Nursing home complaint citations by state: how often they involve harm
Across America’s nursing homes, 12.6% of citations from complaint inspections were graded actual harm or immediate jeopardy from August 2023 to July 2026. Among the 50 states, the share ran from 4.0% in Idaho to 33.7% in South Dakota.
South Dakota, Mississippi, Kentucky, South Carolina and Alabama had the highest shares
In South Dakota, Mississippi, Kentucky, South Carolina and Alabama, complaint citations involved harm at more than twice the national share, above 28% in each.
California had the most complaint citations but one of the lowest shares involving harm
Idaho, Nevada, Maryland, Maine and California were the five states under 6%. California had more complaint citations than any other state, and 5.7% of them involved harm.
Complaint citations involving harm in every state
| State or territory | Complaint citations | Citations involving harm | Share involving harm |
|---|---|---|---|
| Alabama | 410 | 116 | 28.3% |
| Alaska | 84 | 14 | 16.7% |
| Arizona | 1,072 | 67 | 6.2% |
| Arkansas | 597 | 70 | 11.7% |
| California | 18,530 | 1,061 | 5.7% |
| Colorado | 1,179 | 205 | 17.4% |
| Connecticut | 2,039 | 180 | 8.8% |
| Delaware | 689 | 88 | 12.8% |
| District of Columbia | 475 | 30 | 6.3% |
| Florida | 2,529 | 520 | 20.6% |
| Georgia | 2,619 | 278 | 10.6% |
| Guam | 0 | 0 | No complaint citations |
| Hawaii | 245 | 26 | 10.6% |
| Idaho | 1,113 | 45 | 4.0% |
| Illinois | 11,193 | 2,377 | 21.2% |
| Indiana | 3,465 | 263 | 7.6% |
| Iowa | 3,424 | 441 | 12.9% |
| Kansas | 2,151 | 349 | 16.2% |
| Kentucky | 585 | 191 | 32.6% |
| Louisiana | 2,266 | 254 | 11.2% |
| Maine | 565 | 31 | 5.5% |
| Maryland | 2,899 | 143 | 4.9% |
| Massachusetts | 994 | 205 | 20.6% |
| Michigan | 5,000 | 612 | 12.2% |
| Minnesota | 2,503 | 389 | 15.5% |
| Mississippi | 886 | 297 | 33.5% |
| Missouri | 4,256 | 668 | 15.7% |
| Montana | 671 | 86 | 12.8% |
| Nebraska | 1,075 | 89 | 8.3% |
| Nevada | 482 | 21 | 4.4% |
| New Hampshire | 126 | 17 | 13.5% |
| New Jersey | 1,501 | 212 | 14.1% |
| New Mexico | 1,049 | 91 | 8.7% |
| New York | 3,247 | 322 | 9.9% |
| North Carolina | 2,897 | 597 | 20.6% |
| North Dakota | 568 | 84 | 14.8% |
| Ohio | 9,696 | 731 | 7.5% |
| Oklahoma | 1,728 | 228 | 13.2% |
| Oregon | 1,476 | 120 | 8.1% |
| Pennsylvania | 6,752 | 665 | 9.8% |
| Puerto Rico | 7 | 0 | 0.0% |
| Rhode Island | 766 | 164 | 21.4% |
| South Carolina | 467 | 149 | 31.9% |
| South Dakota | 499 | 168 | 33.7% |
| Tennessee | 816 | 210 | 25.7% |
| Texas | 14,578 | 2,419 | 16.6% |
| Utah | 711 | 152 | 21.4% |
| Vermont | 358 | 63 | 17.6% |
| Virginia | 2,385 | 192 | 8.1% |
| Washington | 2,428 | 287 | 11.8% |
| West Virginia | 1,074 | 109 | 10.1% |
| Wisconsin | 3,862 | 450 | 11.7% |
| Wyoming | 328 | 64 | 19.5% |
How to check a nursing home’s inspection results
- Search for the home on Medicare’s Care Compare, which covers nursing homes that participate in Medicare or Medicaid.
- Open its inspection results, including complaint inspections and the full report for each.
- Check each citation’s level of harm. Care Compare shows actual harm (grades G, H and I) as level 3 and immediate jeopardy (grades J, K and L) as level 4, the highest.
- Ask the home to walk you through each citation at level 3 or 4, what it changed afterward and how it checks that those changes are working, with dates and records.
Frequently asked questions
How often do nursing home complaint citations involve harm?
From August 2023 to July 2026, 12.6% of US nursing home citations from complaint inspections were graded actual harm or immediate jeopardy. That was 16,610 of 131,315 citations.
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.
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.
Find your State Survey Agency on CMS.gov.
What does actual harm mean in a nursing home inspection?
Actual harm means inspectors found that a nursing home’s failure harmed a resident, at a level short of immediate jeopardy. Inspectors grade it G, H or I, depending on whether the problem was isolated, a pattern or widespread.
What does immediate jeopardy mean in a nursing home inspection?
Immediate jeopardy is the most serious type of citation a nursing home can get: a failure that caused, or was likely to cause, serious injury, harm, impairment or death to a resident. Inspectors grade it J, K or L.
Which states have the highest share of nursing home complaint citations involving harm?
South Dakota had the highest share of nursing home complaint citations graded actual harm or immediate jeopardy from August 2023 to July 2026, at 33.7%. Mississippi, Kentucky, South Carolina and Alabama were next, all above 28%.
Which states have the lowest share of nursing home complaint citations involving harm?
Among the 50 states, Idaho had the lowest share of nursing home complaint citations graded actual harm or immediate jeopardy from August 2023 to July 2026, at 4.0%. Nevada, Maryland, Maine and California were next, all under 6%.
Which states had the most nursing home complaint citations?
California had 18,530 nursing home complaint citations from August 2023 to July 2026, the most of any state, followed by Texas with 14,578 and Illinois with 11,193.
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. A home’s own inspection results on Care Compare show its citations and their level of harm.
Is assisted living graded the same way as a nursing home?
Assisted living communities do not get the federal actual harm and immediate jeopardy grades. Those grades come from inspections of nursing homes that participate in Medicare or Medicaid. Each state licenses and regulates assisted living under its own rules.
Our residential-care complaints study covers assisted living and other residential care communities.
Sources and download
Download the complete state table. Source: the CMS Health Deficiencies dataset for nursing homes. How we counted these figures.