Nursing Home Health Deficiencies & Harm Rate by State (2026)
418,148 CMS health deficiency citations across 14,635 nursing homes — severity breakdown, top F-tags, and state-level harm rate (G+ citations per facility). Illinois leads at 4.57 harm-rate citations per facility; New Hampshire is lowest at 0.31 — a 14.7x disparity. CMS data with cryptographic provenance.
Contents · 10 sections
Executive Summary
- 418,148 CMS health deficiency citations across 14,635 nursing homes form the basis of this analysis — drawn from the CMS Care Compare NH Health Deficiencies dataset (source modified 2026-04-17).
- 5.59% of all citations (23,368) are Severity G or higher — meaning CMS surveyors found actual harm to a resident. 2.36% are Severity J/K/L (immediate jeopardy — an immediate threat to resident life or safety).
- Illinois leads all states with 4.57 Severity G+ citations per facility cited (666 facilities). New Hampshire is the lowest at 0.31 per facility (74 facilities) — a 14.7x disparity between the highest- and lowest-harm-rate states.
- The three most-cited F-tags are F0880 (Infection Prevention & Control, 23,555 citations), F0689 (Free of Accident Hazards, 21,352), and F0812 (Food Safety, 19,927) — together representing 15.3% of all citations.
- CMS citations are published enforcement records, not Fonteum ratings. Fonteum does not independently inspect, rate, or guarantee any facility. State harm rates are descriptive, not endorsements of any facility or system.
At a glance — for journalists, researchers, and AI agents
What this dataset covers
- 418,148 CMS health deficiency citations across 14,635 nursing homes — severity breakdown, top F-tags, and state-level harm rate (G+ citations per facility). Illinois leads at 4.57 harm-rate citations per facility; New Hampshire is lowest at 0.31 — a 14.7x disparity. CMS data with cryptographic provenance.
- Dataset: 14,635 records analyzed.
What this dataset does NOT cover
- Fonteum analysis is not a quality measurement of any individual provider.
- Counts and rankings describe the Fonteum-indexed or source-published dataset, not the entire U.S. market.
Sources
- Fonteum indexed dataset
Snapshot date: 2026
Dataset scope · Snapshot May 25, 2026
Includes: the healthcare-provider records this study covers, each tracing to a dated public-record source named in the citation footer. Does not include: providers outside the source named for this study, or records not present in that source at the snapshot date. Counts describe this Fonteum healthcare-provider dataset — not a representative census of the U.S. healthcare workforce.
Key findings
What this report is, and is not
This report aggregates the CMS Care Compare NH Health Deficiencies dataset (snapshot fetched 2026-05-08, CMS source modified 2026-04-17) at the national and state levels. It reports CMS-published deficiency citations — the official enforcement record that results from annual and complaint-driven CMS surveys.
It does not:
- Rate any facility on its own. CMS conducts the surveys; Fonteum reports the citation record.
- Recommend or warn against any specific facility.
- Surface facility-level citations on any directory page. This snapshot is research-only.
- Mix CMS enforcement data with consumer reviews.
"Harm rate" as used in this report means Severity G+ citations per facility cited in a given state. It is not a composite score and does not adjust for facility count, bed size, or resident acuity. It is a normalized frequency measure of CMS-documented actual-harm citations.
Source: CMS Care Compare NH Health Deficiencies · CMS source modified 2026-04-17 · Snapshot fetched 2026-05-08. CMS citations are published by CMS; Fonteum reports them, it does not independently inspect or rate any facility.
Severity breakdown
The CMS deficiency severity scale runs from A (isolated, no harm) to L (widespread immediate jeopardy). Fonteum groups these into four bands:
| Severity band | CMS codes | Citations | % of total |
|---|---|---|---|
| No harm | A, B, C | 9,756 | 2.3% |
| Minimal harm | D, E, F | 385,017 | 92.1% |
| Actual harm | G, H, I | 23,368 | 5.59% |
| Immediate jeopardy | J, K, L | 9,862 | 2.36% |
The bulk of citations (92.1%) fall in the minimal-harm band (D–F). Severity D alone accounts for 261,886 citations (62.6%) — the single largest category. Severity G (actual harm, not widespread) accounts for 13,021 citations; Severity J (immediate jeopardy, isolated) accounts for 6,894.
Source: CMS Care Compare NH Health Deficiencies · CMS source modified 2026-04-17 · Snapshot fetched 2026-05-08. CMS citations are published by CMS; Fonteum reports them, it does not independently inspect or rate any facility.
State harm rates (G+ citations per facility)
Top 5 states by harm rate (G+ citations per facility cited):
| State | Harm rate | Facilities cited |
|---|---|---|
| Illinois | 4.57 | 666 |
| Utah | 3.19 | 97 |
| Rhode Island | 3.16 | 73 |
| Washington DC | 2.94 | 17 |
| Vermont | 2.65 | 34 |
Bottom 5 states by harm rate:
| State | Harm rate | Facilities cited |
|---|---|---|
| Nevada | 0.49 | 66 |
| Arkansas | 0.51 | 220 |
| Puerto Rico | 0.56 | 9 |
| Arizona | 0.59 | 140 |
| New Hampshire | 0.31 | 74 |
The 14.7× gap between Illinois (4.57) and New Hampshire (0.31) is the widest state-level enforcement disparity across any CMS Care Compare dataset published by Fonteum to date. Illinois's high harm rate reflects both enforcement intensity and a large, heavily-regulated urban long-term-care market.
