Date of Award

1-23-2026

Document Type

Thesis

Degree Name

Master of Arts (MA)

Department

Criminal Justice

First Advisor

Molly Smith

Abstract

Nursing homes are among the most closely regulated providers in the U.S. healthcare system, with both federal and state agencies working together to monitor care and help protect residents. The COVID-19 pandemic, however, introduced unprecedented challenges for facilities and survey agencies alike, disrupting normal operations, limiting in-person visits, and temporarily shifting regulatory priorities. The purpose of this study was to examine how these pandemic-related disruptions were reflected in the severity and reporting patterns of substantiated abuse and neglect deficiencies in U.S. nursing homes. Using publicly available data from the Centers for Medicare & Medicaid Services (CMS), this study analyzed 39,607 substantiated deficiencies related to abuse and neglect recorded between March 1, 2018, and February 29, 2024. Deficiencies were grouped into three two-year periods – pre-pandemic, pandemic, and post-pandemic – and evaluated using a CMS severity/scope numeric scoring system. A repeated measures ANOVA was used to assess whether mean severity scores differed significantly across the three timeframes, and a chi-square test of independence was used to examine whether the proportion of deficiencies originating from complaints changed over time. Results indicated a statistically significant overall difference in severity scores, driven primarily by higher mean severity in the post-pandemic period compared to the pandemic period, while pre-pandemic severity did not differ significantly from either timeframe. The chi-square analysis showed a statistically significant increase in the proportion of complaint-based deficiencies over time, with complaints comprising roughly half of deficiencies pre-pandemic and more than three-quarters during and after the pandemic. Taken together, these findings suggest that pandemic-related constraints may have temporarily reduced the ability of traditional survey processes to detect serious issues, while complaint pathways remained an important mechanism for elevating resident and family concerns. The results underscore the importance of resilient oversight systems, ongoing collaboration between providers and regulators, and sustained investment in the long-term care workforce to support safe, high-quality care for nursing home residents during both routine operations and future public health emergencies.

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