Advocacy in Action (July 2024): Problem Facilities
Libby Hastings • July 5, 2024
The Long-Term Care Community Coalition (LTCCC) recently released alarming data on the state of nursing facilities across the United States, revealing that nearly one in four nursing homes (24.6%) qualify as "problem facilities." This term encompasses nursing homes that have received a one-star rating on the federal Five-Star Quality Rating System, are part of the Special Focus Facility (SFF) Program or are SFF candidates. These facilities are notable for their substandard care and persistent compliance issues.
National and Kansas-Specific Findings
The data paints a concerning picture of nursing facility care quality nationwide, and Kansas is notably worse than the national average. According to LTCCC's data, out of the 306 nursing facilities in Kansas, 25.2% are classified as "problem facilities", 59.8% of nursing facilities in Kansas are for-profit, and 75% of "problem facilities" in Kansas are for-profit.
The Five-Star Quality Rating System
The Centers for Medicare & Medicaid Services (CMS) utilizes the Five-Star Quality Rating System to aid consumers in comparing nursing homes. This system rates facilities on a scale from one to five stars, with five-star ratings indicating superior care and one-star ratings flagging the poorest quality. The effectiveness and accuracy of the CMS Five-Star Quality Rating System has been debated among long-term care advocates, residents, and their families. A star rating is composed of three parts: outcomes from the state inspection report, staffing, and quality measures.
For-Profit Facilities and Quality Concerns
The LTCCC report highlights a troubling correlation between for-profit status and lower-quality care. A federal government study, released in November 2023, concluded that for-profit nursing facilities tend to have lower quality ratings, fewer registered nurses, and more safety violations, prompting one to wonder if for-profit facilities prioritize financial returns over patient care. A February 2021 study from the National Bureau of Economic Research found that going to a facility owned by a private equity firm increased the chance that a resident would die by 10%, compared with living in another type of facility.
The Special Focus Facility Program
The SFF Program targets nursing facilities with a history of serious quality issues. Facilities are identified based on their performance over the last three standard health survey cycles and three years of complaint surveys. Points are assigned for deficiencies cited during inspections, with higher points given for more severe violations. Those facilities with the highest points become SFF candidates, marking them as requiring significant improvement. The methodology behind the SFF Program is the same as that used for health inspections within the Five-Star Quality Rating System. This rigorous approach ensures that only those facilities with the most concerning track records are selected for intensified oversight.
Implications for Consumers
The LTCCC's findings and data serve as a crucial reminder for consumers to be vigilant when selecting nursing facilities. The prevalence of "problem facilities", especially among for-profit institutions, underscores the importance of thorough research and consideration of a facility's rating and compliance history.
As always, if you would like Consumer Information Reports about any licensed long-term care facility in Kansas, feel free to call or email. There is never a charge for any of our materials.
At KABC, we will continue to advocate for increased staffing, quality care, and financial transparency within for-profit nursing facilities.
