deficiencies, 

43 percent were cited for quality-of-life deficiencies, and 42 percent had dietary services 

deficiencies. 

Most categories of deficiencies had minor increases between 2005 and 2007. The 

pharmacy services category measured the largest percentage-point increase. Deficiencies 

cited in this category, which addresses the accurate dispensation and administration of 

drugs to residents, increased by 5 percentage points. This increase coincided with the 

implementation in 2006 of Medicare Part D, which provided voluntary drug coverage to 

Medicare beneficiaries. In addition, CMS issued guidance in late 2006 that combined 

several drug-related deficiencies and revised its guidelines for citing these deficiencies. 

Three types of deficiencies have been the most common since 2005. Approximately 

36 percent of nursing homes surveyed were cited for deficiencies associated with 

accident hazards each year; between 33 percent and 35 percent of nursing homes were 

cited for deficiencies for the improper storage, preparation, distribution, or serving of 

food; and almost 28 percent were cited for deficiencies for not providing the care 

necessary for residents’ highest practicable physical, mental, and psychosocial wellbeing. These most common deficiencies fell within the quality-of-care category and the 

dietary services category. 

Almost 17 Percent of Nursing Homes Surveyed Were Cited for Actual Harm or 

Immediate Jeopardy Deficiencies in 2007 

In 2007, nearly 17 percent of nursing homes surveyed were cited for immediate jeopardy 

or actual harm deficiencies. Specifically, almost 3 percent of nursing homes were cited 

for immediate jeopardy deficiencies, and 15 percent were cited for actual harm 

deficiencies in 2007.20 The majority of the nursing homes with actual harm deficiencies 

had isolated (G-level) rather than pattern or widespread deficiencies (H- and I-level). 

The most common scope and severity ratings in 2007 were at the D and E levels. 

Eighty-three percent of nursing homes surveyed were cited for D-level deficiencies, and 

63 percent were cited for E-level deficiencies. Both ratings indicate a severity of no 

actual harm with potential for more than minimal harm. Although most of the scope and 

severity levels did not change substantially since 2005, there was a small shift from 

B-level to C-, E-, and F-level deficiencies. This trend indicates that nursing homes were 

cited for more severe deficiencies as well as deficiencies that were wider in scope in 

2007, compared to those in the prior 2 years. Table 4 on the next page shows the scope 

and severity levels for 2005 through 2007, with the largest percentage-point changes in 

bold. 

20 One percent was cited for both deficiencies. 

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Table 4: Pe

at Least On

2005–2007 

Scope and 

Severity 

Level 

2005 

rcentage of

e Deficienc

2006 

 Nursing H

y by Scope 

2007 

omes Surve

and Severity L

Percentage-Point 

Difference, 

2005–2007* 

yed That Had 

evels, 

A 0.0% 0.0% 0.0% 0.0 

B 30.5% 28.7% 27.6% -3.0 

C 20.8% 21.9% 22.2% 1.4 

D 82.4% 83.1% 83.2% 0.9 

E 58.4% 61.8% 62.8% 4.4 

F 19.2% 21.1% 21.2% 2.0 

G 14.1% 15.4% 14.9% 0.7 

H 1.0% 1.1% 1.0% 0.1 

I 0.1% 0.1% 0.1% 0.0 

J 1.2% 1.1% 1.3% 0.1 

K 1.0% 1.0% 1.2% 0.2 

L 0.4% 0.4% 0.4% 0.1 

 Source: OIG analysis of OSCAR data, 2008. 

*Percentage-point difference may vary because of rounding.
 

According to the 2003 OIG report, the most common scope and severity ratings in 2001 

were also at the D and E levels.21 However, the percentage of nursing homes with these 

ratings was somewhat lower than the figures above, at 77 percent and 55 percent, 

respectively. In addition, OIG reported that between 1998 and 2001, there was a shift 

away from G-level to more D- and E-level deficiencies. This shift demonstrated that 

nursing homes had deficiencies that were less severe but equal or wider in scope in 2001 

compared to 1998. 

In each of the past 3 years, a higher percentage of for-profit nursing homes surveyed were 

cited for immediate jeopardy or actual harm deficiencies, compared to the other types of 

nursing homes. In 2007, 17 percent of for-profit nursing homes surveyed were cited for 

these deficiencies, compared to 15 percent of not-for-profit and government homes. In 

addition, a slightly greater percentage of multifacility nursing homes were cited for 

immediate jeopardy or actual harm deficiencies, compared to single-facility homes, at 

17 percent and 16 percent, respectively. 

