Senators Release ‘Secret’ List of Troubled Nursing Homes Considered for Special Focus

A bipartisan pair of U.S. senators on Monday released a previously undisclosed list of more than 400 nursing homes under consideration for placement on the federal government’s roster of properties with serious quality issues.

The list, furnished by the Centers for Medicare & Medicaid Services (CMS), consists of “candidates” for the Special Focus Facilities (SFF) program, a designation for properties that have extended patterns of serious health and safety violations. Though the government makes public information about these singled-out skilled nursing facilities, CMS has not previously disclosed the names of properties that it is targeting for potential inclusion on the SFF list.

Sens. Pat Toomey and Bob Casey, both of Pennsylvania, wrote to CMS in March asking for more detail about the SFF candidates, with the agency formally responding in May. Toomey and Casey then elected to release the information on their own accord on Monday, calling the list a “secret document” in a joint statement.


“While the vast majority of nursing homes provide high-quality care, there are some that are consistently failing to meet objective standards of adequacy,” Toomey, a Republican, said in the statement. “To date, CMS has arbitrarily excluded from public disclosure a subset of these underperforming nursing homes. Moving forward, I hope CMS will give the public this particular list, as well as all relevant information about nursing home quality.”

Special Focus Facilities receive twice the normal amount of inspections from federal regulators, and are subject to civil monetary penalties (CMPs) or expulsion from Medicare and Medicaid eligibility if conditions do not improve. Nursing homes flagged under the SFF program also receive a special identification icon on the consumer-focused Nursing Home Compare website, with the actual star rating hidden until they move out from under the designation.

Only 88 of the nation’s 15,700 nursing homes end up on the SFF list, according to a report released by the senators in conjunction with the CMS data. An additional 435 are listed as potential candidates, the senators wrote, though these facilities do not have any designation on Nursing Home Compare — with some even boasting impressive rankings.


Nearly half of SFF candidates have staffing or quality ratings of three stars or more, with nine logging perfect scores on those metrics.

“As evidenced by this report, oversight of America’s poorest quality nursing homes falls short of what taxpayers should expect,” the senators wrote in their conclusion.

In a written response to the senators’ request, CMS administrator Seema Verma noted that federal budget cuts have winnowed the number of SFF properties, which previously stood at 167 prior to sequestration in 2014. In addition, Verma emphasized that state agencies are best positioned to identify which SFF candidates are most deserving of appearing on the actual list.

“We note that facilities that are candidates for the SFF program will typically have a very low star rating,” Verma wrote. “So, consumers and other stakeholders are alerted to the quality of care issues in these facilities by viewing their star rating and survey results on the Nursing Home Compare website.”

Casey, a Democrat, emphasized in the joint statement his desire to make information about these SFF candidates a permanent part of CMS’s outreach to the public.

“Choosing a nursing home is a difficult, and often painful, decision to make,” Casey said. “Individuals and families deserve to have all the information available to choose the facility that is right for them.”

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