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The Center for Medicare Advocacy issues this Special Report to shine a light on nursing homes throughout the country that have been identified as providing the poorest quality care to residents – while facing limited, if any, enforcement action as a consequence. Known as Special Focus Facilities, (SFFs), these facilities are identified by the Centers for Medicare & Medicaid (CMS) in cooperation with the states. SFFs have a history of serious noncompliance with federal quality standards.  Each month, CMS identifies new SFFs and reviews the current status of previously-identified SFFs.

The June 21, 2018 list of newly-identified SFFs (identified as SFFs for one to three months) includes 13 nursing facilities in nine states; the July 19, 2018 report added five facilities in five states. The Center looked at Nursing Home Compare to identify how many jeopardy-level and harm-level deficiencies the 18 SFFs had in the current and prior survey cycles (and in 2018), whether any Civil Money Penalties or Denials of Payment for New Admissions were imposed in the prior three years, whether the SFFs lacked mandated RN coverage or had other problems in staffing data, and their quality measure ratings.  

Although these 18 SFFs were cited with the highest levels of deficiencies (66 jeopardy-level deficiencies and 23 harm-level deficiencies since 2016), Civil Money Penalties (CMPs) were minimal.  Only 12 of the 18 facilities had any CMPs imposed over the prior three years.  CMPs for these 12 facilities averaged only $27,562 per facility per year over the three-year period.

The failure to impose meaningful enforcement actions against even the most poorly performing facilities in the country, the Special Focus Facilities, reflects an environment of ever-diminishing oversight and raises grave concerns for the safety and welfare of nursing home residents.

The Center’s full report is available at

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