Why Nursing Home Inspections Are Changing—And What It Means for Your Loved One’s Safety

Nursing home inspections expected to fall under Trump budget.

If someone you love lives in a nursing home, you trust that someone is checking to make sure they’re safe, clean, and cared for. These checks, called nursing home inspections, are required by law and are supposed to happen every year. But a big change is coming: the government agency that oversees inspections wants to focus more on complaints and less on regular checkups.

In its proposed 2026 budget, the Centers for Medicare & Medicaid Services (CMS) says it will put more money into complaint-based inspections, which only happen when someone reports a problem. As a result, many facilities might go years without a full inspection unless someone speaks up.

This shift affects how families make decisions, how accurate nursing home ratings are, and whether residents stay safe. Here’s what’s changing, why it matters, and what you can do about it.

What Are Nursing Home Inspections?

Nursing home inspections, also called recertification surveys, are required to happen about every 12 to 15 months. During these inspections, state surveyors check every area of care, including:

• Staff training and conduct

• Food safety and cleanliness

• Infection control

• Medication and nursing services

• Abuse prevention and resident rights

These inspections also directly affect a facility’s rating on the CMS Care Compare website, which many families rely on when choosing a home.

What Is a Complaint-Based Inspection?

If someone—like a family member or nurse—calls CMS or their local state agency and reports something bad, that triggers a complaint inspection. These come in four levels:

🚨 Immediate Jeopardy (IJ) – The most serious. Inspectors must respond within 2 days.
These are life-threatening or extremely dangerous situations.
Examples:

• A resident with dementia wanders out of the building at night and is found hours later outside in extreme weather.

• A staff member hits a resident, and the incident is confirmed by another employee or video footage.

• A diabetic resident doesn’t receive insulin for three days and ends up in the hospital with dangerously high blood sugar.

⚠️ Non-IJ High (NIJH) – Still urgent, must respond within 10 days.
These are very serious problems, but not immediately life-threatening.
Examples:

• A resident develops a pressure sore that worsens over a week because the care plan wasn’t followed.

• Medications are regularly delayed or skipped, and several residents show signs of harm.

• Broken air conditioning during a heatwave is not fixed for several days, putting frail residents at risk.

Medium and Low complaints – These are reviewed later or remotely and may not result in an on-site inspection unless additional issues are found.

Between 2015 and 2024, Immediate Jeopardy complaints increased by 75%, and confirmed serious findings more than doubled. These complaints are serious, and they deserve fast responses. But complaint-based inspections only look at one issue at a time, not the whole picture.

Why This Matters: Less Routine Oversight

CMS’s 2026 budget proposal increases funding for complaint surveys, but expects to inspect only 65% of nursing homes routinely, down from 74% in 2024. This is due to:

• More serious complaints (especially IJ and NIJH)

• Not enough surveyors and ongoing staffing shortages

• Limited federal resources despite growing need

If no one complains, many nursing homes might not be inspected again for years—even if conditions get worse.

Why Star Ratings May Mislead Families

Star ratings on Care Compare depend heavily on the most recent full inspection. If a nursing home hasn’t had one in years, the rating may be misleading.

• A low-rated home might have improved but won’t show it until re-inspected

• A high-rated home could have declined—but the outdated rating hides that from families

What About Inspections in Maryland, Virginia, and DC?

Maryland

• During COVID, many facilities went over 3 years without a full inspection

• Maryland’s failure to regularly inspect nursing home is at issue in class action lawsuit.

• The Office of Health Care Quality is working through the backlog

• Families should request both CMS and state inspection reports

Virginia

• The Virginia Department of Health conducts both routine and complaint inspections

• They’re ahead of many states, but still prioritize complaints over routine visits

• Use the Virginia Health Facility Locator for inspection details

Washington, DC

• Fewer nursing homes, but long inspection delays remain

• Complaint-based inspections come first

• Check DC’s Healthcare Facilities Division for the latest updates

Can States Catch Up by Combining Inspections?

Sometimes. If a complaint is filed and the facility is overdue for a full inspection, states can combine both into one visit. This helps update the public record and reduce delays.

But:

• It’s optional—not every state does it

• If the complaint isn’t serious, the facility might still avoid a full inspection

What You Can Do as a Family Member

• Ask the facility: “When was your last full inspection?”

• File a complaint if you see abuse, neglect, or safety issues

• Use both Care Compare and state inspection tools to get the full picture

• Don’t trust the star rating alone—ask what’s changed since the last inspection

Final Thoughts: Routine Inspections Still Matter

Complaint-based inspections help stop urgent problems. But they don’t replace routine nursing home inspections that look at the full picture of care. Without these, families are left in the dark, and residents may face risks no one is tracking.

If you live in Maryland, Virginia, or DC, ask more questions, stay involved, and push for timely inspections. Oversight saves lives—and it starts with informed families.