When a family starts to worry about a nursing home, the first question is usually a quiet one. Is it just this place, or is this how it is everywhere? The federal government keeps a record that answers part of that question, and almost nobody reads it. We did. We took the Medicare Care Compare file released on 1 August 2026, which covers every nursing home that takes Medicare or Medicaid, and counted the homes carrying the federal abuse flag in every state.
The short answer.
1,426 of the 14,690 US nursing homes in the August 2026 file carry the federal abuse flag. That is 9.7 percent, about one home in ten. The share runs from 27.9 percent in Arizona, 27.8 percent in Wyoming and 27.5 percent in Illinois down to zero in Hawaii and New Hampshire. Regulators fined 6,514 homes a total of $456.8 million over the last three years, and 36 percent of homes report less nurse time per resident than the federal minimum that was repealed in February 2026.
9.7%
of US nursing homes carry the red abuse flag, 1,426 of 14,690.
$456.8M
in federal fines on record for the last three years, across 6,514 homes.
36%
of homes report less nurse time than the 3.48 hour floor repealed in 2026.
Every figure below comes from the same federal file, so they line up with each other. Fines cover the last three years. Staffing is the nurse time each home reports per resident per day, counting registered nurses, licensed practical nurses and nurse aides.
| Measure | Figure |
|---|
| Certified nursing homes in the file | 14,690 |
| Homes carrying the abuse flag | 1,426 (9.7%) |
| Residents living in a flagged home on an average day | about 144,000 |
| Homes with a one star overall rating | 3,015 (20.5%) |
| Special Focus Facilities, plus candidates | 84, plus 441 |
| Homes fined in the last three years | 6,514 (44.3%) |
| Total fines on record, last three years | $456.8 million |
| Homes with $100,000 or more in fines | 1,432 |
| Median nurse staffing per resident per day | 3.68 hours |
| Homes under 3.48 total nurse hours | 5,143 of 14,288 (36.0%) |
| Homes under 0.55 registered nurse hours | 6,423 of 14,279 (45.0%) |
| Median nursing staff turnover in a year | 44.9% |
Source: CMS Nursing Home Provider Information, processing date 1 August 2026. Analysis by MyClaimWorth.
Two numbers in that table deserve a second look. About 144,000 people live in a flagged home on any given day, out of roughly 1.26 million nursing home residents in the file. And nearly half of all homes, 44 percent, were fined at least once in three years. Fines are not rare events that happen to a few bad buildings. They are part of ordinary life in this industry.
On Medicare Care Compare, some nursing homes show a small red hand symbol next to their name. That is the abuse icon. CMS introduced it in October 2019 so families could spot homes with a record of abuse citations without reading every inspection report. It covers neglect as well as abuse.
A home gets the flag in one of two ways:
- Inspectors cited it for abuse or neglect that actually harmed a resident on its most recent inspection cycle. In inspector language that is a severity of G or higher.
- Inspectors cited it for abuse or neglect that could have harmed a resident on both of its last two inspection cycles. That is a severity of D or higher, twice in a row.
The flag has teeth. A flagged home cannot score more than two stars on health inspections, and in the August file every one of the 1,426 flagged homes sits at one or two stars on that measure. Its overall rating can still reach four stars if its staffing and quality scores are strong, which is why a home can look decent at a glance and still carry the flag. Always look for the icon itself, not just the stars.
Worth knowing. The flag is not a verdict and not a full count. It only reflects what inspectors found, cited and wrote down. Abuse that nobody reported, or that inspectors could not confirm, never shows up here. Treat the numbers as the visible part of the problem.
Here is every state and the District of Columbia, sorted by the share of nursing homes carrying the abuse flag. Each state name links to its injury law, filing deadline and fault rule.
A high share does not automatically mean the care in that state is worse. The citations come from state inspection agencies working on behalf of CMS, and some agencies find and cite more than others. A zero can mean excellent care, or it can mean fewer citations written. Hawaii and New Hampshire both had no flagged homes, yet 38.9 percent of New Hampshire homes report less nurse time than 3.48 hours per resident.
