In rural communities, 27% of certified nursing facilities received deficiencies for actual harm or immediate jeopardy, compared to 29% of facilities in urban communities, KFF found.
KFF used Nursing Home Compare as of July 2025 to determine the number of certified nursing facilities in the U.S. that received a deficiency notice. Deficiencies included actual harm and immediate jeopardy warnings. KFF calculated the percentage of facilities in rural and urban communities. Rural counties are those that do not contain at least one metropolitan area.
Illinois has the highest percentage of urban facilities cited at 64%, while South Dakota has the highest percentage of rural facilities cited at 58%.
By contrast, Alaska had no rural facilities cited and only 3% of New Hampshire’s urban facilities were cited.
Here are the states with the percentage of nursing facilities in rural and urban areas that were cited with deficiencies.
Note: Some locations do not have facilities in rural areas, as denoted by N/A.
| State | Percentage of nursing facilities in rural areas | Percentage of nursing facilities in urban areas |
| Alabama | 9% | 16% |
| Alaska | 0% | 33% |
| Arizona | 44% | 14% |
| Arkansas | 10% | 20% |
| California | 36% | 25% |
| Colorado | 36% | 43% |
| Connecticut | 24% | 27% |
| Delaware | 27% | 53% |
| District of Columbia | N/A | 35% |
| Florida | 9% | 19% |
| Georgia | 15% | 14% |
| Hawaii | 8% | 31% |
| Idaho | 22% | 39% |
| Illinois | 57% | 64% |
| Indiana | 15% | 16% |
| Iowa | 31% | 28% |
| Kansas | 33% | 37% |
| Kentucky | 22% | 22% |
| Louisiana | 30% | 29% |
| Maine | 9% | 18% |
| Maryland | 25% | 31% |
| Massachusetts | 40% | 22% |
| Michigan | 29% | 34% |
| Minnesota | 29% | 35% |
| Mississippi | 30% | 40% |
| Missouri | 26% | 27% |
| Montana | 34% | 44% |
| Nebraska | 13% | 27% |
| Nevada | 30% | 18% |
| New Hampshire | 3% | 3% |
| New Jersey | N/A | 23% |
| New Mexico | 38% | 39% |
| New York | 18% | 13% |
| North Carolina | 28% | 38% |
| North Dakota | 36% | 48% |
| Ohio | 23% | 29% |
| Oklahoma | 22% | 23% |
| Oregon | 35% | 30% |
| Pennsylvania | 19% | 25% |
| Rhode Island | N/A | 48% |
| South Carolina | 37% | 26% |
| South Dakota | 58% | 48% |
| Tennessee | 13% | 19% |
| Texas | 28% | 42% |
| Utah | 53% | 41% |
| Vermont | 16% | 29% |
| Virginia | 16% | 27% |
| Washington | 25% | 39% |
| West Virginia | 26% | 32% |
| Wisconsin | 38% | 41% |
| Wyoming | 34% | 17% |
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