Nursing homes that are found guilty of numerous health code and misconduct violations are placed on a special list for special focus facilities, but once they are cleared from the program, many return to their old ways. These facilities put residents at greater risk of harm from health conditions, neglect, and abuse.
What are Special Focus Facilities?
Special focus facilities are placed on a list of nursing homes that have a history of serious quality and care issues. Due to a high number of health code violations, these facilities are identified in a special program that works to make improvements in the quality of nursing home care. Special focus facilities are monitored closely to make sure that care and policy changes are made to improve facility conditions and resident care.
The Centers for Medicare and Medicaid Services (CMS) monitors special focus facilities by sending inspection teams to facilities at least twice each year. Teams look for and identify quality care deficiencies and resident safety issues. If serious problems are noted and not corrected within a certain period of time, CMS can terminate the nursing home facility’s participation in Medicare and Medicaid.
Many nursing homes have deficiencies, but work to keep them to a minimum and resolve them quickly to avoid health code violations which can result in monetary penalties. Nursing homes flagged as special focus facilities have more serious and more frequent violations than normal. Average deficiencies for nursing homes range between one and seven per inspection. Special focus facilities average up to 14 or 15 deficiencies per inspection. They also have a higher number of incidents that cause harm or injury to residents, as well as a pattern of problems that persist over a long period of time, up to three years, without being corrected. When facilities do correct problems, the changes are usually short-lived, and facilities quickly return to their old ways of substandard care once government scrutiny is stopped.
Studies of nursing home facilities placed under special focus status show that very few ever actually lose access to Medicare or Medicaid funding, even though more than 50 percent receive future violations and penalties. Out of 528 special focus facilities that were studied, 275 were responsible for resident injuries after being cleared from facility improvement programs.
Special Focus Improvement Programs
When nursing homes are placed in special focus programs, they are closely monitored by CMS and federal and state health departments. These agencies perform frequent, random facility inspections to make sure that noted violations and problems are corrected. If problems persist, facilities face civil fines and the possibility of losing Medicare and Medicaid funding. Since most state-run and long-term nursing homes rely on Medicare and Medicaid funding as their primary source of revenue, special focus facilities go to great lengths to appease CMS inspectors and pass inspections. If problems are not corrected, enforcement actions escalate. After a CMS inspections, one of three things will occur:
- Graduation – If a special focus facility shows significant improvements in their quality of care and resident safety, the nursing home graduates from the special focus improvement program.
- Time Extension – If the nursing home shows promising progress, the facility is granted an extension of time to make corrections.
- Medicare Termination – If the nursing home does not correct problems and make improvements, Medicare and Medicaid funding is terminated. Depending on State law, the facility may continue to operate, but most eventually shut down or file for bankruptcy once Medicare and Medicaid funds are discontinued.
Choosing Nursing Home Care
Choosing a nursing home for loved ones and family members is an important task, because quality care and safety can vary significantly between facilities. Nursing homes listed as special focus facilities should be avoided if possible, because of their history of substandard care, injuries, and neglect and abuse.
CMS recommends visiting several nursing home facilities that meet requirements for care and budget needs. By visiting potential facilities, it’s easier to talk to administration officials, nurses and caregivers, and other families of existing residents. During the visit, a request can be made to see the results from the latest CMS or State inspection to look for health care violations and safety concerns. A history of the nursing home’s problems and comparisons to other nursing homes can be found on Nursing Home Compare, a helpful website that’s available to the public. It allows consumers to check for nursing homes on the special focus facility list and view the length of time the facility has been on the list. Nursing homes that have been on the list for more than 18 to 24 months should be avoided. This length of time may signal the possibility of Medicare and Medicaid termination and potential closure in the near future.