Substandard Quality-of-Care Deficiencies Increased Slightly Since 2005 

The percentage of nursing homes with substandard quality-of-care deficiencies has risen 

slightly since 2005. In 2007, 3.6 percent of nursing homes surveyed were cited for these 

deficiencies, up from 3.0 percent in 2005. The small increase in substandard quality of 

care differs from the slight downward trend in the 2003 OIG report.22 That report found 

21 OIG, “Nursing Home Deficiency Trends and Survey and Certification Process Consistency,” 

OEI-02-01-00600, March 2003, p. 11. 

22 Ibid., p. 10.
 

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that the percentage of nursing homes cited for quality-of-care deficiencies decreased from 

4.5 percent in 1998 to 4.2 percent in 2001. 

The percentage of for-profit nursing homes with substandard quality-of-care deficiencies 

was higher compared to the other types of nursing homes. In 2007, 4.2 percent of 

for-profit homes were cited for these deficiencies, in contrast to 2.3 percent of 

not-for-profit homes and 3.0 percent of government homes. These percentages increased 

slightly for all three types of homes since 2005. During the same time, the percentage of 

multifacility homes with substandard quality of care deficiencies increased from 

2.9 percent to 3.9 percent while the percentage of single-facility homes stayed at about 

3 percent. 

The Number of Substantiated Complaints Decreased Slightly Since 2005 

The number of substantiated complaints decreased nearly 3 percent since 2005. As 

shown in Figure 3 below, a total of 14,394 complaints were substantiated in 2007, a 

decrease from 14,781 in 2005. The total number of complaints has similarly decreased 

since 2005. Almost 39 percent of complaints in each year were substantiated. 

The number of nursing homes associated with these complaints also decreased. In 2007, 

2,759 nursing homes were associated with at least one substantiated complaint, compared 

to 2,856 in 2005. In each of the past 3 years, almost 40 percent of these complaints were 

related to care or services. About 20 percent of substantiated complaints involved 

resident abuse or neglect. 

Figure 3: Numbers of Complaints and Substantiated Complaints, 2005–2007 

38,147 

40,716 

37,153 

15,806 14,781 14,394 

0 

5,000 

10,000 

15,000 

20,000 

25,000 

30,000 

35,000 

40,000 

45,000 

2005 2006 2007 

Complaints Substantiated Complaints

 Source: OIG analysis of OSCAR data, 2008. 

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CONCLUSION 

Deficiency rates have not changed significantly over the past 3 years. More than 

91 percent of nursing homes surveyed were cited for deficiencies, and a greater 

percentage of for-profit nursing homes were cited for deficiencies than not-for-profit and 

government nursing homes. The most common deficiency categories cited in each of the 

past 3 years were quality of care, resident assessment, and quality of life. Additionally, 

17 percent of nursing homes surveyed in 2007 were cited for actual harm or immediate 

jeopardy deficiencies, and 3.6 percent were cited for substandard quality-of-care 

deficiencies—a slight increase since 2005. Lastly, the number of substantiated 

complaints decreased nearly 3 percent since 2005. 

We note that many factors in addition to quality of care may affect deficiency rates. 

These factors may include an increase in enforcement, additional guidance or training 

from States and CMS, legislative changes, and State surveyor practices. 

This report is being issued directly in final form because it contains no recommendations. 

If you have comments or questions about this report, please provide them within 60 days. 

Please refer to report number OEI-02-08-00140 in all correspondence. 

