More Than 1 in 3 U.S. Nursing Homes Cited for Abuse or Neglect, New Federal Data Analysis Finds

More than one in three U.S. nursing homes, 36.5% of facilities nationwide, received at least one federal citation for abuse, neglect, or exploitation during their most recent government inspection, according to a new analysis from The Schiller Kessler Group of Centers for Medicare and Medicaid Services data covering 14,689 facilities across all 50 states and Washington, D.C. Yet even that figure likely represents a fraction of the true scale of the problem: research cited in the report estimates that only 1 in 24 elder abuse cases nationwide is ever formally reported to authorities.

Federal inspectors issued 10,493 abuse, neglect, and exploitation citations during the most recent inspection cycle, which spans survey dates from late 2019 through March 2026. Nearly 7 in 10 of those citations, 69.4%, were triggered by a resident or family complaint rather than routine oversight, meaning systemic problems frequently continue undetected until someone directly affected speaks up. Of even greater concern, 1,328 citations, 12.7% of the total, involved documented actual harm or immediate jeopardy to residents, the most serious classifications federal inspectors can issue. Across the full study period, a combined 31,068 citations were issued against 9,651 residential facilities nationwide.

Despite the scale of documented violations, the report finds accountability has been inconsistent at best. Between April 2023 and March 2026, nursing home operators paid a combined $467 million in fines across more than 6,600 cited facilities, and an additional 1,949 facilities faced Medicare and Medicaid payment blocks. Yet nearly 1 in 11 facilities, 8.8%, received three or more separate abuse citations within a single inspection cycle, a repeat-violation rate the report’s authors say raises serious questions about whether current financial penalties function as any meaningful deterrent.

The math behind those penalties helps explain why. Spread across the more than 6,600 cited facilities, the $467 million in fines works out to an average of roughly $70,800 per facility, a sum the report notes is dwarfed by the more than $10 million in annual revenue a typical nursing home generates. For large multi-facility operators in particular, the report argues, such penalties likely function as a minor cost of doing business rather than a genuine incentive to improve staffing, oversight, or care practices.

The most common violations point to a specific, recurring pattern of institutional failure. A failure to protect residents from physical, mental, or sexual abuse, neglect, or punishment accounted for 2,831 citations, 27% of the total, while a nearly identical share, 2,830 citations, also 27%, involved a failure to properly report suspected abuse, neglect, or theft to authorities in the first place. A third major category, failure to adequately investigate abuse allegations once reported, added another 1,806 citations, 17.2% of the total. Combined, failures to protect, report, and investigate accounted for 71.2% of all citations issued nationwide, a pattern the report describes as evidence of systemic, rather than isolated, breakdowns in resident protection.

Other significant citation categories included the improper use of psychotropic medications and chemical restraints (883 citations), a failure to establish written abuse prevention policies at all (854 citations), and financial exploitation of residents (522 citations), each pointing to distinct but related gaps in how facilities are staffed, trained, and held accountable.

The scale of documented citations, the report stresses, is likely only a narrow slice of the broader elder abuse crisis in the United States. Researchers estimate that roughly 5 million elder abuse cases occur nationwide each year across all care settings, not just nursing homes, yet just 1 in 24 of those cases is ever formally reported to authorities. That gap suggests the 10,493 citations issued during the most recent inspection cycle, serious as they are, capture only the fraction of cases that happened to surface through a complaint, an inspection, or a family member willing and able to come forward.

“The data shows a system that documents failure after failure but rarely follows through with consequences that actually change behavior,” said an attorney with the legal team behind the report. “Families are often the ones left to notice what oversight alone has missed.”

The report’s authors argue that meaningful reform would need to address not just the frequency of citations but the way penalties are structured, since a facility’s first violation currently carries the same financial consequence as its fifth, regardless of an established pattern of harm.