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U.S. Senate Hearing Reveals Concerns for State Nursing Home Inspections

In May 2023, the U.S. Senate Special Committee on Aging held a hearing to investigate the nursing home inspection system. The results were disheartening that may only worsen without immediate action from nursing homes and the federal inspection system.

The committee found that most states have a backlog for nursing home inspections. The top driving factors affecting the lack of nursing home inspections in the U.S. included poor wages for inspectors, pressures for inspectors to complete more inspections in shorter time periods, and an overall lack of federal funding.

The lack of oversight among nursing home facilities is so dire that Pennsylvania Senator Bob Casey called it a “system in crisis” in his statement to the committee.

With such a concerning backlog, nursing home abuse and neglect could go unreported, leaving those most in need without the care they deserve.

The Nursing Home Inspection Crisis

Nursing home inspection reports are foundational in holding facilities accountable for the quality of care for residents. These reports are also made available to the public via programs like Care Compare, allowing people to see nursing home ratings near them.

But with alarming staffing shortages, these inspections are long overdue, causing inaccurate ratings and leaving residents without support.

The congressional investigation found:

  • 31 states and Washington D.C. had inspection staff vacancy rates of 20% or higher.
  • 9 of these states had more than 50% of their inspector jobs vacant.
  • Kentucky and Alabama were the most alarming, with more than 80% of inspector jobs unfilled.

Senator Casey explained that these vacancies and lack of oversight threaten the safety of nursing home residents “as their complaints collect dust while inspectors struggle to meet the demand.”

Cause of Inspector Understaffing

For years state agencies have struggled to retain inspectors, but several factors seem to increase turnover rates.

Some factors affecting high turnover rates among nursing home inspection staff include:

  • COVID-19: The pandemic caused many staff members to enter early retirement, and many others in the nursing industry decided to find other career paths.
  • High stress and burnout: Inspectors may be pressured to complete inspections quickly without support staff to keep up with their backlog. They also may remain away from home for weeks while traveling between nursing homes, causing much more stress and burnout than other nursing jobs.
  • Stagnant wages: Nursing home inspectors are too often underpaid compared to other nursing positions. In some states, such as Florida, nursing home inspectors are paid less than half the statewide average rate.

The Life-Threatening Result of Inspection Delays

Unfortunately, the result of all these factors often means that many nursing home abuse cases are not investigated or delayed for months or more. These delays can cause abusive situations to worsen and even lead to wrongful death of the resident.

In fact, one Colorado ombudsman, Leah McMahon, provided testimony about multiple cases of abuse that went uninvestigated by the state agency. Most of the cases she discussed were not followed up with by state inspectors until a year or more after the initial report.

One resident who experienced physical abuse and injuries moved out before the state inspectors began an investigation a year later. The resident’s family reported their loved one still suffered mental health struggles, including post-traumatic stress disorder (PTSD) due to the abuse, even after moving out.

Improving Nursing Home Inspections and Facility Conditions

The key takeaway of the Senate’s Special Committee on Aging’s hearing is that a lack of federal funding directly impacts nursing home inspection rates.

The past few decades of research into nursing home conditions have revealed the need for a systemic change — and that begins with proper funding.

During his opening statement, Senator Casey revealed that of the billions of dollars delegated from federal funding to nursing homes, less than $.80/day per resident is dedicated to nursing home oversight.

Congress would need to drastically increase funding as soon as possible to fuel the change necessary for proper oversight and inspections in nursing home facilities.

Take Action for Nursing Home Abuse & Neglect Claims

With state inspection agencies falling behind on investigations, residents are left in abusive and dangerous care facilities. It is crucial for the federal government to take immediate action to address the crisis that many experts anticipate to get worse.

The team at the Nursing Home Abuse Center is committed to advocating for residents and ensuring everyone is treated with dignity. If your loved one has suffered abuse or neglect in a nursing home, you don’t have to wait on the broken inspection system.

Reach out to us now to see if we can connect you with an experienced nursing home abuse law firm for a free case evaluation, legal advice, and more.

Nursing Home Abuse Support Team

The Nursing Home Abuse Center (NHAC) was founded to bring justice to those affected by nursing home and elder abuse. Our mission is to educate and empower victims of abuse and their families to take a stand against this unlawful mistreatment. We work to return dignity back to those who have been broken down by nursing home abuse and neglect.

  1. AARP (January 2021). “10 Steps to Reform and Improve Nursing Homes.” Retrieved from Accessed on July 6, 2023.Accessed on July 6, 2023.
  2. United States Senate Special Committee on Aging (May 2023). “Chairman Bob Casey’s Opening Statement.” Retrieved from Accessed on July 6, 2023.
  3. United States Senate Special Committee on Aging (May 2023). “Residents at Risk: The Strained Nursing Home Inspection System and the Need to Improve Oversight, Transparency, and Accountability.” Retrieved from Accessed on July 6, 2023.
  4. USA Today (May 2023). “Where are the inspectors? How a lack of nursing home oversight is endangering residents.” Retrieved from Accessed on July 6, 2023.