KABC Testifies before the Kansas Silver Haired Legislature Kansas Advocates for Better Care (KABC) is urging state leaders to provide additional funding to eliminate the waitlist for the Home and Community-Based Services (HCBS) Frail Elderly (FE) Waiver, which helps older Kansans access the services they need to remain in their homes and communities. In testimony submitted to the Kansas Silver Haired Legislature (KSHL) on October 6 th in Topeka, KABC Executive Director Dan Goodman emphasized the importance of preserving access to in-home care and preventing older adults from entering nursing facilities before they need that level of care. The FE waiver waitlist, implemented July 6, 2026, has already affected hundreds of older Kansans. Without additional funding, more people could face delays in receiving essential services, potentially accelerating health declines and increasing the likelihood of premature nursing home placement. KABC is recommending $31 million in additional funding for the FE waiver in fiscal year 2027 to address projected funding shortfalls and help eliminate the waitlist. Kansas Silver Haired Legislature Sets 2027 Priorities On October 7 and 8, 65 delegates representing regions across Kansas gathered on the floor of the Kansas House of Representatives in Topeka for the Kansas Silver Haired Legislature's annual session. During the session, delegates approved five resolutions outlining their legislative priorities for 2027. The resolutions focus on supporting older Kansans' independence, financial security, access to care and participation in civic life. The five priorities are: Fund senior transportation Protect in-home care Increase funding for the FE waiver to help older Kansans receive care in their homes and communities. KABC supports this priority and is urging the state to add $31 million in funding for fiscal year 2027 to eliminate the FE waiver waitlist. Strengthen Medicaid Raise the Personal Needs Allowance Increase the Personal Needs Allowance for nursing home residents who receive Medicaid Protect senior voting rights These priorities address interconnected challenges facing older Kansans, from accessing transportation and affordable care to maintaining independence and financial security. The Importance of Care at Home The FE waiver was established to help older Kansans access community-based services that allow them to remain in their homes for as long as possible, delaying or avoiding the need for more costly institutional care. These services can make a significant difference in an older adult's ability to maintain independence, health and quality of life. When needed support is unavailable, however, individuals and families may have fewer options for managing care at home. Kansas already faces challenges in this area. According to the United Health Foundation's America's Health Rankings, Kansas ranks 47th in the nation for placing low-care residents in nursing facilities. KABC is concerned that limiting access to home- and community-based services could contribute to further premature institutionalization. The Cost of Delayed Access The potential impact of the waitlist is significant. According to KABC's testimony, the state faces a projected $31 million shortfall for the FE waiver in fiscal year 2027, putting access to critical in-home services at risk. Historical data also illustrate the potential scope of the problem. In 2003, a similar FE waiver waitlist affected approximately 20% of eligible participants. The Kansas Department for Aging and Disability Services (KDADS) reports that 9,306 Kansans are currently eligible for the waiver. Applying that historical 20% figure to today's eligible population suggests that approximately 1,861 older Kansans could be affected in fiscal year 2027. While this estimate is based on a historical comparison, it underscores the potential consequences of insufficient funding. Investing in Older Kansans The goal is to help older Kansans receive the services they need when they need them, rather than risk declining health or entering institutional care because community-based options are unavailable. As Dan Goodman emphasized in his testimony, investing in home- and community-based services offers an opportunity to support older adults' independence while potentially avoiding the greater costs associated with premature institutionalization. The Kansas Silver Haired Legislature's 2027 priorities provide a framework for addressing the needs of older Kansans across the state. KABC's support for increased FE waiver funding aligns with the Legislature's call to protect in-home care and ensure older adults have meaningful choices about where and how they receive care. KABC will continue advocating for policies and resources that protect older Kansans' access to quality long-term care, wherever they call home.
On Thursday, September 10th, KABC hosted our annual caregiver training, with speaker Jessica Clossen, and membership meeting. Over 30 people attended! The meeting began with a brief introduction to KABC by Libby Hastings, Communications and PR coordinator. Afterward, Karen Weber, KABC Board Vice President, led the membership meeting. During the membership and business meeting, Karen Weber (Vice President), Dave Ranney (Secretary), Rachel Stahle, Dustin Baker, and Deborah Merrill were unanimously voted to retain their current board positions. During the caregiver training portion, Navigation Memory Care: Knowing When It Is Time & How To Choose, Jessica Clossen discussed important tips for navigating memory care, including: The hidden cost of waiting too long and caregiver burnout Defining memory care Memory care transition guidance What to look for in a memory care setting Staffing and training Culture and activities Dining and daily routines We are so incredibly thankful to Jessica for sharing her time and expertize with our attendees. If you'd like to connect with Jessica Clossen, email her at jclossen@dementia-care-consulting.com or call 913-585-5178 . To view the recording of our 2026 caregiver training and membership meeting, please visit our YouTube page here. A copy of the presentation slides is available here .