Understanding the Special Focus Facility Program

Libby Hastings • April 21, 2025

Understanding the Special Focus Facility (SFF) Program: What Families Need to Know When Choosing a Nursing Home in Kansas

When searching for a nursing home for a loved one, families often look for a place that will offer safe, reliable, and compassionate care. One important—but often overlooked—resource that can help inform that decision is the Special Focus Facility (SFF) Program, managed by the Centers for Medicare & Medicaid Services (CMS).


What Is the Special Focus Facility (SFF) Program?

The SFF Program was created by CMS to address the most persistent quality problems in nursing homes across the country. Every nursing home that accepts Medicare or Medicaid is regularly inspected to ensure it meets health and safety standards. Most nursing homes will have a few issues identified during these inspections—typically six to seven deficiencies on average—but some facilities consistently fall far below acceptable standards.


These nursing homes:

  • Have twice as many deficiencies as the average facility,
  • Have more serious issues, including those that cause actual harm to residents,
  • And show a long-term pattern of poor performance over a span of about three years.


Facilities like these may fix issues temporarily, but often fail to address the root causes—resulting in a harmful cycle of repeated violations. That’s where the SFF program comes in.


How the SFF Program Works

CMS uses inspection data to score nursing homes based on both the number and severity of their deficiencies. Facilities with the highest scores (i.e., the most and most serious problems) are added to a list of SFF candidates.


Each state is allowed only a limited number of active SFFs at a time—currently, only 88 facilities nationwide can be enrolled in the program. However, CMS maintains a much longer list of SFF candidates that also meet the criteria but haven't yet been selected for the program due to space limits.


Once a facility is chosen as an active SFF:

  • It is inspected every six months instead of the usual once a year.
  • It may face progressive enforcement, such as financial penalties or losing eligibility for Medicare and Medicaid.
  • It must show real, lasting improvements to graduate from the program.


A facility "graduates" from the SFF program only after it has two consecutive inspections (after being named an SFF) with no more than 12 relatively minor deficiencies and none at a higher severity level. If a facility continues to have serious violations, CMS may consider terminating its participation in Medicare and/or Medicaid.


Why This Matters to Kansas Families

Being informed about a nursing home’s history can help protect your loved ones. Facilities in the SFF program—or on the candidate list—have serious quality concerns. While some may be working hard to improve, others may continue to struggle with systemic issues that put residents at risk.


As of March 2025, the following nursing homes in Kansas are included in the Special Focus Facility (SFF) program:


  • Excel Healthcare and Rehab Topeka (recently closed)
  • Access Mental Health (Peabody)


The following facilities in Kansas are currently on the SFF candidate list:

  • Clearwater Nursing and Rehabilitation Center
  • Good Samaritan Society- Liberal
  • Kearny County Hospital Long-Term Care Unit
  • Legacy at College Hill (Wichita)
  • Legacy on 10th Avenue (Topeka)
  • Medicalodges Jackson County
  • Medicalodges Post Acute Care Center (Kansas City)
  • Meridian Rehabilitation and Health Care Center (Wichita)
  • Riverbend Post Acute Rehabilitation (Kansas City)
  • Tanglewood Nursing and Rehabilitation (Topeka)


The following facilities graduated from the SFF program: 

  • Advena Living of Cherryvale
  • Life Care Center of Osawatomie


Anew Healthcare Oxford is a facility that is no longer participating in the Medicare and Medicaid Program. 

We encourage families to take time to research and ask questions when considering a nursing home. You can access the full national SFF and candidate list on the CMS website here. KABC offers free unbiased Consumer Information Reports on all licensed adult care facilities in Kansas, helping you make an informed choice when deciding between long-term care options. 


Final Thoughts

The Special Focus Facility Program exists to push underperforming nursing homes to do better—but it’s also a signal to the public. When selecting long-term care, knowing whether a facility is on this list can be an important part of making the best choice for your loved one.


If you have questions about how to find quality nursing home care in Kansas or want help understanding a facility’s inspection history, don’t hesitate to reach out to our team.

