Violations linked to Florida nursing homes have doubled in the last four years, according to an investigation by the Tampa Bay Times.

Last year, Florida nursing homes were cited 83 times for putting their older adult residents at risk of immediate danger, and more than half of the serious violations involved staff shortages or insufficient training. Of these violations, 3 out of 5 were prompted by complaints that resulted in inspector visits.

Although the cause for the high level of citations was unclear, the citations recorded a range of issues, including neglect, abuse and poor care.

Florida is home to about 700 nursing homes.

Kristen Knapp, director of communications for the Florida Health Care Association, which represents 80% of nursing homes statewide, told the Times that inspections capture a specific point in time.

Moreover, the citations, posted on the federal government’s Care Compare tool, which helps consumers choose a nursing home, lists inspections related to these violations but often does not show follow-up surveys conducted by nursing homes that show how a nursing home may have improved, she said. And that, Knapp said, was “unfortunate.”

“Surveys are designed not only for oversight, but also to ensure centers have an understanding of what needs to be corrected so they can improve resident care,” she said.

Knapp speculated that the rise in citations, which had remained steady until 2016 when the average rose from 32 to 83 serious violations per year, may be linked to new regulations that came out that year, which allowed for a nursing home to be cited for the same violation multiple times.

“Several of those new requirements have resulted in high-level citations for a small percentage of facilities,” she told the Tampa Bay Times in an emailed statement. “However, the vast majority of care centers in Florida are making great strides to improve quality and better health outcomes for residents.”

Florida is not the only state that has seen a recent uptick in high-level citations. In 2021, 15.3% of recertification surveys in Wisconsin yielded harm citations, the 11th-highest percentage across the 50 states. Colorado ranked No. 1 with about 38%, while the national average was 7.2%. Michigan, Indiana, Illinois and Ohio all ranked within the top 20 highest percentages.

In Wisconsin, administrators and industry stakeholders cited the state’s survey process as a leading cause of high administrative turnover. Rick Abrams, CEO of the Wisconsin Health Care Association said the Wisconsin Health Care Association is advocating for a more ‘collaborative’ and less ‘punitive’ survey process, which he hopes will set new industry norms; although those hopes may not be met with openness from surveyors that are governed by federal mandates. Still, for Wisconsin operators troubled by regulatory burdens and staffing shortages, reevaluating the survey process may be inevitable.