Where do nursing home complaint citations most often involve harm?
In South Dakota, Mississippi, Kentucky, South Carolina and Alabama, more than 28% of nursing home complaint citations were graded actual harm or immediate jeopardy from August 2023 to July 2026. The national share was 12.6%.
Which state has the highest share of complaint citations involving harm?
In South Dakota, 33.7% of nursing home complaint citations from August 2023 to July 2026 were graded actual harm or immediate jeopardy, the highest share of any state.
How serious was the harm in these five states?
The five states reach the top in different ways. Nationally, 7.0% of nursing home complaint citations from August 2023 to July 2026 were graded actual harm and 5.6% immediate jeopardy. South Carolina, Kentucky and Alabama hold the three highest immediate jeopardy shares in the country, each more than four times the national figure.
South Dakota
South Dakota’s high share is mostly actual harm rather than immediate jeopardy. Of its 168 citations involving harm, 149 were actual harm, and its immediate jeopardy share was below the national figure.
Mississippi
Mississippi stands out for both actual harm and immediate jeopardy, each about one in six of its complaint citations and more than double the national figure for that grade.
Kentucky
Kentucky’s inspectors found more immediate jeopardy than Michigan’s inspectors, who wrote over eight times as many complaint citations. Kentucky had 141 citations graded immediate jeopardy to Michigan’s 93.
South Carolina
Immediate jeopardy dominates South Carolina’s share, outnumbering actual harm 116 citations to 33.
Alabama
Alabama makes the top five because of immediate jeopardy. Its actual harm share, 4.6%, was below the national figure, while 97 of its 116 citations involving harm were immediate jeopardy.
Where does your state rank?
Shares range more than eightfold, from South Dakota at the top to Idaho at the bottom. See the five states where nursing home complaint citations least often involved harm.
| Rank (1 = highest share) | State or territory | Complaint citations | Citations involving harm | Share involving harm |
|---|---|---|---|---|
| 1 | South Dakota | 499 | 168 | 33.7% |
| 2 | Mississippi | 886 | 297 | 33.5% |
| 3 | Kentucky | 585 | 191 | 32.6% |
| 4 | South Carolina | 467 | 149 | 31.9% |
| 5 | Alabama | 410 | 116 | 28.3% |
| 6 | Tennessee | 816 | 210 | 25.7% |
| 7 | Rhode Island | 766 | 164 | 21.4% |
| 7 | Utah | 711 | 152 | 21.4% |
| 9 | Illinois | 11,193 | 2,377 | 21.2% |
| 10 | Massachusetts | 994 | 205 | 20.6% |
| 10 | North Carolina | 2,897 | 597 | 20.6% |
| 10 | Florida | 2,529 | 520 | 20.6% |
| 13 | Wyoming | 328 | 64 | 19.5% |
| 14 | Vermont | 358 | 63 | 17.6% |
| 15 | Colorado | 1,179 | 205 | 17.4% |
| 16 | Texas | 14,578 | 2,419 | 16.6% |
| 17 | Kansas | 2,151 | 349 | 16.2% |
| 18 | Missouri | 4,256 | 668 | 15.7% |
| 19 | Minnesota | 2,503 | 389 | 15.5% |
| 20 | North Dakota | 568 | 84 | 14.8% |
| 21 | New Jersey | 1,501 | 212 | 14.1% |
| 22 | New Hampshire | 126 | 17 | 13.5% |
| 23 | Oklahoma | 1,728 | 228 | 13.2% |
| 24 | Iowa | 3,424 | 441 | 12.9% |
| 25 | Montana | 671 | 86 | 12.8% |
| 25 | Delaware | 689 | 88 | 12.8% |
| 27 | Michigan | 5,000 | 612 | 12.2% |
| 28 | Washington | 2,428 | 287 | 11.8% |
| 29 | Arkansas | 597 | 70 | 11.7% |
| 29 | Wisconsin | 3,862 | 450 | 11.7% |
| 31 | Louisiana | 2,266 | 254 | 11.2% |
| 32 | Georgia | 2,619 | 278 | 10.6% |
| 32 | Hawaii | 245 | 26 | 10.6% |
| 34 | West Virginia | 1,074 | 109 | 10.1% |
| 35 | New York | 3,247 | 322 | 9.9% |
| 36 | Pennsylvania | 6,752 | 665 | 9.8% |
| 37 | Connecticut | 2,039 | 180 | 8.8% |
| 38 | New Mexico | 1,049 | 91 | 8.7% |
