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.
Kansas has announced that it is exiting the Money Follows the Person (MFP) program, citing a drastic reduction in and possible elimination of federal funding. According to the Kansas Department for Aging and Disability Services (KDADS), the state had planned to reinstate the program on July 1 after several years of inactivity. Instead, Kansas is now withdrawing from the program altogether. For many Kansans, this decision represents a significant missed opportunity. The MFP program was created to help states rebalance their long-term services and supports systems by making it easier for people to move from institutional settings, such as nursing facilities, back into homes and communities. The program provided funding for critical transition expenses, including home modifications, furniture, bedding, kitchen supplies, and other necessities that help make community living possible. At its core, MFP recognized a simple truth: most people want to live in their own homes and communities, not institutions. Research consistently shows that older adults overwhelmingly prefer to age in place. In an AARP survey, 75 percent of older adults reported wanting to remain in their homes as they age. Yet many feel they will eventually have no choice but to move into a facility because the supports needed to remain at home are unavailable or unaffordable. Programs like MFP help bridge that gap. When people remain in nursing facilities despite being able to live safely in the community, there are consequences, not only for the individual, but for the state as a whole. First, individuals lose autonomy and control over their daily lives. Living in the community allows people to decide when they wake up, what they eat, who they spend time with, and how they participate in their neighborhoods. These choices may seem small, but they are fundamental to dignity and quality of life. Second, unnecessary institutionalization can contribute to social isolation. People living in their own homes can remain connected to friends, family, faith communities, volunteer opportunities, and local activities. Community integration promotes both physical and emotional well-being. Third, keeping people in nursing facilities when they could thrive in the community often comes at a higher cost to the Medicaid system. Home and community-based services are frequently less expensive than institutional care while also aligning with what most people prefer. Helping individuals remain in the least restrictive setting can benefit both taxpayers and the people receiving services. Finally, programs like MFP help remove barriers that prevent people from exercising their right to choose where they receive care. Transitioning from a nursing facility to the community is often not as simple as opening the front door and leaving. Many individuals need assistance securing housing, obtaining household items, modifying their homes for accessibility, or coordinating services. Without dedicated funding and support, these barriers can become insurmountable. Kansas has made progress over the years in expanding home and community-based services, but significant challenges remain. Housing shortages, workforce shortages among direct care workers, and waiting lists for services continue to make community living difficult for many people. The loss of Money Follows the Person means one fewer tool available to help Kansans return home.
2026 legislative wrap-up for long-term care advocates in Kansas.