If you're searching for a nursing home or rehabilitation facility, before you head out you should download this list of "Special Focus Facilities," which will help you avoid those nursing homes with a troubled history of very poor quality as revealed by regular quality inspections by State survey agencies.

These facilities are identified by the Centers for Medicare & Medicaid services (CMS) as having a history of ranking in the lowest 10% of all nursing facilities in their state. As a group they have:

• More problems than other nursing homes (about twice the average number of deficiencies),

• More serious problems than most other nursing homes (including harm or injury experienced by residents), and

• A pattern of serious problems that has persisted over a long period of time (as measured over the three years before the date the nursing home was first put on the SFF list).

The CMS report divides problematic nursing homes into five categories:


          A:  New Additions: Nursing homes newly added to the Special Focus Facilities list which
        have not yet had a standard survey since being added to the list.

B: Not Improved: Nursing homes that have failed to show significant improvement despite having had the opportunity to show improvement in at least one survey after being named as a Special Focus Facility nursing home.

C. Improving: Nursing homes that have shown significant improvement, as indicated by the most recent survey, and CMS is waiting to see if the improvement continues over time. If the improvement continues for about 12 months (through two standard surveys), these nursing homes will graduate from the Special Fosuc Facilities list. "Significant improvement" means that the most recent standard survey (and any later compliant investigations) found no deficiencies in which there was actual harm to any resident, and no deficiency in which there was systemic potential for harm

D. Recently Graduated: These nursing homes not only improved, but they sustained significant improvement for about 12 months (through two standard surveys). CMS congratulates these nursing homes and list their names as "graduates" for a few months after they graduate so that anyone who has been tracking their progress will be informed. "Graduation" does not mean that there may not be problems in quality of care, but does generally indicate an upward trend in quality improvement compared to the nursing home's prior history of care.

E. No Longer in Medicare and Medicaid: These are nursing homes that were either terminated by CMS from participation in Medicare and Medicaid within the past few months, or voluntarily chose not to continue such participation. In most cases the nursing homes will have closed, although some nursing homes that leave Medicare later seek to show better quality and re-enter the Medicare program after demonstrating their ability to comply with all Federal health and safety requirements.

Although you should probably always try to avoid Special Focus Facilities, you should never assume that any nursing home not on the list is a "good" nursing home. Remember that even achieving a "100%," or "no deficiencies," inspection score simply means that the facility met all the state and federal MINIMUM guidelines. There are no extra points awarded for exceeding minimum standards, so there is no way to identify exemplary, excellent, or even very good facilities from the information provided by CMS.

It is always extremely important that you visit any facility you might be considering. Just because a particular nursing home has been suggested by a social worker, a hospital discharge planner, or a "placement specialist" does not mean it will meet your standards. Social workers and discharge planners are seldom able to actually visit individual facilities themselves. "Placement advisors/specialists" often receive referral fees from the facilities they recommend.

Download the CMS Special Focus Facilities list