Illinois, Rhode Island, New Mexico Lead U.S. in Nursing Home Penalties

If you’re helping a parent—or concerned about long-term care planning for your future—you want confidence that the care setting you choose is safe. The latest federal data show troubling penalties for nursing homes in some states, while assisted living and memory care communities operate under weaker state oversight. Add in the fact that most nursing home residents rely on Medicaid, and the stakes for planning ahead couldn’t be higher.

While most long-term care services are delivered at home or in assisted living, there is still a need for nursing home care. Most Medicaid services are provided in nursing homes. Medicaid pays for long-term care for those with limited financial resources.

Health insurance and Medicare only pay for short-term skilled care, usually in a nursing home. Long-Term Care Insurance will pay for extended care services in any environment.

• Learn More: The Basics of Long-Term Care Insurance

Illinois Leads Nation in Nursing Home Penalties

A July 2025 review by Florida law firm Anidjar & Levine examined the Centers for Medicare & Medicaid Services (CMS) nursing home penalties dataset, ranking states by penalties per 100 certified facilities and average fine per facility.

On a 100-point scale, Illinois scored the maximum 100/100.

• Illinois: 2,312 penalties across 682 facilities; $78.4 million in fines (≈$114,965 per facility).
• Rhode Island: 218 penalties across 74 facilities; fines $6.74 million (≈$91,073 per facility).
• New Mexico: 201 penalties across 68 facilities; fines $4.49 million (≈$66,037 per facility).

Other states in the top 10 included Washington, Montana, Michigan, Texas, Missouri, Vermont, and North Carolina.

The Long-Term Care Community Coalition (LTCCC), which independently analyzes CMS enforcement data, reports that nursing homes nationwide have accrued more than $560 million in fines in the past three years, with Illinois consistently near the top.

What Penalties Do—and Don’t—Tell You

A higher penalty rate doesn’t always mean worse care. States with stricter inspection practices may issue more fines, while others may under-report problems. For families, this means you should focus less on statewide rankings and more on the inspection history of individual facilities.

You can use CMS’s Care Compare tool to check deficiencies, staffing levels, and penalty history for facilities you are considering. Pair that with on-site visits at different times of day to get the full picture. However, they don't cover assisted living or memory care facilities.

The LTC News Caregiver Directory has the largest database of caregivers and long-term care facilities, showing Google ratings and more. The free tool allows you to search for extended care providers by zip code.

• Guide to Home Care: Services, Costs, and Search Tools
• Guide to Assisted Living: Facility Services, Costs, and Search Tools
• Complete Guide To Nursing Homes

Who Pays for Nursing Home Care? Mostly Medicaid

Many families assume there are “Medicaid homes” and “private-pay homes.” In reality, almost all facilities accept multiple payer sources. However, there are facilities where the majority of residents are on Medicaid.

• 96% of nursing homes are dually certified for both Medicare and Medicaid. “Private-pay only” facilities are rare. Keep in mind that Medicare only pays for short-term skilled care. Medicaid requires you to have limited financial resources.
• As of July 2024, 63% of residents relied on Medicaid as their primary payer, 13% on Medicare (short-term stays), and 24% on private pay or Long-Term Care Insurance.

This makes Medicaid the dominant funding source in nursing homes nationwide. Private payers—especially those with Long-Term Care Insurance—typically gain faster access to extended care and more choice, and often better quality of care.

Assisted Living and Memory Care: Fewer Penalties, More Private Pay

Unlike nursing homes, assisted living (AL) and memory care facilities are regulated at the state level. That means there’s no comprehensive federal database for violations. Families face a patchwork of oversight, with transparency depending heavily on where you live.

Still, research and reporting paint a concerning picture:

• A 2019 survey found 28% of assisted living residents reported abuse, ranging from verbal mistreatment to physical harm.
• In 2025, a fire at Gabriel House in Massachusetts killed 10 residents. State records revealed prior violations, including medication mismanagement, unsafe conditions, and staff neglect. Certification had been temporarily revoked in 2016 before being reinstated.
• A 2025 Guardian investigation uncovered systemic problems in assisted living, including hidden fees, understaffing, and lack of dementia-care training—even in costly, high-end facilities.

