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Feds List Worst Nursing Homes

52 facilities make the 'worst of the worst' list

December 4, 2007

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It’s one thing when a consumer group says you’re bad. It’s even worse when the U.S. Government puts you on its list of “the worst.” That’s the case for 52 nursing homes, who find themselves in the Centers for Medicare & Medicaid Services uncomfortable spotlight.

The agency says the list, identified in governmentspeak as "special focus facilities" (SFFs), should offer individuals and their families powerful new information when choosing nursing homes.

“Nearly three million Americans, most of who are enrolled in Medicare or Medicaid, depend on the nation’s 16,000 nursing homes at some point during each year to provide life-saving care,” said CMS Acting Administrator Kerry Weems. “Release of this national list of special focus facilities reinforces CMS’ commitment to provide beneficiaries and their families the information they need when making long-term care choices.”

The government said it resorted to releasing the list because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next, for many of the same problems as before.

Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies, the agency said.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and is no longer identified as an SFF, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid.

CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

The CMS policy of progressive enforcement means that any nursing home, not just those identified as an SFF, that reveals a pattern of persistent poor quality is subject to increasingly stringent enforcement action. If problems continue, the severity of penalties will increase over time, ranging from civil monetary penalties, denial of payment for new admissions and, ultimately, removal from Medicare and/or Medicaid.

As of October 2007, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest five or 10 percent in each state.

The “worst” list includes 52 facilities that are at the top of the poorest performers in those states and among those facilities that have failed to improve significantly.

Typically, these facilities achieve improved survey results after being selected for the initiative. The CMS data indicate that about 50 percent of the nursing homes identified as SFFs significantly improve their quality of care within 24-30 months, while about 16 percent are terminated from Medicare and Medicaid.

In addition to publishing the list of SFFs, CMS is taking many other steps to improve the quality of care in the nation’s nursing homes including a new program that will make the payment system more sensitive to quality improvements; developing new, more stringent systems for criminal background checks on facility workers and applicants; unprecedented focus on preventing catastrophic pressure ulcers in nursing home residents; and improving the state survey process.

“CMS’ effort to identify poor performing nursing homes is intended to promote more rapid and substantial improvement in the quality of care in identified nursing homes and end the pattern of repeated cycles of non-compliance,” Weems noted.

In addition to consulting the CMS list, beneficiaries and their families looking for a nursing home should take other steps including:

• Visit the nursing home. Talk to staff, residents, and other families. Request to see the results from the last state or CMS survey.

• Prior to a visit, review the survey history of the nursing home on Nursing Home Compare to better understand any areas that may be problematic.

• Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home.

• Call the state survey agency to learn more about the nursing home. If the facility is in the special focus initiative, find out how long it has participated. Facilities in the program for 18-24 months are either close to “graduating” because of significant improvements to care, or ending their participation in Medicare and Medicaid.

• Call your local state nursing home ombudsman, Administration on Aging, and local groups to learn more about the nursing home.

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