The Skilled Nursing Equipment Problem Nobody Can Measure

A 2020 study at Johns Hopkins Hospital tracked 67,111 infusion pump movements across 93 care areas, so researchers could answer a basic question: where is our equipment right now?

Skilled nursing cannot answer it.

In 2018, New York's State Comptroller audited 36 nursing homes across the state. At one 120-bed facility, auditors counted approximately 500 pieces of resident care medical equipment. Surveyors would have been required to test four of them. Less than one percent.

That four is not an arbitrary number. The state's sample is banded by building size: three pieces at a facility under 100 beds, four from 100 to 200, five from 200 to 300, six above that. The band is set by bed count, not by how much equipment the building actually holds.

Of those 500 items, how many were where someone needed them? Nobody knows. Not the surveyors, and usually not the building.

When the auditors asked all 36 facilities to produce an equipment inventory, 22 could not. The inventories of the 14 that had one were incomplete.

This is not a story about neglect. Across those same 36 buildings, auditors examined a separate sample of 532 items, roughly 15 per building, and found them "in good condition overall." The equipment was fine. The record of it was missing.

The auditors themselves drew a narrow conclusion, questioning "whether the Department's standard sample sizes are optimal." The limits are worth keeping in view: 36 facilities, a judgmental sample, one state, fieldwork ending in 2017. Its subject was equipment oversight and maintenance, not spending. It was never a national measurement.

The national picture reads the same way. Since January 2024, surveyors have written 285,300 health citations across 14,251 facilities. Within that, citations for keeping essential equipment working safely appear at about eight percent of the country's roughly 14,700 certified facilities, 57th of 209 deficiency types. Widen the count to every tag that mentions equipment and it reaches about ten percent. That looks like a rare problem. But a survey rule that inspects three to six items per building cannot tell you whether the equipment is fine or whether nobody looked.

You cannot measure what you do not look at, and you cannot look at what nobody has listed.

Sources

• New York State Comptroller, audit 2016-S-80 (2018). The 501-item and four-tested figures, the size-banded sample rule, the 22-of-36 inventory finding and the 532-item condition finding are quoted from this document.
• CMS Health Deficiencies dataset, current to August 1, 2026. Citation counts are for surveys dated on or after January 1, 2024. The eight percent figure is tag F0908, "keep all essential equipment working safely"; the wider ten percent figure adds F0810, F0906 and F0907.
• Martinez et al., Journal of the American Medical Informatics Association (2020). The infusion pump movement figures come from this study, whose network data covers January to November 2017.