CMS Failing To Find Long-term Fixes for Problem Nursing Homes: OIG Report

Some facilities that dropped out of the CMS Special-Focus nursing home improvement program were later listed as having graduated.

A new report warns that nearly two-thirds of nursing homes enrolled in a Medicare program meant to improve poor care reverted to serious deficiencies within a few years after completing the initiative.

According to the findings of a new U.S. Centers for Medicaid and Medicare (CMS) Special-Focus Facility program report issued by the U.S. Department of Health and Human Services Office of the Inspector General (OIG), most nursing homes that participated either failed to make lasting improvements or never completed the program at all.

The Special-Focus Facility program, administered by CMS, is designed to improve care at the nation’s most poorly performing nursing homes. Facilities are selected for the program based on a history of repeated and serious violations of federal quality-of-care standards. Once designated, they receive more frequent inspections, stronger enforcement actions, and targeted guidance to correct systemic problems.

However, the OIG found that the program’s structure and limited capacity have hindered its effectiveness. Only two nursing homes per state are typically selected for participation at any given time, despite roughly 10 facilities per state demonstrating similar levels of persistent noncompliance. Some facilities remain on the SFF candidate list for up to a decade without ever being chosen or receiving the intended assistance.

According to the new OIG report, the Special-Focus Facility program is not working for a number of reasons, including:

• Many facilities relapse after graduating: Between 2013 and 2022, about two-thirds of nursing homes that completed the Special-Focus program later experienced recurring quality issues similar to the ones that placed them in the program originally.
• Limited program capacity: The Special-Focus program includes only two nursing homes per state at a time, even though an average of 10 facilities per state continue to show serious, ongoing care violations.
• Graduation data reveals long stays: Of the 645 nursing homes designated as Special-Focus Facilities over the past decade, 495 graduated from the program. Among the 429 that entered and exited during that period, 96 remained in the program for more than two years, with some staying longer than three.

The report also showed some nursing homes exited the program without graduating, sometimes due to closure or license termination.

The report also highlighted data-quality issues in CMS’s tracking. In one case, a nursing home that closed due to serious care problems was later mistakenly listed as having “graduated,” even though it had never met the program’s criteria for completion.

Even among facilities that did officially graduate, the OIG found that many later reversed improvements and returned to patterns of poor care.

OIG Nursing Home Improvement Recommendations

The OIG recommended that CMS consider implementing enhanced enforcement actions against nursing homes that graduate and fail to continue to meet compliance.

Additionally, the OIG said the program should implement non-financial enforcement remedies that encourage compliance and incorporate nursing home ownership information into the program. In the past, the CMS has rejected recommendations that nursing home ownership be considered when identifying Special-Focus Facilities, according to the OIG.

The CMS’s Special-Focus Facility program has come under fire in the past. In 2019, the agency compiled a list of 400 nursing homes that consistently provided poor care or had serious safety problems, but the list was kept private. In response, two U.S. Senators released the list of under-performing nursing homes to the public in a move calling for more transparency.

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