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Appendix A 

Percentage of Nursing Homes Surveyed With 

Deficiencies by State, 2005–2007 

STATE 2005 2006 2007 

Alabama 97.6% 97.0% 96.8% 

Alaska 80.0% 100.0% 100.0% 

Arizona 92.9% 96.2% 97.4% 

Arkansas 95.4% 97.6% 97.9% 

California 98.6% 98.2% 99.1% 

Colorado 95.0% 95.9% 96.6% 

Connecticut 95.6% 97.4% 98.7% 

Delaware 97.6% 100.0% 97.6% 

District of Columbia 100.0% 100.0% 100.0% 

Florida 97.1% 96.8% 97.2% 

Georgia 95.2% 95.0% 88.1% 

Hawaii 100.0% 97.9% 97.4% 

Idaho 94.4% 100.0% 100.0% 

Illinois 87.1% 87.5% 90.4% 

Indiana 89.2% 88.9% 89.1% 

Iowa 85.3% 86.6% 88.4% 

Kansas 92.3% 95.2% 96.9% 

Kentucky 90.1% 91.2% 87.6% 

Louisiana 92.5% 91.8% 94.7% 

Maine 100.0% 98.2% 95.2% 

Maryland 93.4% 96.9% 94.4% 

Massachusetts 83.3% 81.4% 80.3% 

Michigan 95.4% 94.4% 96.0% 

Minnesota 96.6% 98.6% 97.5% 

Mississippi 86.6% 87.1% 86.7% 

Missouri 88.0% 89.7% 92.5% 

Montana 96.5% 92.8% 91.4% 

Nebraska 86.9% 91.6% 91.4% 

Nevada 82.6% 90.9% 83.3% 

New Hampshire 85.7% 70.3% 83.5% 

New Jersey 88.7% 88.0% 92.2% 

New Mexico 92.7% 92.5% 97.1% 

New York 90.4% 91.2% 92.0% 

North Carolina 88.8% 91.1% 89.6% 

North Dakota 98.7% 97.6% 93.5% 

Ohio 86.1% 85.9% 87.4% 

Oklahoma 93.7% 95.5% 93.8% 

Oregon 72.6% 74.1% 81.4% 

Pennsylvania 89.7% 93.4% 89.7% 

Rhode Island 85.7% 86.8% 76.3% 

South Carolina 93.1% 96.9% 92.7% 

South Dakota 89.8% 94.2% 88.6% 

Tennessee 95.5% 91.1% 92.0% 

Texas 92.1% 91.4% 89.6% 

Utah 86.3% 93.3% 97.5% 

Vermont 91.7% 100.0% 94.6% 

Virginia 84.4% 87.2% 93.1% 

Washington 90.9% 91.5% 90.9% 

West Virginia 97.5% 96.2% 95.8% 

Wisconsin 79.3% 83.8% 85.6% 

Wyoming 100.0% 100.0% 100.0% 

Source: OIG analysis of OSCAR data, 2008. 

OEI-02-08-00140 Trends in Nursing Home Deficiencies and Complaints 
 

 

 

 

Page 14 – Kerry Weems 

Appendix B 

Average Number of Deficiencies per Nursing Home 

Surveyed by State, 2005–2007 

STATE 2005 2006 2007 

Alabama 7.2 6.8 6.4 

Alaska 5.3 9.5 6.5 

Arizona 8.7 9.2 7.7 

Arkansas 9.3 10.7 8.6 

California 10.2 11.3 11.8 

Colorado 8.5 9.3 9.7 

Connecticut 8.0 8.5 9.0 

Delaware 8.3 13.1 13.3 

District of Columbia 13.6 12.5 14.4 

Florida 7.5 8.3 8.0 

Georgia 6.6 6.8 6.5 

Hawaii 8.5 7.0 7.0 

Idaho 8.8 9.9 8.7 

Illinois 4.4 4.9 5.3 

Indiana 5.8 6.8 7.9 

Iowa 4.2 4.3 5.0 

Kansas 8.9 9.8 9.9 

Kentucky 4.5 5.5 4.5 

Louisiana 8.2 7.1 7.9 

Maine 8.5 8.3 8.3 

Maryland 7.8 9.5 9.8 

Massachusetts 5.3 5.2 5.5 

Michigan 7.4 7.6 8.8 

Minnesota 8.5 10.1 10.2 

Mississippi 3.7 4.0 4.3 

Missouri 6.2 7.1 8.2 

Montana 6.3 6.4 6.9 

Nebraska 4.1 5.3 6.9 

Nevada 9.4 10.2 6.9 

New Hampshire 5.5 4.5 4.4 

New Jersey 4.2 4.3 4.3 

New Mexico 7.7 7.1 7.1 

New York 4.1 4.6 5.3 

North Carolina 4.9 4.7 4.4 

North Dakota 4.8 4.8 4.3 

Ohio 4.5 4.8 5.5 

Oklahoma 8.0 8.9 9.1 

Oregon 4.7 4.8 4.7 

Pennsylvania 4.6 5.2 4.6 

Rhode Island 4.9 3.5 2.5 

South Carolina 8.2 7.9 7.6 

South Dakota 4.0 4.9 4.5 

Tennessee 6.6 5.9 5.7 

Texas 6.5 6.8 6.5 

Utah 4.2 4.7 5.7 

Vermont 6.4 7.2 8.0 

Virginia 5.2 6.4 7.3 

Washington 6.3 6.3 6.6 

West Virginia 7.9 7.8 8.6 

Wisconsin 3.3 4.2 4.7 

Wyoming 7.9 15.1 12.3 

 Source: OIG analysis of OSCAR data, 2008. 

OEI-02-08-00140 Trends in Nursing Home Deficiencies and Complaints