African-American man showing grief while leaning on cane
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An organization dedicated to helping seniors find care issued a report Tuesday raising alarm about the number of nursing home abuse citations in 2023, but senior care leaders say a more punitive approach to surveys is actually hurting residents and their facilities.

The report used last year’s Medicare data to highlight that nursing homes received nearly 95,000 health citations during that time frame. Of that number, nearly 7,700 — or approximately 8% — were citations for abuse, neglect or exploitation.

That 8% figure has held steady each year since 2021, according to Corie Wagner, senior editor of industry research at In 2019, however, CMS data shows the total number of citations was around 58,000  — or about 61% of last year’s total — with only 2,500 (4%) being abuse incidents.

Of the abuse citations, around 30% were tied to facilities not reporting abuse or neglect, and 11% resulted from a lack of policies to deter abuse.

“This information is essential because awareness is necessary for making a change,” Wagner told McKnight’s Tuesday. “Though abuse citations did not make up the majority of health citations, eight percent is still a significant share. Until the number reaches zero, elder abuse will still be an important issue to address.”

Data trends are difficult to discern from these numbers alone, noted Melissa Brown, chief operating officer of Gravity Healthcare Consulting.

“While even one abuse citation is one citation too much, it is difficult to determine if there is actually more abuse occurring, or if the surveyors are being more precise during surveys,” she told McKnight’s Tuesday.

Heightening oversight

In recent months, federal and state governments have been ramping up investigations into fraud and abuse cases in eldercare. The Department of Justice convened a two-day summit in February to coordinate efforts on this issue between all levels of government.

Long-term care leaders have steadily pledged their willingness to cooperate with regulators to eradicate elder abuse. Such commitments also typically note that elder abuse is rare at nursing homes.

Skilled nursing representatives also have also worried that increased oversight could add to the burden already placed on facilities’ limited time and resources. Even if no wrongdoing is found, they remind, nursing homes would still need to deal with the cost and distraction inherent to any investigation.

“It is appalling how many more overall citations have occurred as compared to pre-pandemic levels,” Brown said, highlighting the difference between a more collaborative approach from surveyors before the pandemic to a more aggressive and punitive approach taken by the current administration.

“The current administration has placed a large, public target on SNFs, and this is proven with the 79% increase of overall survey citations from 2019 to 2023,” she continued. “Now is the worst time for Medicare to punish the SNFs that have survived the pandemic and are providing a vital level of care for seniors…. SNFs are hanging on by a thread. These expensive citations can be the nail in the coffin for great SNFs that got caught in the crosshairs.”

The report said that nursing home residents are at particular risk for abuse as a population due to the complex cognitive and physical challenges many face as they age. Abuse may also go unreported or unpunished in such cases. 

Following the report, Wagner called for heightened awareness and training from nursing homes and for stricter penalties for abuse incidents to be instituted by lawmakers.

“Nursing homes must be committed to taking all suspected and reported abuse allegations seriously and investigating each one in a timely fashion,” Wagner said. “They must train their staff in identifying the signs of abuse, and make sure every worker understands how to promptly report abuse of residents. Policymakers should create stronger penalties and fines for facilities and workers who commit abuse.”