Size matters too. Wyoming's 27.8 percent is 10 homes out of 36. Illinois's 27.5 percent is 183 homes out of 666, and Illinois also carries $75.1 million in fines, about one dollar in every six fined nationally. Texas is second on fines with $53.5 million, and 71.3 percent of its homes report less than 3.48 nurse hours per resident.
State law shapes staffing. California has required 3.5 direct care hours per patient day since July 2018 under its Health and Safety Code, and only 1.9 percent of its homes fall under 3.48. The flag and the star rating also measure different things. Arizona has the highest flag share in the country, yet only 7.9 percent of its homes hold a one star overall rating, compared with 37.1 percent in Illinois and 34.0 percent in Louisiana.
When we split homes by how much nurse time they report, a clear pattern shows up. The less time nurses and aides spend with each resident, the more likely the home is to carry the abuse flag.
| Nurse hours per resident per day | Homes | Flagged | Share flagged |
|---|
| Under 3.0 hours | 1,088 | 227 | 20.9% |
| 3.0 to under 3.48 hours | 4,055 | 459 | 11.3% |
| 3.48 to under 4.1 hours | 5,121 | 443 | 8.7% |
| 4.1 hours or more | 4,024 | 256 | 6.4% |
14,288 homes that report total nurse staffing. Source: CMS, 1 August 2026; analysis by MyClaimWorth.
Homes under three hours are flagged at more than three times the rate of homes at 4.1 hours or more. That is a link, not proof that low staffing causes abuse, since the same homes may differ in other ways. But it matches what families describe: call lights that go unanswered, residents left in bed, and nobody around to see what happens at night.
It also matters because the federal floor is gone. A rule published on May 10, 2024 would have required 3.48 total nurse hours per resident per day, including 0.55 hours from registered nurses and 2.45 from nurse aides, plus a registered nurse on site 24 hours a day. Federal courts in Texas and Iowa struck the core of it in 2025. Congress then barred enforcement until September 30, 2034, and CMS repealed it in a rule published December 3, 2025, which took effect on February 2, 2026. Today 45 percent of homes report less registered nurse time than the 0.55 hours that rule would have required.
Three out of four nursing homes in the file are run for profit. Those homes carry the flag at nearly twice the rate of nonprofit homes, and more than twice as often hold a one star rating.
| Ownership | Homes | Share flagged | One star overall |
|---|
| For profit | 10,877 | 10.7% | 23.6% |
| Nonprofit | 2,868 | 5.7% | 10.7% |
| Government | 945 | 10.9% | 14.7% |
Source: CMS, 1 August 2026; ownership as reported to CMS. Analysis by MyClaimWorth.
You do not need a lawyer or a records request to see most of this. It is public, and it takes a few minutes per home.
- Search the home on Medicare Care Compare. Go to medicare.gov/care-compare, choose nursing homes, and search by name or ZIP code.
- Look for the red hand icon next to the name. If it is there, the home was cited for abuse or neglect under the rules above.
- Open the inspection report. Each citation has a tag and a severity letter. F600 covers abuse and neglect, F686 covers pressure ulcers, and F689 covers falls and accident hazards. Letters G to I mean a resident was actually harmed, and J to L mean immediate jeopardy, the most serious level.
- Check the penalties. Fines and payment denials from the last three years are listed, with dates you can match against your own timeline.
- Check staffing and turnover. Compare nurse hours per resident, weekend hours and staff turnover with the state average shown on the same page. The national median turnover is 44.9 percent a year.
- Ask for the records. A resident, or their legal representative, has a federal right to see their records within 24 hours, not counting weekends and holidays, and to get copies within two working days of asking.
A flag on the building does not prove your relative was harmed, and a home without a flag can still be responsible for an injury. A claim rests on three things: a real injury, proof the home fell below the standard of care, and a link between the two. Common examples are a hip fracture after a fall the care plan should have prevented, a pressure ulcer that reached stage 3 or 4, sudden weight loss or dehydration, medication errors, and assault by staff or another resident.
