How Some Bad Nursing Homes Get Special Treatment

And why you'll probably want to steer clear of these 'Special Focus Facilities.'


An occasional home in the "Best Nursing Homes" rankings is identified with a mark as a "Special Focus Facility." In this case, "special" is not good. An SFF is a home with a history of subpar or erratic results in health inspections so persistent that it has been tabbed for extra monitoring and inspections by the federal Centers for Medicare and Medicaid Services and the state where it operates. An SFF home that doesn't improve can lose its Medicare and Medicaid credentials, putting it out of business unless it can draw on private-pay residents. Here's an FAQ on these homes:

How does a nursing home become an SFF?
Not because of a single health deficiency—even a serious one, such as spoiled food that makes several residents ill. But if similar problems show up on three consecutive inspections, that's one of three flags. A second would be that a relatively large number of residents were or could have been affected. And if repeat inspections were necessary because the home didn't correct a problem, that's the third.

How many SFF homes are there?
There can be no more than 135. The actual number, if not 135, is always close to that.

Whoa—out of more than 15,000 homes, only 135 are that bad?
Many more homes could and should be added to the list, say nursing home experts. But funding to pay for the extra monitoring and analysis that SFF homes require is limited to about $1 million, an amount that covers no more than 135 homes. Each state is allocated one to six SFFs, based on the total number of nursing homes—California gets six and Vermont one, for example.

Should I steer clear of an SFF?
Maybe not. For one thing, if you live in a lightly populated area that doesn't have many nursing homes, it may be difficult. As with any home on your candidate list, you should visit it to see what it's like.

[See America's Best Nursing Homes, and search for one near you.]

Should an SFF home get especially intense scrutiny?
No question about it, says Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, whose members include nonprofit nursing homes. Ask administrators what systemic problems got the home in trouble, and find out how they have been addressed. If care was erratic because turnover was out of sight, for instance, what has the management done to make the nursing staff more willing to stay?

There are SFF homes with three stars. How is that possible?
Three stars in the ratings may be a sign of improvement and might even signal that the home is on its way off the SFF list.

Should I think about using a home that has just shed its SFF status?
A "graduate," as the Centers for Medicare and Medicaid Services calls a home that has moved out of the SFF ranks, might indeed be a prospect. It has acknowledged its problems, drawn up and executed an approved action plan, and shown clear improvement in two consecutive inspections. A new consciousness may have taken hold. One graduate in California boosted its quality so much in just 12 months that it got a five-star rating when its SFF status was lifted. But be on the alert if you're considering a new SFF graduate. Until only recently, it was a home with a history.

Should I remove my loved one from an SFF?
Not necessarily. Moving a resident accustomed to the rhythms and routines of a home can be upsetting, even traumatic. If you are generally satisfied with the level of care, says CMS spokesperson Mary Kahn, stand careful watch. "One family member who is attentive and an activist can go a long way toward assuring their loved one receives good care," she says.

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