America's 52 Worst Nursing Homes

The Centers for Medicare & Medicaid Services has released the first-ever official list of America’s Worst Nursing Homes— a move that leads us to suspect that the Department of Health & Human Services must be getting pretty fed up if they are resorting to public shaming. The list includes the 52 most egregious health and safety violators of the 128 SFF, or “Specialty Focus Facilities,” in the U.S.

A Special Focus Facility is basically a nursing home that is on double-secret probation— subject to twice as many inspections as a non-SFFs, with the threat of funding cuts for non-compliance.

According to the CMS, the average facility isn’t perfect (6-7 violations is the national average.) Those designated as SFFs are guilty of either more violations or more serious violations than usual, as well as a history of fixing problems just long enough to pass inspection, then going right back to business as usual. The CMS dubs this “yo-yo compliance,” and the SFF program is designed to deal with it by combining more frequent inspections with more stringent enforcement until the nursing home falls back in line.

If the facility in question doesn’t shape up, correct the underlying problems that lead to violations and “graduate” from the SFF program (in about 18-24 months) their funding is cut and they will likely close.

How To Use The List:

The CMS offers some tips to people who may be considering a nursing home on the list.

1) Use Nursing Home Compare to look up the CMS survey results and see what “areas may be problematic.” It’s important, says the CMS, to pay attention to how long the facility has been on the SFF list. If they have been listed for more than 18-24 months, they are either close to graduating or close to losing their funding completely. It’s important to know which.

We looked up a random nursing home in Philadelphia that has been on the list for 34 months. There were 24 violations listed, including: Failing to “keep each resident free from physical restraints unless needed for medical treatement,” “Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores,” “Make sure that each resident’s nutritional needs were met,” “Provide proof that all residents’ personal money which is deposited with the nursing home, is secure,” and “Store, cook, and give out food in a safe and clean way.”

Most of the violations have been corrected, but a few, including the last three mentioned above, are still pending.

2) Visit the nursing home. While you’re visiting, feel free to discuss the violations and ask what the nursing home is doing to improve their patient care. You can contact your local State Ombudsman or Administration on Aging and ask them for more information on the nursing home.

Without further ado, the list of America’s Worst Nursing Homes (PDF).

America’s Worst Nursing Homes (PDF) [CMS]
Special Focus Facility (“SFF”) Initiative – Background (PDF) [CMS]
Nursing Home Compare []


Edit Your Comment

  1. Wow.

    Picked one at random. Just because it isn’t in the 50 worst doesn’t mean it isn’t bad.

  2. BigNutty says:

    Always walk in unannounced, one time in the morning and one time in the night and smell the place. You can tell a lot from your nose.

  3. mattbrown says:

    How ’bout a nice warm glass of shut-the-hell-up?!

  4. lostsynapse says:

    So how do I go about nominating nursing homes for the Nobel Peace Prize for their innovative approach to the problem of global overpopulation?

  5. othium says:

    The companies that own and run these facilities are more concerned at how to cut costs, not improve conditions for the consumers they are serving.

    I worked at one place for over ten years, hoping it would get better, but had to finally get a second job and cut my hours as a PCA. Although it was rewarding to help people everyday, I found the stress and physical demands to be too much of a risk for the extremely low hourly wage I was paid. The only staff that have stayed on are the last few “good” staff, and the majority are ones who just don’t care one way or another.

    I would report violations on average of one or two a week, but most were not followed up on and deemed to be “not serious enough to warrant an investigation”.

    Sadly, this situation will only get worse as the the number of people who need these types of services are growing fast. In Minnesota, the turnover rate in my field is over 60 percent and less people are choosing to work in this area. Unless some major changes happen, it will just continue to get worse..

  6. trollkiller says:

    I delivered pharmaceuticals to nursing, group and assisted living homes for over 5 years. In that time I saw good homes and not so good homes. Funny thing the newest and “cleanest” homes were not always the best, in fact most of the times they were the worst.

    If place smells and none of the staff seems to notice, that is a bad sign. That means that smell is always there no matter what the manager says. The manager or whoever is giving the tour WILL lie to you. They will tell you the smell is due to it being laundry day, sewer is backed up or a resident “just had an accident”. Also if it smells heavy of citrus that means they are trying to cover the stench.

    Watch the residents while you are being given the tour, do any of them interact with the tour guide? Does the tour guide interact with the residents? Do the residents have that thousand yard stare? Are the staff talking over the residents or to them?

    Nursing homes are NOT hospitals. Nursing homes are the resident’s homes. It should feel that way. The residents should look relaxed and should be enjoying themselves. They should not look timid.

    I will take a place with worn out tile and walls that need painting if the staff loves their residents over a shiny new place with staff that is just doing their job. BTW shiny places with by the book staff will pass inspection but the residents will be miserable.

    I was told more times than I can count how I was the highlight of the day. All I did was treat them like anybody else whose home I was visiting. So if you have someone in a nursing home, please visit them often. Yeah it is a pain in the ass to make the time, but they will appreciate it to no end. I should never be the highlight of their day, you should.

  7. othium says:

    @trollkiller: Your post was very good and I can verify that the tips you gave about what to look for when touring a home are right on the money. Most of those who give the tours in my company aren’t even familiar with the current consumer’s names or even any of the staff that work there. They only answer general questions. One touring manager was asked some specific questions regarding the staffing ratio and whether the home had consistent people at that particular home. She had to turn to me for the answer as I was nearby doing some paperwork. I told them “In the last seven years I had worked at that facility, it had not been fully staffed and that the schedule changed on an hourly basis due to call-ins and people quiting with little notice.” This manager was quite embarrassed. Recent tours do not allow the questioning of staff and state that this change is for “privacy concerns”.

  8. tno says:

    Several years ago my father was ill and needed to spend time in a skilled nursing facility. After two wretched facilities, we decided to do a little investigating before trying again. My first stop, the local rescue squad. I have been in EMS for several years and have seen, here in my city, the best and the worst out of nursing homes. So, it seemed logical to speak to squad members where my parents live.

    The results were surprising. The captain I questioned told me he could only talk to me about one of the local facilities because he was involved in litigation against the others. That told me all I needed to know. I don’t think that everyone will have this clear a decision to make but I suspect that queries to your local rescue squad could yield some useful information.