In most fields and areas of life, there are consequences for failing to live up to basic standards. In nursing homes though, this is often not the case. Nursing homes are given inspections or surveys, in order to ensure they are complying with basic standards necessary for the welfare of their residents. However, historically facilities that showed deficiencies during these inspections have had very little in the way of consequences for falling in and out of compliance with regulatory standards. In response to this the Centers for Medicare & Medicaid Services (CMS) created the Special Focus Facility Initiative.

Surveys and inspections of nursing homes are performed by Centers for Medicare & Medicaid Services. For consistent underperformers, the Special Focus Facility initiative attempts to bring them back into compliance, and penalize them for failing to improve. There are several ways a nursing home can be labeled a Special Focus Facility. First, they can show more deficiencies than the average nursing home in a given survey (the average home shows about 6-7). This typically requires that the facility show about twice deficiencies than an average home. Another way a home can become considered a Special Focus Facility is if it shows more serious issues than an average home. Finally, a home can become a Special Focus Facility if it shows deficiencies over a period of time (typically about a 3-year period).

Obviously just labeling a home as a Special Focus Facility would not by itself have much of an effect. The initiative seeks to penalize facilities the longer that that stay out of compliance for an extended period. This initially includes requirements that Special Focus Facilities be visited at least as much as other nursing homes (about twice a year) for surveys. The punishments become more serious over time. They can eventually even include loss of Medicare/Medicaid eligibility. Civil fines for lack of compliance are also a possibility.

The Special Focus Facility initiative is intended to produce swift results. Within 18-24 months of a Special Focus Facility designation the home is expected to go one of three routes. The ideal route is that the home makes improvements gradually over time. A secondary course is that the home has its Medicare and Medicaid eligibility. Given the reliance of facilities on Medicare/Medicaid this is typically a death blow. Finally, in some circumstances there can be an extension of time of the Special Focus Facility program if progress has been made, but is not yet completely satisfactory.

So what are results of this initiative? In about 50% of the instances a home is placed on the list it will eventually improve. However, about 16% of homes that end up on the list eventually have their Medicare and Medicaid eligibility terminated. It is important to note that homes are still allowed to stay open while on this list. This often means that families and their loved ones are placed in the a perilous spot, until the home improves or closes. Based on this, it can be concluded the program is a step in the right direction, but not a completes solution to sub-standard nursing home care.