More than a fourth of nursing homes nationally reported at least one serious deficiency, with 5% of the deficiencies cited in the last survey cycle rising to the level of actual harm or immediate jeopardy (IJ) posed to residents, representing serious risks, including injury, impairment or death, according to a KFF analysis released Thursday.

That’s about 6,700 health deficiencies categorized as IJs or actual harm. Most involved isolated incidents rather than widespread problems, KFF found. Meanwhile, about 28% of nursing homes have reported at least one serious deficiency so far this year.

About 93% of health deficiencies in the last cycle were classified as having the potential to cause harm without resulting in actual harm to residents.

KFF also found that nursing homes with lower staffing levels were more likely to receive serious deficiencies than facilities with higher staffing levels. Widespread deficiencies, or those seen as part of a recurring pattern rather than isolated incidents, were also associated with lower staffing levels.

But for certain common deficiencies that occur in nearly all nursing homes, the frequency of citations doesn’t differ significantly based on staffing levels.

Overall, KFF found that adequate staffing is closely linked to better quality of care and fewer serious safety violations.

Most health deficiencies don’t result in immediate harm but still have the potential to negatively affect resident health and safety, according to KFF’s report. Health deficiencies are defined as failures in clinical care, medical treatment and daily living conditions; KFF used Nursing Home Care Compare to pull data for the report.

Findings are all within the context of changing federal oversight under the Trump administration, KFF reporters said, a time characterized by the repeal of the Biden era staffing rule, a greater focus on complaint-based inspections and delays in reporting ownership information.

State agencies usually conduct routine inspections while CMS oversees the process via federal monitoring surveys to verify state inspection accuracy. But 2026 guidance indicated that fewer federal validation inspections would happen because of the 2025 federal government shutdown.

About 87% of nursing homes received a standard survey within the last 15 months, while some facilities haven’t been inspected in more than two years.

Complaint surveys played a significant role in identifying problems, KFF reported, accounting for a quarter of all deficiencies found during the most recent inspection cycle.

The remaining three-fours of health deficiencies were identified via standard surveys.