We Analyzed 59,346 Senior Care Facilities — Key Findings

When you're searching for a senior care facility for your parent, you're told to trust the ratings. Five stars means excellent. One star means bad. Simple, right? Wrong. At Kinporch, we aggregated publicly available Centers for Medicare & Medicaid Services (CMS) inspection data on 59,346+ verified senior care facilities across the United States. What we found should alarm you. The data reveals a system where nearly every facility receives at least one deficiency, where deficiency rates have surged 40% in a single decade, and where the star rating system itself is designed by CMS to ensure that 20% of all facilities will always be rated at the bottom — regardless of actual performance.

The Core Finding: 9.5 Deficiencies per Facility, Up 40% Since 2015

According to the Kaiser Family Foundation's 2025 analysis of CMS data, the average nursing facility now carries 9.5 deficiencies on its record. That's up from 6.8 deficiencies per facility in 2015 — a 40% increase in just one decade. To put that in context: in 2015, a facility averaging 6.8 deficiencies was considered borderline problematic. Today, 9.5 is the national average.

What are these deficiencies? According to KFF data, the most common violations include failure to provide necessary care (the single largest category), failure to report abuse or neglect to authorities, infection control failures, insufficient staffing or inadequate staff training, and poor medication management. These aren't bureaucratic technicalities. Failure to provide necessary care and failure to report abuse are tied directly to resident harm.

The Hidden Severity: 27% of Facilities Have Deficiencies Linked to Actual Harm

Here's where the data gets darker. Of all nursing facilities in the United States, 27% have deficiencies specifically cited for actual harm or jeopardy to residents, according to KFF's 2025 analysis of CMS inspection records. This doesn't mean 27% of facilities caused harm once. It means CMS inspectors documented evidence that the facility's practices could result in harm or did result in documented harm.

CMS doesn't hand out these citations lightly. The agency classifies deficiencies on a scale: potential for minimal harm (most common, still the majority of deficiencies) and actual harm or immediate jeopardy (what 27% of facilities receive). The second category means CMS inspectors found evidence that residents were at immediate risk of death, serious bodily injury, or permanent harm. Learn more about how to interpret these findings in our guide on how to read nursing home inspection reports .

The Star Rating Design: A System Built on Forced Distribution

When you see a nursing home with 5 stars on CMS, it feels definitive. When you see 1 star, it feels like a failing grade. Neither impression is accurate. CMS Star Ratings are relative, not absolute. By design, the top 10% of facilities in each state receive 5 stars, the bottom 20% receive 1 star, and the middle 70% get 2, 3, or 4 stars.

This is CMS's deliberate methodology. It means that in any state, one facility must be in the bottom 20%, earning 1 star — no matter how well it actually performs relative to national standards. The three domains CMS evaluates are health inspections (deficiency frequency and severity), staffing levels (nurse-to-resident ratios), and quality measures (readmissions, infections, etc.). Inspections are unannounced and typically last 3-5 days. Read our complete guide to CMS star ratings for a deeper breakdown.

Nearly All Facilities Get At Least One Deficiency

According to KFF data, nearly all nursing facilities receive at least one deficiency during CMS inspections. There is essentially no such thing as a "deficiency-free" facility in America. This raises a hard question: if nearly all facilities have violations, are the violations meaningful?

The answer is yes and no. On one hand, it suggests that CMS standards are comprehensive and catch real issues in almost every facility. On the other hand, it means that the presence of some deficiencies is not unusual — the question becomes whether the deficiencies are minor, widespread, severe, or tied to harm. Use Kinporch's facility search to see the full deficiency breakdown for any facility in our database.

The 40% Increase Over a Decade: Why It Matters

The jump from 6.8 to 9.5 average deficiencies since 2015 could mean several things. First, actual conditions may have worsened — staffing shortages, post-pandemic strain, and operational challenges could genuinely be increasing violations. Second, CMS inspection rigor may have increased — more thorough inspections might catch more violations, even if underlying conditions haven't changed. Third, regulatory scope may have expanded — CMS may have added new categories of deficiencies over the decade.

The reality is likely a combination. What's certain is that facilities today face significantly more documented violations than they did ten years ago. For families, this means that comparing a facility's current deficiency count to historical averages is essential — and reviewing the specific inspection findings matters more than ever.

What This Data Means When You're Choosing a Facility

The Kinporch database aggregates all publicly available CMS data on verified facilities. We don't filter, recommend, or hide any information. Here's how to interpret what you'll find:

Read the deficiency details, not just the count. Two facilities with the same number of deficiencies can be very different. One might have five minor violations and four major ones. Another might have nine minor violations and none major. CMS data includes the severity classification and the specific violation cited. Read them.

Compare star ratings within your state. A 1-star facility in California isn't necessarily worse than a 1-star facility in Texas. But within your state, the relative comparison is more meaningful. A 5-star facility is in the top 10% of your state; a 1-star facility is in the bottom 20%. Search by state on Kinporch for direct comparisons.

Check for recent deficiencies vs. historical ones. CMS inspection history spans years. Recent deficiencies matter more than those from 2015. If a facility had violations five years ago but has been clean for three years, that's different from ongoing violations.

Look for the "actual harm or jeopardy" flag. In CMS data, deficiencies are classified by severity. Facilities with multiple citations for "actual harm or jeopardy" are in the 27% category — those with documented evidence of serious resident risk. This is the data point that should trigger deeper investigation.

How Kinporch Uses This Data

Kinporch's directory includes all 59,346+ verified facilities with direct links to their complete CMS inspection records. We show full deficiency lists (not summaries), severity classifications, inspection dates, staffing ratios, quality measure data, and ownership information. No referral fees — we're not paid when families choose a facility. You can see exactly what CMS found and when. No filters. No incentives to hide bad data.

Search Kinporch's database of 59,346+ verified facilities. Filter by state, city, or quality metrics. View unfiltered CMS deficiency data for any facility. Use the cost calculator to understand pricing in your area.

Related reading:

• How to Read a Nursing Home Inspection Report (And What Red Flags to Look For)
• Understanding CMS Star Ratings for Nursing Homes
• Why Kinporch Doesn't Take Referral Fees (And Why It Matters)

Search senior care facilities on Kinporch — with unfiltered CMS data, no referral fees, and transparent quality metrics for 59,346+ facilities nationwide.