Interpretation caution: Harm rate reflects citations per facility cited — not outcomes per resident or per bed. States with fewer but larger facilities, or with more aggressive survey regimes, may show higher rates independent of underlying care quality. This metric is a measure of CMS survey findings, not a direct measure of care quality.
Source: CMS Care Compare NH Health Deficiencies · CMS source modified 2026-04-17 · Snapshot fetched 2026-05-08. CMS citations are published by CMS; Fonteum reports them, it does not independently inspect or rate any facility.
Limitations
- Snapshot date. CMS source modified 2026-04-17; fetched 2026-05-08. CMS publishes quarterly updates; values shift with each release.
- Harm rate is not risk-adjusted. G+ citations per facility cited does not adjust for bed size, resident acuity, payer mix, or survey frequency. High harm rates may reflect aggressive survey enforcement as much as care quality differences.
- F-tag top-3 is not exhaustive. 418,148 citations span hundreds of distinct F-tags. Only the three most-cited are detailed here.
- No facility-level data. State aggregates are research-only. No facility-level citations attach to provider profiles.
- Immediate jeopardy subset overlap. Severity J/K/L (immediate jeopardy) is a subset of Severity G+ for counting purposes. The 2.36% immediate-jeopardy share is already included in the 5.59% G+ share.
- CMS methodology is canonical. Citation severity classifications reflect CMS survey findings. Fonteum does not re-adjudicate severity levels. Any replication must reference CMS's published surveyor guidance.
- No quality claim. State harm rates are descriptive statistics from CMS enforcement data. They are not endorsements, recommendations, or guarantees about any state's nursing homes, and Fonteum does not rate, inspect, verify, endorse, or guarantee any facility.
Source: CMS Care Compare NH Health Deficiencies · CMS source modified 2026-04-17 · Snapshot fetched 2026-05-08. CMS citations are published by CMS; Fonteum reports them, it does not independently inspect or rate any facility.
Methodology
- CMS Care Compare NH Health Deficiencies snapshot fetched 2026-05-08 (CMS source modified 2026-04-17). Stored at
public/research/data/cms-nh-deficiencies-2026-05-08.json. - Severity groupings follow the CMS A–L scale: no harm (A–C), minimal harm (D–F), actual harm (G–I), immediate jeopardy (J–L).
- Harm rate = Severity G+ citations ÷ facilities cited, computed per state.
- Top F-tags ranked by raw citation count across all severity levels.
- National pct_g_plus = G+ citations ÷ total citations (all severity levels with known code).
- Snapshot summary stored in
_summaryblock of the JSON artifact; national figures read directly from_summary.total_citations,_summary.pct_g_plus,_summary.pct_immediate_jeopardy.
Source: CMS Care Compare NH Health Deficiencies · CMS source modified 2026-04-17 · Snapshot fetched 2026-05-08. CMS citations are published by CMS; Fonteum reports them, it does not independently inspect or rate any facility.
Citation and reuse
Permitted with attribution to Fonteum Research and a link back to this page. Suggested citation:
Fonteum Research. Nursing Home Health Deficiencies & Harm Rate by State (2026). Published 2026-05-25. https://fonteum.com/research/nursing-home-deficiency-harm-rate-2026
The underlying CMS data is a U.S. Government Work in the public domain (https://www.usa.gov/government-works). Direct citations to CMS should reference https://data.cms.gov/provider-data/topics/nursing-homes.
Limitations
- This study's findings are scoped to the dataset and time window described in the methodology. They do not constitute medical, legal, or financial advice.
- Fonteum does not independently rate, inspect, verify, endorse, or guarantee any provider referenced in this study.
Methodology
Read the full methodology
CMS Care Compare NH Health Deficiencies snapshot (source modified 2026-04-17, fetched 2026-05-08). 418,148 citations across 14,635 facilities. Severity groupings: no harm A–C; minimal harm D–F; actual harm G–I; immediate jeopardy J–L. Harm rate = Severity G+ citations ÷ facilities cited per state. National pct_g_plus = 5.59%; pct_immediate_jeopardy = 2.36%. Top F-tags by raw citation count. No risk adjustment for bed size, acuity, or survey frequency. CMS citations are published enforcement records; Fonteum does not independently inspect or rate any facility.
CMS Care Compare NH Health Deficiencies snapshot (source modified 2026-04-17, fetched 2026-05-08). 418,148 citations across 14,635 facilities. Severity groupings: no harm A–C; minimal harm D–F; actual harm G–I; immediate jeopardy J–L. Harm rate = Severity G+ citations ÷ facilities cited per state. National pct_g_plus = 5.59%; pct_immediate_jeopardy = 2.36%. Top F-tags by raw citation count. No risk adjustment for bed size, acuity, or survey frequency. CMS citations are published enforcement records; Fonteum does not independently inspect or rate any facility.