| 39 | Nebraska | 1,075 | 89 | 8.3% |
| 40 | Oregon | 1,476 | 120 | 8.1% |
| 40 | Virginia | 2,385 | 192 | 8.1% |
| 42 | Indiana | 3,465 | 263 | 7.6% |
| 43 | Ohio | 9,696 | 731 | 7.5% |
| 44 | District of Columbia | 475 | 30 | 6.3% |
| 45 | Arizona | 1,072 | 67 | 6.2% |
| 46 | California | 18,530 | 1,061 | 5.7% |
| 47 | Maine | 565 | 31 | 5.5% |
| 48 | Maryland | 2,899 | 143 | 4.9% |
| 49 | Nevada | 482 | 21 | 4.4% |
| 50 | Idaho | 1,113 | 45 | 4.0% |
| Too few citations to rank | Alaska | 84 | 14 | 16.7% |
| Too few citations to rank | Guam | 0 | 0 | No complaint citations |
| Too few citations to rank | Puerto Rico | 7 | 0 | 0.0% |
| National | 131,315 | 16,610 | 12.6% |
What to ask a nursing home
Three questions show how a particular home handled its own inspections:
- Walk me through your recent inspections. What did inspectors cite, and when?
- What did you change after each citation?
- How do you check that those changes are working, and can I see the records?
Frequently asked questions
Which states have the highest share of nursing home complaint citations involving harm?
South Dakota, Mississippi, Kentucky, South Carolina and Alabama had the highest shares of nursing home complaint citations graded actual harm or immediate jeopardy from August 2023 to July 2026, each above 28%. The national share was 12.6%.
What is a nursing home complaint inspection?
A complaint inspection is a visit state inspectors make to a nursing home to investigate a complaint or an incident the home reported. Every nursing home that participates in Medicare or Medicaid also gets a full inspection about once a year.
What do “actual harm” and “immediate jeopardy” mean in a nursing home inspection?
In a nursing home inspection, actual harm means a failure that hurt a resident, and immediate jeopardy means a failure that caused, or was likely to cause, serious injury, harm, impairment or death. Inspectors give each citation a letter grade for how severe and how widespread the problem was. Medicare’s Care Compare website shows actual harm (grades G, H and I) as level 3 and immediate jeopardy (grades J, K and L) as level 4, the highest.
Which state has the highest share of nursing home complaint citations graded immediate jeopardy?
South Carolina had the highest share of nursing home complaint citations graded immediate jeopardy from August 2023 to July 2026, at 24.8% compared with 5.6% nationally. Kentucky and Alabama were close behind.
Does a state’s high share of complaint citations involving harm mean its nursing homes are unsafe?
A state’s share of complaint citations involving harm describes its complaint inspections as a whole; it says nothing about any particular nursing home. To judge one home, read its own inspection reports on Medicare’s Care Compare.
How do I check a nursing home’s inspection results?
Medicare’s Care Compare shows the inspection results of nursing homes that participate in Medicare or Medicaid, including complaint inspections and the full report for each.
Look up a nursing home on Care Compare.
How do I file a complaint against a nursing home?
You can file a complaint against a nursing home with your State Survey Agency, the state office that inspects nursing homes and investigates complaints. Anyone with a concern about a resident’s care can file, by any means the agency accepts, including phone, mail, online or in person.
Sources and downloads. These figures come from our study, Nursing home complaint citations by state: how often they involve harm. Download the ranked table or the complete state table. Source: the Centers for Medicare & Medicaid Services Health Deficiencies dataset for nursing homes. How we counted these figures.