There’s some surprising new information available about nursing homes that anyone who has or is seeking residence for a loved one in a nursing facility ought to know.

 

Back in 1987, the Nursing Home Reform Act created a federal-state partnership that established oversight and enforcement policies to ensure nursing home standards. Part of the reform included the creation of the Special Focus Facility (SFF) program to provide more regular residence inspections.

 

The SFF program monitors consistently underperforming nursing homes. All facilities are subject to statewide inspections at least once every 15 months and are ranked on a Five Star Quality Rating System. After three inspections, the survey rating results are converted into points based on the deficiencies in a center’s operations, scope, and effectiveness.

 

The 88 facilities across the nation with the worst scores are entered into the SFF program as participants. The Centers for Medicare and Medicaid Services (CMS) then monitors these facilities through surveys at least once every six months. However, the rest of the facilities with the highest number of points in each state are labeled as SFF candidates.

 

Candidates are not considered participants in the SFF program and therefore are not subject to the same penalties and increased inspections of participants. There are more than 400 current candidates to the SFF program, but over 900 facilities have found themselves on the candidate list since 2005.

 

Due to the budget and resource limits of CMS, only 88 facilities at a time are considered participants even if a greater number qualify with participant-level citations. The 88-participant limit recognizes less than 0.6% of the 15,700 nursing homes across the nation as Special Focus Facilities, although 2.5% of the nation’s facilities hold statistics that could qualify them as participants.

 

Not even a state investigation or complaint survey can shift a candidate to participant status. As soon as a facility ‘graduates’ from their status as an SFF participant, a candidate facility will take its place as a new SFF participant.

 

CMS does not survey candidates any more frequently than non-candidates or subject them to additional penalties or reporting requirements. CMS also does not provide resources or education to participants or candidates; a facility is expected to improve its own status.

 

What’s more, a facility’s status as a candidate is not released to the public.

 

CMS, the state in which the facility is run, and the facility itself are the only sources required and eligible to know this information.

 

Concerned about this lack of available knowledge, U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA) decided to take action. On March 4 of this year, the Senators asked CMS to provide the candidate list and information about facilities’ operations, scope, and effectiveness.

 

On May 12, CMS sent the April 2019 SFF candidate list of those nursing homes facing critical health and safety violations to the Senators. After reviewing the list and learning more about CMS practices, the Senators then published the list in a June 2019 report on underperforming nursing homes. The report cited a variety of infractions in facilities, from lack of proper nutrition to unsanitary living conditions to physical abuse, sexual assault and premature death.

 

Kentucky candidates on the CMS list include:

  • RIVER HAVEN NURSING AND REHABILITATION CENTER, 867 McGuire Ave, Paducah, KY 42001

  • WOODCREST NURSING AND REHABILITATION CENTER, 3876 Turkeyfoot Rd, Elsmere, KY 41018

  • MOUNTAIN MANOR OF PAINTSVILLE, 1025 Euclid Ave, Paintsville, KY 41240

  • KLONDIKE CENTER, 3802 Klondike Ln, Louisville, KY 40218

  • SPRINGHURST HEALTH AND REHAB, 3001 N Hurstbourne Pkwy, Louisville, KY 40241

 

Kentucky also has an SFF participant:

  • TWIN RIVERS NURSING AND REHABILITATION CENTER, 2420 W 3rd St, Owensboro, KY 42301

 

The report’s analysis of a CMS online “Nursing Home Compare” feature determined that SFF participants are marked with a yellow triangle. The web feature displays a star rating for each facility based on its inspections, staffing data, and quality scores. The yellow triangle listed under participant facilities is the only available piece of information for these residences; participant facilities do not have star ratings.

 

“Nursing Home Compare” does not thoroughly explain the SFF program, why or how a facility becomes an SFF participant, a facility’s length of time in the program, whether a residence has made any improvements, or why all participants lack a star rating. The site also is not consistently updated.

 

As for all other non-SFF participant nursing homes, the site exhibits no indication of whether a facility is an SFF candidate. There are no telltale characteristics to help in this determination, either.

 

In fact, 48% of SFF candidates had quality ratings of three or more stars, and 49% had staffing ratings of three or more. Nine candidates even had perfect quality and staffing scores.

 

For example, one Kentucky SFF candidate facility with an overall rating of two stars and a staffing rating of four stars neglected to change or shower a resident with a skin graft due to a burn wound, despite doctor’s orders.

 

While Senators Casey and Toomey hoped to spread awareness of the hidden status of these types of underperforming facilities through their report, they also hoped CMS would release the list of SFF candidates publicly. Although CMS declined their initial request, the Center announced on June 5 their decision to publish the list of SFF candidates for anyone to access.

 

Upon news of this announcement, Senator Casey remarked, “Our bipartisan work will ensure that families have all the information at their fingertips when choosing a nursing home. Now we must work in a bipartisan fashion to ensure the SFF program is working properly and that CMS has the funding it needs to improve underperforming nursing homes nationwide.”

 

Senator Toomey added, “Ensuring that families have all the information they need about a nursing home will improve the quality of care at facilities across the country. I look forward to continuing to work with Senator Casey to improve nursing home quality and transparency at government health care agencies.”