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US govt agency lists worst of worst nursing homes

The US Centers for Medicare & Medicaid Services’ agency (CMS) has identified 52 nursing homes as ‘special focus facilities’ (SFFs), those facilities are viewed by the government as the worst of the worst operating in the United States.

CMS acting administrator, Kerry Weems, said “release of this national list of special focus facilities reinforces CMS’ commitment to provide beneficiaries and their families the information they need when making long-term care choices”.

The government said it resorted to releasing the list because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next, for many of the same problems as before.

Such facilities with a ‘yo-yo’ compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies, the agency said.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either significantly improves and is no longer identified as an SFF, is granted additional time due to promising developments, or is terminated from Medicare and/or Medicaid.

The CMS policy of progressive enforcement means that any nursing home, not just those identified as an SFF, that reveals a pattern of persistent poor quality is subject to increasingly stringent enforcement action. If problems continue, the severity of penalties will increase over time, ranging from civil monetary penalties, denial of payment for new admissions and, ultimately, removal from Medicare and/or Medicaid.

As of October 2007, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest 5% or 10% in each state.

The ‘worst’ list includes 52 facilities that are at the top of the poorest performers in those states and among those facilities that have failed to improve significantly.

In addition to publishing the list of worst nursing homes, CMS says it is taking many other steps to improve the quality of care in the nation’s nursing homes, including a new program that will make the payment system more sensitive to quality improvements; developing new, more stringent systems for criminal background checks on facility workers and applicants; unprecedented focus on preventing catastrophic pressure ulcers in nursing home residents; and improving the state survey process.

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