Nursing Homes With a Track Record—a Bad One

They’re called Special-Focus Facilities. But this is one time when “special” means: beware.

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Among the 15,547 nursing homes in the full set of U.S. News rankings, 131 are tagged as "Special-Focus Facilities." Consider it a red flag. These homes have been singled out by the state where they operate and by the federal Centers for Medicare and Medicaid Services as nursing homes with long histories of subpar or inconsistent health inspections. Here's more about SFFs:

What makes a nursing home an SFF?
A history. A single event, even a serious one such as spoiled food that sickens several residents, isn't enough. But similar findings in three consecutive inspections are one of three required SFF flags. The second is that a deficiency affected or could have affected many residents. The third is that the problem remained unresolved on follow-up inspections.

What happens if the home doesn't improve?
It can lose its Medicare and Medicaid credentials and will have to shut down or rely entirely on private-pay residents.

Does 131 truly reflect the number of troubled homes?
Many more could and should be added to the SFF list, say nursing home experts. But the roughly $1 million budgeted as the federal share of the cost of the extra SFF analysis and monitoring will cover no more than 135 homes. Each state can designate a number of SFFs based on its total count of nursing homes. California, for example, can submit six homes (the maximum) and Vermont one.

Should I steer clear of an SFF?
Some nursing-home insiders say yes, but that may be difficult in a lightly populated area with few homes. If an SFF must be on your candidate list, come armed with tough questions. Ask a top administrator what is being done to get off (and stay off) the list. Ask what caused the problems and how the underlying causes have been addressed. If care was erratic because nurse turnover was out of sight, for instance, have steps been taken to make the nursing staff more willing to stay?

I see SFF homes with three stars. How is that possible?
The homes may have improved and are on the road to becoming "graduates," as CMS calls homes that have moved out of the SFF ranks.

Should I consider a home that has just graduated?
Graduating means that a home 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. But be on the alert if you're considering a recent graduate. Until only recently, it was a home with a patchy or problematic history.

Should I remove my loved one from an SFF?
Not necessarily. Moving a resident who has grown used 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, it's better just to be watchful. "One family member who is attentive and an activist," she says, "can go a long way toward ensuring their loved one receives good care."

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