Tennessee audit finds thousands of unresolved nursing home complaints, inspection delays

HAMILTON COUNTY, Tenn. — A new state audit is raising concerns among Tennessee lawmakers after finding thousands of unresolved nursing home complaints and revealing that more than half of the state’s long-term care facilities have fallen behind on required inspections.

The Tennessee Comptroller’s audit of the Health Facilities Commission says that 13,096 complaints regarding patient harm were made between July 2022 and April 2025.

42% (5,534) of those complaints were investigated late, with some up to 1,000+ days overdue, according to the audit.

4,756 complaints have not been investigated at all.

The audit says this backlog even affected immediate-jeopardy complaints—those involving potential serious injury or death.

The audit also notes that 51% of facilities (341 of 670) were not inspected within the federally required 15-month timeframe.

22 facilities had not been inspected in five years.

The backlog of federal nursing home surveys also grew from 176 overdue in 2022, to 192 by April 2025, according to the audit.

A new backlog of 149 state-assisted living surveys also emerged in the audit’s findings.

State law requires all nursing homes to have a current inspection by December 31th, 2026.

But the audit says…

“The commission may be challenged to eliminate [the backlog] by the deadline.”

As for what contributed to the backlog in inspections, the audit says:

• Regional offices use inconsistent scheduling methods for inspections.
• Central office does not adequately monitor progress.
• The Commission relies on two incomplete systems (LARS and ASPEN) that don’t reconcile data, meaning they can’t ensure every facility is tracked.

A legislative oversight committee reviewed the audit Wednesday.

Logan Grant, Executive Director of the Health Facilities Commission spoke about the backlog, saying…

“We inherited a backlog, a substantial one. And then we’ve been trying to increase our ability….our capacity to perform surveys in the meantime. Every year we’ve come before the general assembly, we’ve requested additional positions, additional survey positions that is. We’re hoping that we’ll be able to obtain some to help us out.”

But lawmakers say these delays are unacceptable.

“I know you all inherited basically a bomb and it kind of went off in your face. But its very very important, five years is too long, period. There is no excuse for that. And I know your all’s hands is kind of tied down with the shutdown type things, but five years we can’t have happen,” Rep. John Crawford says.

The committee recommended the Health Facilities Commission get another four-years to get back on track.

The State Audit Division says they expect to look at the commission again. However, they do not have a timeline for that next inspection.

Read the full audit below: