Deficiencies in nursing homes, both on average and those deemed more serious, have increased over time – partly as a result of decreasing staffing levels.
Between 2015 and 2023, facilities with serious deficiencies, or violations of federal regulations, increased from 17% to 26%, according to a data note published on Friday by KFF. The average count of deficiencies increased from 6.8 to 8.9, an increase of 31%, KFF researchers found.
KFF’s analysis examined characteristics of nursing facilities and the people living in them using Nursing Home Compare, state-level data and Certification and Survey Provider Enhanced Reports (CASPER) datasets collected by surveyors during nursing home inspections.
Another study from Abt Associates found that better-staffed nursing homes are cited for fewer deficiencies, connecting the dots between increased deficiencies and lower staffing levels.
“While there is ample evidence that higher levels of staffing are associated with better quality and fewer deficiencies in care, there are ongoing questions about how such care will be financed and whether there are sufficient workers to meet the needs of an aging population, in nursing facilities and in other settings,” according to the KFF report.
The Biden Administration has also requested increased funding in the president’s budget for survey and certification of nursing facilities in 2024, KFF researchers said, with the Centers for Medicare & Medicaid Services (CMS) pointing to an increase in the overall number of nursing home complaints since 2015. Additional survey resources have been needed while funding remained the same, CMS said.
Researchers also found that the number of nursing facilities dropped by 4% during the same time period, from 15,648 facilities in 2015 to 15,003 in 2023.
“The decreased number of nursing facilities reflects the net change in the number of certified facilities after accounting for newly-certified facilities and facilities that are no longer certified, including facilities that closed,” according to the KFF report.
The number of nursing facility residents decreased by 12% as well. KFF linked the drop in new nursing home residents to people increasingly opting for home and community based services over institutional settings.
And, despite increasing acuity levels, the average number of hours of nursing care that residents received per day decreased by 9%. It’s a concerning trend considering the looming federal minimum staffing requirement for the sector.
Other key characteristics of nursing homes – including the share of residents by primary payer and share of facilities by ownership type – stayed stable over time, KFF said. Medicaid was the primary payer for 62% of residents as of July, serving over 6 in 10 residents, while Medicare made up 13%. The remaining 25% of residents had private insurance or out-of-pocket.
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