Worst US Nursing Homes Listed

On November 29, 2007, the agency began publishing the names of Special Focus Facility (SFF) nursing homes that had failed to improve significantly after being given the opportunity to do so.

Serious deficiencies include such things as failing to give residents their medications in the correct dose at the correct time, taking steps to prevent abuse or neglect, inappropriate use of restraints and failure to prevent or properly treat bed sores.

Once a facility is selected as an SFF, state survey agencies are responsible for conducting 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.

Between November and February, CMS worked with states to assure that the SFF list* is current and provides consumers with the information needed to make a distinction between nursing homes that are improving and those that are not. 

This updated and expanded list identifies facilities by the category they fall within, such as:

• New Additions:  nursing homes added within approximately the past six months;
• Not Improved: nursing homes that have failed to improve significantly in at least one survey after being named as a SFF nursing home;
• Improving: nursing homes that have significantly improved on the most recent survey, including no findings of harm to any resident and no systemic potential for harm;
• Recently Graduated: nursing homes that have sustained significant improvement for about 12 months, indicating an upward trend in quality improvement compared to the nursing home’s prior history of care; and those
• No Longer in Medicare and Medicaid: nursing homes that were either terminated by CMS from participation in Medicare within the past few months, or voluntarily chose not to continue participation.

The SFF initiative was created by CMS in 1998 in response to the number of facilities that were consistently providing poor quality of care. Those facilities were periodically instituting enough improvement so that they would pass one survey, only to fail the next (for many of the same problems as before).  Facilities with this compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

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.  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.

There are currently about 131 active facilities identified as an SFF. This number varies over time as nursing homes are graduating or leaving Medicare and Medicaid and new nursing homes are in the process of being added to the SFF list.

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.

Nursing Home List: http://www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf