Senators Release GAO Report on Program For Worst Nursing Homes Nationwide

Last week Senators Herb Kohl (D-WI) and Chuck Grassley (R-IA) released a report by the U.S. Government Accountability Office (GAO) on the Special Focus Facility (SFF) Program, which monitors nursing homes that earn the worst quality ratings. The study recommends that the SFF program, administered by the Centers for Medicare and Medicaid Services (CMS), be expanded to accommodate more of the 580 homes GAO found to be the poorest performing. The program currently only includes 136 nursing homes.

"If far more than 136 nursing homes are found to have the bleakest conditions, then perhaps we should consider expanding the Special Focus Facility program," said Kohl. "Regardless, we should use the tools we have to let American consumers know which homes the federal government considers the very worst, whether or not they receive additional scrutiny through the program."


To conduct the study, GAO refined the methodology for choosing SFF participants by including input from CMS’s Five-Star Quality Rating System, adding weight to deficiencies awarded for resulting in actual harm to a resident, considering the home’s long-term performance history. The report recommends that CMS consider a nursing home’s performance relative to other homes nationally, instead of comparing ratings within state lines. GAO also noted that the worst nursing homes possess some key characteristics. For instance, they were more likely to be for-profit and part of a chain, have more beds and residents, and have an average of almost 24 percent fewer registered nurse hours per resident per day.

In March, Grassley and Kohl reintroduced the Nursing Home Transparency and Improvement Act, a bill that would give consumers more information about individual nursing homes and their track record of care, give the government better tools for enforcing high quality standards, and encourage homes to improve on their own. The bill was recently included by Chairman Max Baucus (D-MT) in the Senate Finance Committee’s health reform legislation.

A link to the GAO report can be found here: