State surveyors cited F578 930 times at 919 of the 12,591 U.S. nursing homes they inspected in the 12 months from August 2025 through July 2026 (7%), the 29th most cited tag in the country. CMS words it as “honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive”. 30 of those citations were immediate jeopardy.
The 12 months from August 2025 through July 2026. Source: CMS's nursing home health citation file, processed September 1, 2026.
| State | Rank there | Citations | Buildings cited |
|---|---|---|---|
| Maryland | #19 | 51 | 51 (24%) |
| Idaho | #12 | 17 | 16 (24%) |
| Alabama | #9 | 4 | 4 (20%) |
| California | #24 | 184 | 180 (17%) |
| Michigan | #18 | 61 | 60 (15%) |
| South Dakota | #16 | 13 | 13 (15%) |
| Vermont | #13 | 5 | 5 (15%) |
| Washington | #30 | 25 | 25 (13%) |
| Maine | #17 | 9 | 9 (13%) |
| Connecticut | #21 | 19 | 19 (11%) |
| New Mexico | #34 | 8 | 7 (11%) |
| Oregon | #22 | 12 | 12 (10%) |
| Hawaii | #16 | 4 | 3 (10%) |
| Ohio | #29 | 67 | 67 (9%) |
| North Carolina | #16 | 34 | 34 (9%) |
| Wisconsin | #32 | 24 | 24 (8%) |
| Arizona | #16 | 10 | 10 (8%) |
| Montana | #39 | 5 | 5 (8%) |
| Mississippi | #20 | 13 | 13 (7%) |
| West Virginia | #37 | 8 | 8 (7%) |
| Delaware | #34 | 3 | 3 (7%) |
| Texas | #33 | 65 | 65 (6%) |
| Pennsylvania | #45 | 39 | 39 (6%) |
| Illinois | #40 | 35 | 34 (6%) |
| Louisiana | #30 | 15 | 15 (6%) |
| North Dakota | #20 | 4 | 4 (6%) |
| Iowa | #33 | 19 | 19 (5%) |
| Missouri | #49 | 19 | 19 (5%) |
| Massachusetts | #38 | 14 | 14 (5%) |
| Kansas | #44 | 10 | 10 (5%) |
| Nevada | #45 | 3 | 3 (5%) |
| Rhode Island | #46 | 3 | 3 (5%) |
| Florida | #29 | 23 | 22 (4%) |
| Minnesota | #47 | 14 | 14 (4%) |
| Georgia | #23 | 13 | 13 (4%) |
| New Jersey | #47 | 11 | 11 (4%) |
| Kentucky | #18 | 9 | 9 (4%) |
| Oklahoma | #33 | 8 | 8 (4%) |
| Virginia | #58 | 6 | 6 (4%) |
| Indiana | #50 | 15 | 14 (3%) |
| New York | #51 | 11 | 11 (3%) |
| Wyoming | #48 | 1 | 1 (3%) |
| South Carolina | #27 | 4 | 4 (2%) |
| Colorado | #64 | 3 | 3 (2%) |
| Nebraska | #58 | 3 | 3 (2%) |
| Utah | #67 | 1 | 1 (2%) |
| Tennessee | #62 | 2 | 2 (1%) |
| Arkansas | #42 | 1 | 1 (1%) |
| New Hampshire | #46 | 1 | 1 (1%) |
| Alaska | #35 | 1 | 1 |
A tag is ranked by how many times it was cited. “Buildings cited” counts the inspected buildings that drew the tag at least once, and its percentage is of every building inspected; we print a percentage only where 20 or more buildings were inspected. “Rank a year earlier” is the same ranking over August 2024 through July 2025. CMS publishes citations months after the survey, so the newest months are still filling in: compare ranks across the two years, not counts. Immediate jeopardy is CMS severity J, K or L; actual harm is G, H or I. No building is named on this page: open a building for its own inspections.
Each whole calendar year since 2018, the first under the F-tag numbers CMS adopted in November 2017.
| Year | Citations | Share of all U.S. citations |
|---|---|---|
| 2018 | 1,485 | 1.2% |
| 2019 | 1,405 | 1.1% |
| 2020 | 445 | 0.8% |
| 2021 | 905 | 1.0% |
| 2022 | 1,106 | 1.1% |
| 2023 | 1,077 | 1.0% |
| 2024 | 1,220 | 1.0% |
| 2025 | 1,037 | 0.9% |
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