The Senate Special Committee on Aging has just released one of the most damning reports on the nation’s nursing homes that I’ve seen in a long time. The short document should be required reading for any family thinking of moving a relative to a nursing facility.

Pennsylvania Senator Robert Casey, a Democrat, who is the ranking member on the committee along with Pennsylvania’s other senator Patrick J. Toomey, a Republican, recently revealed a special but unpublicized program to flag and monitor the worst nursing homes in the country.

Bad nursing homes, it seems, have always been part of the fabric of America, and back in the Reagan administration, Congress passed a tough law to improve care for those who have to live in them. The additional oversight, known as the federal Special Focus Facility program, is supposed to increase oversight of nursing facilities that have repeated deficiencies as documented by state survey agencies.  The agencies conduct the inspections for the Centers for Medicare & Medicaid Services.

The existence of the program has largely been hidden from the public.

This special program divides the worst of the worst into two groups – those called “participants” , which receive additional oversight, and those called “candidates,” which are nursing facilities that might move up to the participant list someday. Right now the government has identified 88 nursing homes across the country as “participants” and about 400 facilities as “candidates.” Until now, though, the candidate list has not been available to the public.

Just about every state has some facilities on one or the other list. For example, there are 34 homes from California on the candidate list, 17 in Indiana, six in North Dakota, five in South Dakota, and six in Kentucky.

Facilities listed as participants are supposed to get more frequent inspections and government oversight than other homes, which are inspected every 12 to 15 months by state inspectors working on behalf of the federal government.

A facility on the candidate list may move into the participant column if conditions in the home warrant more oversight – but only if space allows.  In 2013, CMS reduced the number of the participants from 152 to 62 because the agency didn’t have enough budget and staff to cover more. The number of facilities has increased a bit since then.   

The names on the participant list are public, but as the senators point out in their report, CMS doesn’t make it easy to identify them. On the CMS website, these problematic facilities are not given star ratings as are most other facilities.  Instead they are designated with a small yellow triangle that looks like a caution traffic sign.

The senators concluded this designation “is not readily transparent or easily understood among would-be residents and their families.”

It’s even worse with the 400 or so facilities on the candidate list.  Until now the list has not been made public. Nor do these facilities receive more frequent inspections the way those in the participant group do.

Families should think twice before sending a relative to a facility in either group.

The Aging Committee has now listed the names of those “candidate” facilities on its website.  CMS said last week it will now make that list public.

There is more “buyer beware” advice in the report.  Senators flagged trouble with the star ratings CMS uses to help families select nursing homes. Many families rely on them to choose a facility. So do hospital discharge planners.

But the stars are misleading and may not always direct families to the best nursing facilities.  That’s something I’ve observed for years as I’ve reported on problems with the nation’s nursing homes.

The senators examined star ratings for a sample of facilities on the candidate list and found that almost half of them had a quality rating of three stars or better. Five is best. Remember that homes on this candidate list are only one step away from being subject to more frequent inspections because of what the government considers poor track records caring for patients.

Even more astonishing is that nine facilities on the candidate list had perfect staffing and quality scores.

With results like those how can any family rely on the CMS ratings?  They can’t.

My advice:  Look at which facilities are on the participant and candidate lists and avoid them. If they are the only game in town, then proceed with caution and keep a very close eye on any relative you send to one of them.

What has been your experience with nursing homes? Write to Trudy at  trudy.lieberman@gmail.com.

This piece was originally published as part of Rural Health News Service series, “Thinking About Health,” on 6/11/19.