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Nursing Home Deficiencies on Decline in U.S.

Over 1.4 million people in the United States currently receive long-term care in a nursing home. This number is expected to double by the year 2050. Unfortunately, with over 15,700 nursing homes in the country, the quality of care provided in each nursing home can vary substantially.

This is a major concern for families and residents. How do they know the facility is reputable, safe and has a caring staff? Seniors are one of the country's most vulnerable populations. Often ensuring the safety and security of the nursing home facility is a duty which falls to the senior's family, usually their adult children.

Safety Oversight of U.S. Nursing Homes

Nursing home facilities are subject to strict regulation and oversight. They are often regulated on the state, by state health departments, and city level, by local regulations and ordinances. Nursing home facilities are also regulated on the federal level. This is because nursing home facilities are funded by federal Medicaid funds.

Nursing Home Functions

In order to understand how nursing homes are regulated, the basic functions of the facility must first be established. Nursing homes throughout the United States provide 24-hour skilled medical care for seniors. Typically, the senior will require at least some degree of assistance with one or more activities required for daily living.

Activities which require assistance include dressing, preparing meals, bathing and other hygiene-related issues. Management of prescription medication and other medical care is another major service provided by nursing home facilities.

Over half of all nursing home residents are over the age of 85. This age group is expected to increase until the year 2026. Additionally, the CDC expects that over 2.8 million people will need nursing home care by 2050. As the nursing home population grows, proper oversight will be necessary to ensure both existing and new facilities are safe, accountable and secure.

Nursing Home Data Compendium

On March 25, 2016, the Nursing Home Data Compendium for 2015 was published. This document, created by the Department of Health and Human Services, pulled data from three major sources:

  • CASPER database for survey and certification information
  • U.S. Bureau of the Census for population data
  • Minimum Data Set

The Data Compendium for 2015 covers a variety of nursing home characteristics, survey results and resident information. The Compendium also reveals any health deficiencies and findings of substandard quality of care.

The Results of the Compendium

Overall, the results were generally positive and reassuring. The number of deficiency-free facilities increased from 8.8% in 2009 to 10.2% in 2005. Note, this is an increase in facilities which were found to be free from issues.

This is a reversal of a previous downward trend. From 2005 to 2008, reports of health deficiencies in nursing facilities were on the increase. Fortunately, regulation and other factors have helped decrease health deficiencies.

There are five major categories of health deficiencies:

  • Improper storage and/or cooking of food
  • Accidents caused to residents due, at least in part, to lack of employee supervision.
  • Accidents caused to residents due, at least in part, to improperly maintained facilities
  • Improper resident care involving physical and mental well-being
  • Lack of proper measures to control and prevent the spread of infections.

Some of these are also considered deficiencies in quality of care. The good news is findings of substandard care have also decreased: In 2008, substandard care reports were at 4.4%. This dropped to 3.2% in 2014.

The report also identified states with an increase in nursing homes as well as ones with a decrease. Nineteen states had an increase in the number of facilities. Of those, the biggest increases were in:

  • Alaska (20% increase)
  • Nevada (8.2% increase)
  • Arizona (5.8% increase)

States with the biggest decline in facilities:

  • Vermont (7.5% decline)
  • North Dakota (5.9% decline)
  • Maine (4.6% decline)
Selecting a Quality Nursing Home

This is often a job for the adult child of the senior who is looking for nursing home care. Unfortunately, there is no real shortcut here. Finding a high quality nursing home requires time and legwork.

Experts recommend a visit to the nursing home. While a scheduled visit is usually a great step initially, searchers are encouraged to stop by the facility during the day unannounced. This will help determine both a more accurate picture of day-to-day activities as well as general security of the facility.

There are two major areas which can reveal a lot about the state of the entire nursing home: the facility and the staff.


An older facility is not necessarily inferior, while a newer facility isn't necessarily superior. The important issue is the current state of the facility. First, is the facility clean? Next, is it well-maintained?

Even a high-quality nursing home will have on-going maintenance issues. The issue is how quickly and efficiently maintenance issues are handled. Additionally, nursing home maintenance requires special challenges.

Nursing homes require a calm, quiet atmosphere. Is any construction kept away from the residents as much as possible? Are the maintenance employees friendly and eager to interact with the residents?


Does the staff treat the residents with friendliness and respect? Obviously, even the worst staff will be on their best behavior during the initial meeting. This is why experts recommend unscheduled visits. Also, established residents are often another useful source of information.

Aside from the courteous professionalism, staff availability is another major factor in overall resident safety. The staff-to-resident ratio should be high enough to ensure residents are never left unattended or in potentially dangerous situations.


The Nursing Home Data Compendium brought a lot of relief to anyone looking for nursing home care. Substandard quality of care and health deficiency are at an 11 year low. As the population ages, and nursing home care is required by more and more people, the recent report adds a bit of reassurance to anyone hesitant about finding a quality facility.

Written by Claire Simmons

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