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.
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Inside Kansas Nursing Homes: A Special Series Returns in Honor of KABC’s 50th Anniversary In celebration of Kansas Advocates for Better Care’s 50th anniversary, we are proud to reintroduce a powerful special series from our early days as Kansans for Improvement of Nursing Homes. Originally launched in the mid-1980s, Inside Kansas Nursing Homes: Through the Eyes of the Experts offered an unflinching look at nursing home care across Kansas, as observed by those who know it best: the relatives, friends, residents, and caregivers of residents. Now, nearly four decades later, we are bringing this vital series back, with the same grassroots spirit and commitment to truth. This first issue of Volume One marks the beginning of our updated report on the current state of nursing home care in Kansas, informed by the honest voices of frequent visitors who witness daily life inside these facilities. Since April 2025, we have been gathering recorded and transcribed conversations with individuals who care deeply about their loved ones in long-term care. These candid reflections are edited to preserve confidentiality—identifying details are removed, names are changed, and nursing homes are referred to by assigned numbers and regions. Mentions of facilities in passing are designated with alphabetical letters (e.g., Nursing Home A). Over the next year, we aim to gather insights on at least 40 to 50 percent of Kansas’s 305 nursing homes. Volume One of this series, covering roughly 40 homes, will be released in serial form over the coming weeks. Through these voices, we invite readers to reflect, question, and advocate, just as we did in the 1980s. Because meaningful change begins when we listen.