In the first three months of 2026, federal inspectors cited nursing homes more often for failing to protect residents from other residents than for any other category of abuse, neglect, or exploitation, including abuse by employees.
That finding comes from a KFF Health News analysis of federal inspection reports, reported by Jordan Rau and published by NPR. Since the start of 2024, the Centers for Medicare and Medicaid Services has faulted nursing homes at least 700 times for failing to protect residents from physical, sexual, or verbal abuse by other residents.
For families choosing a facility, this reframes a question most people ask incorrectly. The instinct when touring a nursing home is to assess the staff. The federal record suggests that the more commonly documented failure is supervision, and that the risk often comes from another resident down the hall.
How the Count Was Produced
Methodology matters here, because a citation count is not a count of incidents.
The analysis examined citations for violations of the Medicare and Medicaid regulation establishing each resident's right to be free from abuse, neglect, and exploitation. It looked only at the most serious citation levels: those where inspectors determined that one or more residents had been harmed, or that a facility's actions caused, or were likely to cause, residents to be in immediate jeopardy of serious injury, impairment, or death.
Reports since January 2024 were reviewed, and those explicitly describing resident-to-resident altercations were tallied. A more detailed analysis covered a subset from January through March 2026 involving harm or immediate jeopardy, with each report categorized by type of abuse, neglect, or exploitation. That subset is where the comparison with staff-perpetrated abuse comes from.
Two limits follow directly from that design. Citations reflect what inspectors found and documented during surveys, not the total number of altercations, which remains unknown. And federal inspection records cover only nursing homes. Assisted living facilities, including most memory care units, are regulated by states and do not appear in this data at all.
That second limitation is substantial. Some of the most serious cases in the reporting occurred in assisted living settings that no federal count would capture.
What Research Suggests About How Often This Happens
Because citations undercount, prevalence research is the better guide to scale.
Cornell University researchers studying 14 assisted living facilities in New York estimated that roughly 1 in 7 residents experienced aggression within a single month, counting verbal, physical, or sexual acts. A separate Cornell study of 10 New York nursing homes estimated 1 in 5 residents experienced an altercation in a month.
Most of that is verbal. The researchers estimated that about 4 percent of assisted living residents and 5 percent of nursing home residents experienced physical assaults in a month.
Another Cornell study found Connecticut police were called to nursing homes over resident-to-resident conflicts more often than for allegations of staff abuse, theft, and residents wandering away combined. A national analysis of CDC survey data calculated that nearly 8 percent of assisted living residents engaged in physical aggression toward other residents or staff.
Research has consistently found that residents who act aggressively are disproportionately likely to have dementia. More than 900,000 of the roughly 2.2 million people living in these settings have Alzheimer's disease or another dementia.
The Industry Position, and the Counterargument
Long-term care operators say not every altercation can be prevented, and the argument is not frivolous.
Presbyterian Homes & Services, a nonprofit senior living chain, said in a statement that caring for people with advanced dementia is complex and that "behaviors can change in ways that are difficult to fully predict or prevent, even with clinical interventions in place."
There is a clinical basis for that. Dementia can impair the brain circuits governing impulse control and threat perception. As cognition declines, people lose the ability to interpret what is happening around them or to put distress into words. Pain, infection, and medication side effects may surface as shouting, pushing, or hitting. Facilities are also difficult environments by design: noise, close quarters, rigid routines, and intimate care delivered by rotating staff whom residents cannot recognize.
Geriatrician Al Power, an advocate for alternative dementia care models, framed the resident's experience directly, noting that a person does not feel safe when strangers arrive to remove their clothes.
The counterargument is about warning signs rather than perfect prediction. Eilon Caspi, a dementia consultant and researcher who studies these altercations, said that in the vast majority of incidents "there are warning signs in the months, weeks, days, hours, and sometimes minutes" beforehand.
Laura Mosqueda, a geriatrician at USC's Keck Medicine and a senior adviser to the National Center on Elder Abuse, put the accountability question this way: the concern is ending up blaming two people with cognitive impairment or uncontrolled mental illness "when they're supposed to be in an environment where people are safe."
Camille Russell, Kansas' long-term care ombudsman until 2024, said she found nurses and aides were often "woefully undertrained" in basic dementia care.
What Families Can Actually Ask and Check
Specialists point to a set of measures that reduce risk: closer supervision of residents with a history of aggression, moving high-risk residents nearer to nursing stations, separating residents with repeated conflicts, and adjusting roommate assignments and seating in shared spaces. Each resident should have a care plan, staff should be trained to recognize individual triggers and intervene early, and organized activities matter because unoccupied residents are more likely to clash.
Antipsychotic and other psychotropic medications are frequently used, but they carry increased risk of falls, strokes, and death, which makes them a poor substitute for staffing.
Questions worth asking before or during a placement:
How are roommate assignments made, and what triggers a room change? Ask what happens when a resident objects to a roommate.
What is the overnight staffing ratio in the memory care unit specifically, and how often are rounds conducted during sleeping hours?
How are residents with a history of aggression identified at admission, and what is documented about behavior from a prior facility?
What is the process when a family member reports a concern about another resident, and what response time is expected when a call pendant is pressed?
Would we be asked to hire a private aide if one-on-one supervision became necessary? Some facilities require this, at a cost of thousands of dollars a month on top of fees that can already exceed $10,000.
Before choosing a nursing home, check its inspection history on Medicare's Care Compare, which posts citation records. That tool covers nursing homes only. For assisted living, the equivalent records are held by the state licensing agency, and families have to know to ask.
If you believe a resident is in danger, contact the facility administrator in writing, then the state long-term care ombudsman, then the state survey agency. Written complaints create a record that verbal ones do not.
The confirmed finding is that resident-to-resident abuse led federal nursing home abuse citations in early 2026. The people most at risk are residents with dementia, who are both more likely to be involved in altercations and least able to report them. The most reasonable action for families is to ask specifically about supervision and roommate policies and to check inspection records before making a choice. The central uncertainty is how often this happens in assisted living, where no federal record exists.
Frequently Asked Questions
What did the analysis find? That in the first quarter of 2026, CMS cited nursing homes more often for resident-to-resident abuse than for any other category of abuse, neglect, or exploitation, including abuse by staff.
How many citations have there been? At least 700 since the start of 2024 for failing to protect residents from physical, sexual, or verbal abuse by other residents.
Does this cover assisted living facilities? No. Federal inspection records cover nursing homes only. Assisted living, including most memory care, is regulated by states and does not appear in this data.
Does a citation count equal an incident count? No. Citations reflect what inspectors documented during surveys. Research suggests altercations are far more common than citations, with estimates as high as 1 in 5 nursing home residents experiencing one in a month.
What does the industry say? That dementia behaviors can change unpredictably and cannot always be prevented even with clinical interventions in place. Researchers counter that warning signs usually precede incidents.
What should I ask when touring a facility? How roommate assignments and room changes are handled, overnight staffing in memory care, how residents with a history of aggression are identified at admission, and expected response times to call pendants.
Where do I report a concern? Start with the facility administrator in writing, then the state long-term care ombudsman, then the state survey agency. Written complaints create a record.
