According to the U.S. Government Accountability Office (GAO), the federal government is overlooking hundreds of the nation’s worst nursing homes in a program that is intended to focus inspections and oversight of them. The report, Nursing Homes – CMS’s Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain-Affiliated and For-Profit, was released on September 28, 2009.
The Centers for Medicare and Medicaid Services (CMS) established the Special Focus Facility (SFF) program to address poor performance by nursing homes that are considered among the worst in the nation. Nursing homes targeted by CMS and state survey agencies receive more intensive oversight, including more frequent inspections.
The GAO found that the program fails to include most of the nation’s worst performing nursing homes because it is limited to 136 facilities at any point in time. The GAO determined that 580 nursing homes could be considered the most poorly performing, more than four times as many as are targeted by CMS.
The GAO reports that 40 California nursing homes were among the worst in the nation, although only 6 homes were actually included in the Special Focus Facility program. California has about 1300 skilled nursing facilities.
The most poorly performing homes are more likely to be part of a for-profit nursing home chain. They also tended to be larger in size and have far less registered nurse staffing (24 percent fewer hours) than average.The GAO report is the latest in a long series of reports criticizing nursing home conditions and poor enforcement of federal standards.
It provides valuable analysis and recommendations on the Special Focus Facility program, which is little more than a token enforcement program. The truth, however, is that the nation and California have far more terrible nursing homes than would be targeted if the GAO recommendations were implemented.