Nursing Homes With Serious Quality Issues

Once again it's worth our while to publish Medicare's list of nursing home that has serious quality issues. What follows is from Medicare's most recent report concerning these ratings:

This webpage offers a list of nursing homes that (a) have had a history of serious quality issues and (b) are included in a special program to stimulate improvements in their quality of care. Please take a minute to review this background information on our “Special Focus Facility” initiative. The background here will help you be as informed as possible when you discuss your long term care options with any nursing home that is listed here – and what they are doing to improve their quality of care.

Background

The Centers for Medicare & Medicaid Services (CMS) and States visit nursing homes on a regular basis to determine if the nursing homes are providing the quality of care that Medicare and Medicaid requires. These “survey” or “inspection” teams will identify deficiencies in the quality of care that is provided. They also identify any deficiencies in meeting CMS safety requirements (such as protection from fire hazards). When deficiencies are identified, we require that the problems be corrected. If serious problems are not corrected, we may terminate the nursing home’s participation in Medicare and Medicaid.

Most nursing homes have some deficiencies, with the average being 6-7 deficiencies per survey. Most nursing homes correct their problems within a reasonable period of time. However, we have found that a minority of nursing homes have:

•More problems than other nursing homes (about twice the average number of deficiencies),

•More serious problems than most other nursing homes (including harm or injury experienced by residents), and

•A pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the SFF list).

Although such nursing homes would periodically institute enough improvements in the presenting problems that they would be in substantial compliance on one survey, significant problems would often re-surface by the time of the next survey. Such facilities with a “yo-yo” or “in and out” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. To address this problem CMS created the “Special Focus Facility” (SFF) initiative.

How the Special Focus Facility (SFF) Initiative Works

CMS requires that SFF nursing homes be visited in person by survey teams twice as frequently as other nursing homes (about twice per year). The longer the problems persist, the more stringent we are in the enforcement actions that will be taken. Examples of such enforcement actions are civil monetary penalties (“fines”) or termination from Medicare and Medicaid. Within about 18-24 months after a facility is identified by CMS as an SFF nursing home, we expect that there will be one of 3 possible outcomes:

(a)Improvement & Graduation: The nursing home graduates from the SFF program because it has made significant improvements in quality of care - and those improvements are continued over time;

(b)Termination from Medicare: The nursing home is terminated from participation in the Medicare and Medicaid programs. While such a nursing home may continue to operate (depending on State law), usually it will close once Medicare and Medicaid funding is discontinued. In such a case the State Medicaid Agency (and others) will assist all nursing home residents to transition to another residence that can provide a better and acceptable quality of care. This may include a variety of possibilities, such as another nursing home, a community-based setting, or apartment with good support services.

(c)Extension of Time: The nursing home is provided with some additional time to continue in the SFF program because there has been very promising progress, such as the sale of the nursing home to another owner with a much better track record of providing quality care.

How Can You Use This Information

If you are considering admission to a nursing home included on this list you may want to:

•Above all, visit the nursing home. Talk to staff, residents, and other families. You may request to see the results from the last State or CMS survey (it should be in a place that is easily accessible.)

•Before your visit, look at the survey history of the nursing home on Nursing Home Compare to see what areas may be problematic.

•Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home.

•Call the State survey agency (link to Nursing Home Compare) to find out more about the nursing home. Look at the length of time that a nursing home has been on the SFF list. This is particularly important if the nursing home has been an SFF nursing home for more than 18-24 months, since such nursing homes are closer to either graduating (due to improvements) or ending their participation in Medicare and Medicaid.

•Call your local State Ombudsman, Administration on Aging, and local groups to find out more about the nursing home.

•Use the Nursing Home Brochure found at http://www.medicare.gov/Publications/Pubs/pdf/nursinghome.pdf and “Guide to Choosing a Nursing Home” http://www.medicare.gov/Publications/Pubs/pdf/02174.pdf - both publications are available on Nursing Home Compare.

Read more from this Medicare report entitled Special Focus Facility (“SFF”) Initiative and the GAO report entitled CMS’s Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated and For-Profit

Health, Fitness and Style, News and Issues, Government, Tam Gray

Nursing Homes With Serious Quality Issues

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