Unlike nursing homes, which rely mostly on Medicaid, assisted living and memory care are overwhelmingly private-pay. Industry surveys show more than 80% of assisted living revenue comes from private sources.

Medicaid waivers exist in some states, but only about 18% of AL residents receive Medicaid support, and even then, coverage is limited to services—not room and board.

• What this means for you: If you—or your loved one—need assisted living or dementia care, planning is critical. Families with Long-Term Care Insurance have more access to higher-quality care communities. Without it, choices may be limited to what’s affordable out-of-pocket.

How to Check Assisted Living Violations in Your State

Because there’s no single federal database, you’ll need to rely on state and local tools:

• State licensing portals (e.g., FloridaHealthFinder, California’s Department of Social Services, Texas Health and Human Services) publish inspection reports and complaints.
• Local ombudsman offices can share recent complaints or inspection findings.
• Consumer reviews should be considered cautiously, but can highlight repeated issues.
• Ask direct questions:

• Has this facility been fined in the past three years?

• What were the most recent state inspection results?

• What is your staff turnover rate?

• How many caregivers are on shift overnight?

Before Selecting Extended Care for a Loved One

Before choosing any care setting for a loved one, you should take several important steps to ensure quality and financial stability. For nursing homes, begin with the federal CMS Care Compare tool, then follow up with in-person visits to see conditions firsthand.

If you are considering assisted living or memory care for a loved one, check your state’s inspection portals, search the LTC News Caregiver Directory, and narrow down your choices.

Then be sure to ask direct questions about staffing and care practices, and tour the facility unannounced at different times of day to get a realistic picture of daily operations.

Use the LTC News Cost of Care Calculator to compare their cost to the current (and future) median average costs of extended care services in your area. Long-Term Care Insurance can play a crucial role in expanding options, getting a room in a top facility, and reducing family burden.

When your loved one is entering a care facility, be sure to inform the admissions director about any existing Long-Term Care Insurance policy. Facilities often give priority to residents with coverage, and in many cases, it can move your loved one to the front of the line for admission to higher-quality options.

You can get free help filing an LTC Insurance claim. LTC News partners with Amada Senior Care to provide free claim support with no cost or obligation. Their trained experts can walk you through the entire process and help you access benefits quickly and correctly — File a Long-Term Care Insurance Claim.

The Bottom Line

Illinois may top the nation in penalties, but nursing home risks exist everywhere. Assisted living and memory care facilities, while often more home-like, operate with weaker oversight and depend heavily on private funds.

For families, the lesson is clear: rely on data, ask hard questions, and plan early for how you will pay. If you have savings and loved ones you care about, affordable Long-Term Care Insurance can be a big part of your retirement plan.

Make sure you work with a specialist in long-term care planning who can provide accurate quotes from all the top-rated insurance companies offering long-term care solutions. This is not the role of a general financial advisor or insurance agent, as they often lack the training and licensing needed to give the best guidance. Even those who are licensed frequently represent only one or two companies, limiting your options.

Choosing independent Long-Term Care Insurance specialists you can trust is crucial for obtaining accurate and tailored quotes. Look for specialists with extensive knowledge of LTC Insurance, including a deep understanding of underwriting, policy design, and claims processes.

LTC News has pre-screened independent Long-Term Care Insurance experts who understand the complexities of Long-Term Care Insurance and can accurate quotes from all the top insurance companies offering long-term care solutions.

These experts often hold the CLTC designation, are endorsed by the American Association for Long-Term Care Insurance, and are highly recommended as Ramsey Trusted Pros by Dave Ramsey's organization.

Whether your family is currently in crisis with a loved one who needs care, or you are preparing for the future costs and burdens of aging, LTC News has the tools and resources available to help you and those you love.