The records you gathered above become evidence. Inspection reports from the same months, the staffing numbers for those dates, photographs of injuries, the care plan and any incident reports help show what the home knew and when. Federal rules require a home to report suspected abuse, or any allegation that involves serious bodily injury, within two hours, and other allegations within 24 hours, so ask whether a report was made and to whom.
💡Check the admission packetA nursing home cannot make an arbitration agreement a condition of admission or continued care, and every such agreement must let the resident cancel it within 30 calendar days of signing. If your parent signed one, keep a copy. It affects where a claim can be heard, not whether harm happened.
What a case is worth depends on the injury and the state. Our nursing home settlement guide puts minor neglect with a full recovery at about $25,000 to $150,000, serious harm at $150,000 to $1 million or more, and wrongful death at $500,000 to $5 million. Deadlines differ by state and can be short, so check the filing deadlines early. If a resident died, the rules in our wrongful death guide apply, and some states allow punitive damages when understaffing or abuse was known and ignored.
How common is abuse in US nursing homes?
In the August 2026 Care Compare file, 1,426 of the 14,690 nursing homes that take Medicare or Medicaid carry the federal abuse flag, which is 9.7 percent, or about one home in ten. On an average day about 144,000 residents live in those homes. The flag only counts abuse and neglect that inspectors found and cited, so it is a floor, not a full count of what happens inside the buildings.
Which state has the most nursing homes cited for abuse?
By share, Arizona is highest at 27.9 percent of its homes, followed by Wyoming at 27.8 percent and Illinois at 27.5 percent. By raw count, Illinois leads with 183 flagged homes, then Texas with 137 and California with 113. Hawaii and New Hampshire had no flagged homes in the August 2026 file.
What does the red hand icon on Medicare Care Compare mean?
It is the abuse icon. CMS adds it when inspectors cited a home for abuse or neglect that actually harmed a resident on its most recent inspection cycle, or cited it for abuse or neglect that could have caused harm on both of its last two inspection cycles. A flagged home also has its health inspection rating held to one or two stars.
Is a nursing home with the abuse flag always unsafe?
Not always, but it is a reason to read the inspection report before you trust the home with someone you love. The flag reflects specific citations, which a home can dispute and fix. The report tells you what happened, how serious it was, and whether the home corrected it. A home without the flag can still have serious problems, so check staffing and fines as well.
Was the federal nursing home staffing rule repealed?
Yes. The 2024 rule would have required 3.48 total nurse staffing hours per resident per day, including 0.55 hours from registered nurses and 2.45 from nurse aides, plus a registered nurse on site around the clock. Two federal courts struck the core of it in 2025, Congress barred enforcement until 2034, and CMS repealed it in a rule that took effect on February 2, 2026. Some states, such as California, keep their own minimums.
Can I still sue if my parent signed an arbitration agreement at admission?
Often you still have options. Federal rules say a nursing home cannot make an arbitration agreement a condition of admission or continued care, and the agreement must give the resident 30 calendar days to cancel it after signing. Whether a signed agreement can be enforced depends on how it was presented and on state law, so bring the admission paperwork to any lawyer you speak with.
How much are nursing home abuse and neglect cases worth?
The ranges we publish in our nursing home settlement guide run from about $25,000 to $150,000 for minor neglect with a full recovery, $150,000 to $1 million or more for serious harm such as deep pressure ulcers or a hip fracture from a preventable fall, and $500,000 to $5 million for wrongful death. Evidence of known understaffing or repeated citations can push a case higher.
About one US nursing home in ten carries the federal abuse flag, and in a few states it is closer to one in four. The flag, the fines and the staffing numbers are all public, and together they tell you more than any brochure. If someone you love was hurt in a nursing home, write down what you saw, keep every document, and look up the home before the details fade.
