Data shows nursing home inspection backlog is improving very slowly. Here's how it looks in your state.

Marijan Murat/picture alliance // Getty Images More than one year since the COVID-19 public health emergency ended, state and federal agencies are still struggling to respond to a rising volume of nursing home complaints nationwide. Nursing Homes analyzed nursing home inspection data from the Centers for Medicare & Medicaid Services, or CMS, to illustrate the extensive backlog in nursing home inspections since the pandemic began in 2020. Nursing homes provide care for more than 1.2 million aging Americans today, according to the Department of Health and Human Services. During the height of the pandemic, these facilities became ground zero in the country’s efforts to curb the gruesome impact of coronavirus, which American Health Care Association President and CEO Mark Parkinson called “a perfect killing machine” for elderly patients. Now, those facilities are facing a slew of lawsuits alleging wrongful death amid a lack of oversight as regulators struggle to inspect a heap of complaints directed at facilities nationwide, a 2023 investigation published by Newsweek found. In a follow-up, a Senate committee later found in a report published that May that inadequate federal investment in inspections had “put older adults and people with disabilities at risk.” Nursing home inspections allow the federal agency to be sure facilities receiving Medicare funds comply with rules and regulations that uphold residents’ civil and legal rights. These inspections help ensure communication with doctors and families in the event of an injury, that nursing homes take responsibility for handling residents’ financial and personal belongings, and that they provide a certain standard of care that includes controlling and preventing infection. The CMS contracts with state health departments to conduct surveys of nursing homes across the U.S. However, the COVID-19 pandemic caused the CMS to limit survey activity periodically throughout the public health emergency declaration from March 2020 to May 2023, according to the agency. Through that period, it directed states to focus surveys of nursing homes on assessing compliance with infection prevention and control standards to mitigate the spread of COVID-19. Nationwide, nearly 1 in 4 nursing homes (or 3,573) are overdue for a recertification inspection, meaning they haven’t received an inspection in over 15 months. And more than 1 in 10 nursing homes (or 1,754) haven’t received that inspection in two years or more. In a statement provided to Stacker, CMS spokesperson April Washington said the agency is “committed to holding facilities accountable for meeting these standards.” However, as surveys have resumed, the agency acknowledged that states have struggled to clear a backlog of inspections necessary to ensure facilities are in compliance with CMS regulations, citing limited resources. Those backlogs look different from state to state as the CMS and a congressional investigation point to lacking budgets as a major factor behind some states’ inability to catch up. In many places, an inability to hire and retain inspectors is hampering efforts to ramp up oversight again. Improvements to inspection backlog stalling Dom DiFurio // Nursing Homes Before the pandemic, 9 in 10 active homes were surveyed annually. The number of recertification inspections in 2020 fell to just 27%. Even as the pandemic receded, the backlog remained more or less unchanged throughout 2023, federal data shows. For 2023, only about 2 in 3 (66%) active providers were surveyed, a four-percentage-point increase from 2022. It’s important to note that the agency’s rules don’t require all nursing homes to receive a recertification survey by inspectors every year, as the data is presented, but rather every 15 months. The plateau in nursing home recertification inspections comes as the need for nursing home services increases. Nursing homes struggle to maintain high levels of care with a worsening labor shortage. More American families than ever are projected to need long-term care for loved ones as an aging baby boomer population enters its retirement years, dubbed the “Silver Tsunami.” One estimate projects 3,000 more nursing home facilities will be needed by 2030 to meet the health care needs of a generation that will be entirely 65 or older by then. Nursing home inspection crunch varies across states