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 the background information below on the “Special Focus
Facility” initiative. The background 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.
List A - New Additions: These are nursing homes newly added to the SFF initiative (but which have
not yet had a standard survey since being added to the list). If you wish to learn more about a specific home, please contact
the State survey agency or the Ombudsman's office in your area which can be found in the Helpful Contacts section of Nursing Home Compare.
List B – Not Improved: These are nursing homes that have failed to show significant improvement
despite having had the opportunity to show improvement in at least one survey after being named a SFF nursing home.
List C - Improving: These are nursing homes that have show significant improvement, as indicated by
the most recent survey, and CMS is waiting to see if the improvement continues over time. If the improvement continues, these
nursing homes will graduate from the SFF list.
List D – Recently Graduated: These are nursing homes that not only improved, but they sustained
significant improvement for about 12 months (through two surveys). We congratulate these nursing homes and list their names as
“graduates” for a few months after they graduate so that anyone who has been tracking their progress will be informed.
List E – No Longer in Medicare and Medicaid: These are nursing homes that were either terminated by
CMS from participation in Medicare and Medicaid within the past few months, or voluntarily chose not to continue such
participation. In most cases the nursing homes will have closed, although some nursing homes that leave Medicare later seek to
show better quality and re-enter the Medicare program after demonstrating their ability to comply with all Federal health and
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, they require that the problems be
corrected. If serious problems are not corrected, they may terminate the nursing home’s participation in Medicare and
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, they 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),
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)
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:
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;
Termination from Medicare: The nursing home is terminated from participation in the Medicare and
Medicaid 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
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
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 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
Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing
Call the State survey agency (link to Nursing Home Compare) to find out more about the nursing 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
If you currently reside in a SFF nursing home, please know that this home is being closely monitored (it is inspected twice
as often as other nursing homes). You may also direct any questions you have to the contacts above. The good news is that about
50% of the nursing homes in the SFF program significantly improve their quality of care within 24-30 months after being
selected for the SFF initiative, while about 16% tend to be terminated from Medicare and Medicaid.
How to Interpret the Lists
Below we list nursing homes in five (5) different categories:
List A – New Additions: Nursing homes newly added to the SFF (which have not yet had a standard
survey since being added to the list).
List B – Not Improved: Nursing homes that have failed to show significant improvement despite
having had the opportunity to show improvement in at least one survey after being named as a SFF nursing
List C – Improving: Nursing homes that have shown significant improvement, as indicated by the
most recent survey, and CMS is waiting to see if the improvement continues over If the improvement continues for about 12
months (through two standard surveys), these nursing homes will graduate from the SFF list. “Significant improvement” means
that the most recent standard survey (and any later compliant investigations) found no deficiencies in which there was
actual harm to any resident, and no deficiency in which there was systemic potential for harm (i.e. no deficiency above an
List D – Recently Graduated: These nursing homes not only improved, but they sustained
significant improvement for about 12 months (through two standard surveys). CMS congratulates these nursing homes and list
their names as “graduates” for a few months after they graduate so that anyone who has been tracking their progress will be
“Graduation” does not mean that there may not be problems in quality of care, but does generally indicate an upward trend
in quality improvement compared to the nursing home’s prior history of care.
List E – No Longer in Medicare and Medicaid: These are nursing homes that were either
terminated by CMS from participation in Medicare and Medicaid within the past few months, or voluntarily chose not to
continue such. In most cases the nursing homes will have closed, although some nursing homes that leave Medicare later seek
to show better quality and re-enter the Medicare program after demonstrating their ability to comply with all Federal
health and safety requirements.
Important Note about Information Delays
The State survey agencies are responsible for entering survey information into CMS’ databases and providing
updates as needed. Every attempt is made to assure the accuracy and timeliness of the information on the list. However, data
lags of up to several months can occur between completion of a survey and posting of data on this list. We advise interpreting
this information cautiously and supplementing it with information from the ombudsman's office, the State survey agency, or
Continued Improvements in the Special Focus Facility Initiative
This list is the latest in a series of improvements CMS is making to address the problem of chronically under-performing
nursing homes. In 2005, for example, it increased the number of SFF nursing
homes by 30% and strengthened enforcement. In November 2007 it began publishing the names of SFF nursing homes
that had failed to improve significantly. In February 2008 it added all other
SFF nursing homes in a format that allows consumers to distinguish between nursing homes that were improving compared with
those that are not. In April 2008 it added cross-links between the individual nursing home pages on the NH
Compare website with the full SFF list. In August 2008 it announced methods by which SFF nursing homes may obtain
additional technical assistance from the local Quality Improvement Organizations (QIOs) to help them improve quality. In December 2008 it began rating all nursing homes using a Five-Star Quality Rating System on the website medicare.gov/NHCompare.