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A report by the Long Term Care Community Coalition says nursing home deficiencies increased in 2024 compared with 2022, while fines declined 56.5%. Forty-nine states imposed fewer fines in 2024, and average fines per resident fell from $186 to $153. The report also found wide differences between states in how deficiencies were cited and rated for severity.
A new report from the Long Term Care Community Coalition says nursing home deficiencies increased in 2024 compared with 2022, while fines fell 56.5% and 49 states imposed fewer fines. The findings point to a widening gap between recorded problems and financial penalties, though the report’s figures alone do not show why fines declined or whether residents experienced more harm.
The New York-based nonprofit analyzed deficiencies and penalties from 2022 through 2024, measuring findings and fines on a per-resident basis as well as examining facility-level data. LTCCC said this approach is intended to assess how oversight affects nursing home residents. Its report found that 94% of deficiencies cited nationwide during the period were rated below the level of actual harm.
Despite the increase in deficiencies in 2024 compared with 2022, the total number and amounts of fines declined, according to the report. Average fines per resident dropped from $186 in 2022 to $153 in 2024. State figures varied: Illinois recorded the highest average fines per resident, at $465, while Arizona recorded the lowest, at $35.
The report also compared state citations in five areas: infection prevention and control, nurse staffing, pressure ulcers, antipsychotic drugs and residents’ rights. In infection control, Tennessee rated 11.3% of deficiencies as causing harm or placing residents in immediate jeopardy. Alabama, Alaska, Maryland and Nevada, as well as the District of Columbia, cited no infection-control deficiencies at those severity levels during the three years studied.
How Penalties Differ Across States
Fines are one way regulators can penalize nursing homes for violations, so a decline alongside more cited deficiencies raises questions about how consistently enforcement is being applied. The report’s state comparisons show that residents’ exposure to deficiencies rated as harmful or immediately dangerous can look different depending on where a facility operates.
The findings do not establish that falling fines caused poorer care, or that every deficiency posed a direct threat to residents. They do, however, describe a regulatory picture in which more deficiencies did not translate into more fines. For residents and families, the difference matters because inspection findings and penalties are among the public indicators available when evaluating facility oversight.
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What Inspectors Cited From 2022–24
Federal and state nursing home oversight relies on inspections that identify deficiencies and assign severity ratings. The LTCCC report focuses on both the number of citations and their seriousness, rather than treating every deficiency as an equivalent event. It also uses a per-resident lens to compare potential exposure across facilities and states.
In staffing, the report found that 30 states, the District of Columbia and Puerto Rico did not cite harm from understaffing in any nursing home in 2024. It also found that 10 states did not rate any antipsychotic-drug deficiency as causing harm or immediate jeopardy during the three-year period. These are findings about recorded citations and ratings, not proof that the underlying problems were absent.
““persistent accountability gap””
— Long Term Care Community Coalition
What the Report Cannot Establish
The report describes trends in citations and fines, but the source material does not explain why penalties declined or whether changes in inspection practices, enforcement decisions, facility conditions or other factors contributed. It also does not establish that states with no citations at a specified severity level had no underlying problems; it records what inspectors cited and how those citations were classified.
The source summary does not provide state-by-state totals for all five subject areas, details on individual facilities, or a breakdown of fine changes by penalty type. The relationship between the reported trends and residents’ day-to-day care therefore remains unclear. The 94% figure refers to deficiencies classified below actual harm, not to the share of nursing homes that were safe or free of problems.
Next Steps for State Oversight
LTCCC is urging stronger and more consistent enforcement, but the report does not identify a specific regulatory change or implementation schedule. The next developments to watch are whether state or federal regulators respond to the findings, explain the decline in fines, or change how inspections, severity ratings and penalties are applied.
More detailed state-level data and future inspection and enforcement results will help show whether the trends continued after 2024. Until then, the report offers a snapshot of the three-year period rather than a forecast of future penalties or care outcomes.
Key Questions
What did the report find about nursing home fines?
The Long Term Care Community Coalition reported that fines declined 56.5% from 2022 to 2024, even as cited deficiencies increased in 2024 compared with 2022. Forty-nine states imposed fewer fines in 2024.
How did average fines per resident change?
The reported average fell from $186 per resident in 2022 to $153 in 2024. The report also listed Illinois at $465 per resident and Arizona at $35.
Does the report say nursing homes became less safe?
No. It reports trends in deficiencies, severity ratings and fines; those figures alone do not establish changes in overall safety or prove why penalties declined.
What does the 94% figure mean?
LTCCC found that 94% of deficiencies cited nationwide from 2022 to 2024 were classified below the level of actual harm. That is a rating of cited deficiencies, not a measure of how many facilities were safe.
What happens after the report?
LTCCC called for stronger, more consistent and resident-centered oversight. The report summary does not specify a formal response or a timeline for regulatory changes.
Source: rss
