When it’s time to choose a nursing home for yourself or a loved one, making the choice can be one of the most difficult yet important decisions. And although there are many general guides on what to look for when choosing a nursing home, one resource that is still little known is the Specialty Focus Facility Initiative Program run by the Centers for Medicare and Medicaid (CMS).


What is the Specialty Focus Facility Initiative?

CMS, together with individual states, visit nursing homes on a regular basis to determine if the nursing homes are meeting the levels of care required by CMS. During these inspections, the survey teams identify any deficiencies that affect the quality of care provided or fail to meet CMS safety requirements. These deficiencies are required to be fixed, otherwise the nursing home’s participation in Medicare and Medicaid can be terminated.

Most nursing homes have some level of deficiencies, with the average being 6-7 deficiencies per survey. While many nursing homes are able to correct the issues found within a reasonable time period, a minority have more problems than other nursing homes, more serious problems, or continue to have serious problems over a long period of time. Although such nursing homes periodically instituted enough improvements in the presenting problems that they would be in substantial compliance on one survey, they would be determined as providing substandard quality of care on the next. These facilities with a “yo-yo” compliance history rarely addressed the underlying systemic problems, giving rise to repeated cycles of serious deficiencies. To address this problem CMS created the “Special Focus Facility” (SFF) initiative.


How does the SFF initiative work?

SFF nursing homes are visited twice as often as regular nursing homes in person by survey teams. Problems that persist for long periods of time result in more stringent enforcement actions including monetary fines or termination from Medicare and Medicaid.

Usually, once a facility has been identified as a SFF nursing home by CMS, one of three outcomes will occur:

  • The nursing home improves enough that they are removed from the SFF program.
  • The nursing home is provided additional time to continue in the SFF program due to promising progress.
  • The nursing home is terminated from participation in Medicare and Medicaid programs.

How can I use this information?

CMS recommends that if you are considering admission to any nursing home on this list, you should:

  • Visit the nursing home. Talk to the staff, residents, and other families that you see. Request to see the results from the last State or CMS survey.
  • Review the survey history of the nursing home on Nursing Home Compare (https://www.medicare.gov/nursinghomecompare/search.html) to see what areas may be problematic.
  • Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home.
  • Call your state survey agency to find out more about the nursing home. Look at the length of time that a nursing home has been on the SFF list. This is particularly important if the nursing home has been an SFF nursing home for more than 18-24 months, since such nursing homes are closer to either graduating (due to improvements) or ending their participation in Medicare and Medicaid.
  • Call your local State Ombudsman, Administration on Aging, and local groups to find out more about the nursing home.

Note: Because state survey agencies are responsible for entering survey information into CMS’s databases and providing updates, data lags of up to several months can occur between completion of a survey and posting the data on this list. CMS advises interpreting the information on the SFF list cautiously and supplementing it with information from the state survey agency, information from the ombudsman’s office, or other resources.

CMS regularly updates the SFF list and makes the list available for download at their site: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/nhs.html

Click here to see the current list of nursing homes on the CMS SFF list.