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.
Dan Goodman, KABC Executive Director, recently provided testimony to both the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE) during their Fiscal Year 2026 budget hearings. Our message was clear: Kansas must invest in systems that protect the dignity, independence, and well-being of older Kansans. Key Recommendations from KABC Protect Access to In-Home Services • Projected shortfalls of $27M in FY26 and $70M in FY27 threaten the HCBS Frail Elderly Waiver. • Without funding, older Kansans may face a waitlist for services, leading to premature nursing home placement. Strengthen Care Coordination • Frail Elderly, Physically Disabled, and Brain Injury waiver recipients currently lack dedicated case management. • KABC urged implementation of the long-overdue $20M Community Care Coordination Service. Improve Oversight & Resident Protections (KDADS) • Surveyor vacancies are near 50%, delaying inspections and weakening resident protections. • We called for wage increases and innovative staffing models to close gaps in oversight. Increase the Personal Needs Allowance • Nursing home residents in Kansas receive only $62/month for personal expenses. • KABC supports raising this allowance—closer to the $70 national average—and tying it to cost-of-living adjustments. Continue the Statewide Senior Resource Guide (KDADS) • KABC requested $150,000 to maintain and distribute the statewide guide annually. • This investment ensures older Kansans have access to accurate, trusted information on care and services. Why It Matters By 2030, more than 20% of Kansans will be age 65 or older. Budget decisions made today will directly impact whether older Kansans can age with dignity, safety, and independence. Read KABC’s full testimonies to KDADS here and KDHE here .
Steve shares his journey through multiple long-term care facilities after a major surgery, describing repeated medication errors, poor food quality, untrained staff, and systemic neglect. His story highlights how understaffing, weak oversight, and profit-driven management leave residents without advocacy and dignity.