Nursing Home Abuse Citations


In October 2019, as a part of CMS’s initiative to improve quality in nursing homes and to help give consumers more information, a new icon was added to some facilities on Nursing Home Compare.  Those facilities with a history of Abuse received a controversial “Red Hand” icon, and with it, a cap on Star Ratings.


Nursing Homes receive an annual unannounced Health Inspection (or Survey) and at that time, surveyors may issue deficiencies in several categories based on their observations.

There are 5 types of deficiencies that qualify for abuse (see below).  Facilities with either:

  • A harm-level abuse deficiency (scope/severity G or higher) on the most recent Survey, or
  • Repeat abuse deficiencies (scope/severity D or higher on each of the last two Surveys)

will earn the “Red Hand.”  In addition to the icon appearing on Nursing Home Compare, facilities with this Abuse designation have their Survey Star Rating capped at 2 stars

As a result, consumers may be less likely to send their loved ones to the home, hospitals may be less likely to refer, and financing more difficult to come by.  In our analysis, approximately 5% of Nursing Homes have been cited for Abuse.

Within StarPRO, we highlight not only those facilities that have the Abuse flag, but also those with any deficiencies in the abuse category.  As Surveys cycle in and out, it can be valuable to understand whether or not a facility is at risk for an abuse citation in the future or in case CMS broadens the definition.

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  Below are the deficiencies that can qualify a facility for abuse:
  • F600: Protect each resident from all types of abuse, such as physical, mental, sexual abuse, physical punishment, and neglect by anybody
  • F602: Protect each resident from the wrongful use of the resident’s belongings or money
  • F603: Protect each resident from separation from other residents, his/her room, or confinement to his/her room
  • F223: Protect each resident from all abuse, physical punishment, and involuntary separation from others
  • F224: Protect each resident from mistreatment, neglect, and misappropriation of personal property
For more details on the Abuse flag, read the CMS Memo.

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