Reviewing data involving 81,769 standard nursing home health inspections from 2016 to April 2024, researchers find that delays in two consecutive standard inspections lead to more total deficiencies, but not to lower nurse staffing levels. Wilson Lin, Lauren Xiaoyuan Lu, Susan Feng Lu, “Do Inspection Delays Lead to Quality Decline? Evidence from U.S. Nursing Homes” (article can be downloaded from link), Social Science Research Network (Jun. 2025). In more nuanced findings about the effects of delayed surveys, the researchers find (1) for-profit facilities are more affected by delayed surveys than non-profit facilities, “likely due to their profit-driven operational policies;” (2) survey areas related to resident care and safety “experience significant deterioration as inspection delays increase;” and (3) negative effects are more pronounced when delays exceed 24 months.” Surprisingly, the researchers find that survey delays did not affect nurse staffing levels, a finding they attribute to the frequent monitoring of staff through the payroll-based journal (PBJ) system.
In “Uninspected and Neglected: Nursing Home Inspection Agencies are Severely Understaffed, Putting Residents at Risk,” the Majority Staff of the Senate Special Committee on Aging reported in May 2023:
Federal data show that, as of early May 2023, 28 percent of the Nation’s 15,000 nursing homes have not received a comprehensive annual inspection for 16 months or more, placing them behind on statutorily mandated annual inspection schedules. One in nine nursing homes across the Nation have not received an annual inspection in two years.
The federal survey budget has remained flat for more than a decade and the result is failure to protect residents. Full federal funding for oversight activities is critical and long overdue.
July 10, 2025 – T. Edelman