The “watch list” of nursing homes identified by the Centers for Medicare & Medicaid Services (CMS) as “underperforming” rose to 131 yesterday. These facilities, called Special Focus Facilities (SFFs) by CMS, have had systemic compliance problems that have resulted in repeated serious deficiencies. Serious deficiencies include such things as medication errors and problems preventing and treating pressure ulcers (bed sores, pressure sores, decubitus ulcers).
CMS first began publishing the SFF list in November 2007. Its decision to expand the public list results from the public backlash that followed the release in November of only a partial list — 54 of 128 poor performers — and revelations that the complete list had been made available to industry insiders, but not the public. Once a facility is classified as an SFF, state survey agencies inspect the facility twice as often and apply progressive penalties until the nursing home either improves significantly and is removed from the SFF list, receives more time to make changes, or is terminated from Medicare and/or Medicaid.
The new SFF list includes more nursing homes and further classifies them into one of several categories: “new additions” (nursing homes added to the SFF list within the past six months); “not improved” (nursing homes that failed to improve significantly in at least one survey after appearing on the SFF list); “improving” (nursing homes that have significantly improved on the most recent survey, including no findings of harm to any resident and no systemic potential for harm); “recently graduated” (nursing homes that have enjoyed significant improvement for about 12 months, indicating an upward trend in quality improvement compared to their prior history of care); and “no longer in Medicare and Medicaid” (nursing homes that were either terminated by CMS from participation in Medicare within the past few months or voluntarily chose not to continue participation). See the current CMS list of underperforming nursing homes.
The acting administrator of CMS said “[w]e are issuing more information on special focus facilities to better equip beneficiaries, their families, and caregivers to make informed decisions and stimulate robust improvements in nursing homes having not improved their quality of care.” For the expanded list, we can be thankful. The SFF list helps put more information in the hands of consumers, and more information is a good thing when trying to avoid a bad nursing home.
But the SFF list isn’t perfect. It doesn’t list all offenders. That is, a nursing home can’t be considered “good” just because its name doesn’t appear on the list. Bad nursing homes might have been lucky enough not to get “caught” by surveyors or families. Also, the concept of a good nursing home is fluid and relative. A nursing home that provides good care today might provide poor care tomorrow. A nursing home on the SFF list might also have perform poorly in the areas measured by CMS but provide better overall care than a facility that doesn’t appear on the list. So, where does that leave us? Families need to place the SFF list into context — it’s a starting point, not an end point, in the quest for good nursing home care.
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Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.
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Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.