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Advocacy in Action (June 2025): One Investigator, 70 cases, APS is Stretched Too Thin

May 29, 2025
In a recent article published by The Beacon, reporter Blaise Mesa spotlights a heartbreaking case that exemplifies both the critical importance and serious strain facing Kansas Adult Protective Services (APS). The article, “One elder abuse investigator has 70 cases. Kansas doesn’t say how swamped other caseworkers are,” tells the story of Shirley Crow, an 85-year-old woman with Alzheimer’s whose family trusted a caretaker to manage her daily medications and appointments. That trust was broken. Despite filing a report with APS, Shirley’s family received few updates. Weeks after their report, Shirley passed away. Her case remains open—one of 10,000 APS investigations initiated in Kansas each year. The assigned APS caseworker? She has 70 other cases. This is not a story about blame. As Shirley’s daughter-in-law, Stacy Crow, told The Beacon , “We got an investigator that I truly believe has a heart… I understand they have an overwhelming demand… I don’t fault them. I just want things to change.” And so do we. Systemic Overload and the Urgent Need for Reform The Kansas Department for Children and Families (DCF), which oversees APS, has not publicly disclosed average caseloads. While DCF clarified post-publication that they do track this information, they choose not to release it, citing confidentiality. The lack of transparency and standardization prevents meaningful accountability and reform. National standards suggest 20–25 cases per worker is a manageable caseload. Kansas APS staff, in some cases, are handling double or triple that amount. With cases increasing year over year— 18,056 in fiscal year 2025 alone—the risk of delayed intervention or missed warning signs only grows. This Is a Wake-Up Call. At KABC, we continue to push for better protections for older adults, more robust support for APS investigators, and greater transparency and accountability from state agencies. In our recent blog post, “ What Happens When You Report to Adult Protective Services? ” we outline the crucial role APS plays in protecting vulnerable adults and how reporting suspected abuse can quite literally save lives. To report suspected abuse, neglect, or exploitation of a vulnerable adult in Kansas: For older adults living at home in the community or in facilities licensed by the Kansas Department of Aging and Disability Services when the perpetrator is not a resident of or staff of the facility, report to the following: Adult Protective Services (APS): 1-800-922-5330 If an emergency, call your local law enforcement agency or 911 Reporting initiates a multi-step process involving a prompt in-person visit, interviews, and, when needed, development of a service or prevention plan. The goal of APS is to protect, not to punish- to connect individuals to medical care, housing, legal services, or safety planning. But APS cannot fulfill that mission if it's underfunded, overwhelmed, and operating in the dark.  What Needs to Change: Transparency: Kansas must publicly release average caseload data and investigation timelines. Support for APS Workers: State leaders must prioritize hiring and retaining qualified APS staff and ensure manageable caseloads. Federal Investment: Continued and expanded federal funding for APS is essential—not optional. Public Awareness: Communities need to understand when and how to report suspected abuse, and how they can be part of the safety net. The APS system should be a lifeline, not a last resort.

5 Questions to Ask When Choosing a Long-Term Care Facility

May 21, 2025
Choosing a long-term care facility for yourself or a loved one is one of the most important decisions you can make. Beyond basic safety and cleanliness, the right facility should support a person’s independence, dignity, and overall quality of life. To help you make an informed choice, here are five essential questions to ask, along with key follow-ups that can give you a deeper sense of what daily life will be like at the facility. 1. How does the facility support independence and person-centered care? Person-centered care means that residents are active participants in their care and daily routines. Ask: Can residents choose when to wake up and go to bed? Are meals and activities tailored to individual preferences? Is there flexibility for “early birds” and “night owls”? Look for signs that staff respect residents’ individuality—such as accommodating dietary preferences and encouraging participation in meaningful activities. 2. What medical and rehabilitation services are available on-site? Quality care goes beyond assistance with daily activities. Ask about: Access to hospice care and pain management Availability of wound care and ostomy specialists In-house physical, occupational, speech, and mental health therapies Staffing levels—how many nurses and aides are on duty at different times of day? These services can have a major impact on recovery, mobility, and comfort. 3. What is the atmosphere like during meals and activities? Daily life should be engaging and social. Ask to observe a meal or an activity session. Consider: Are residents out of their rooms and interacting with others? Do meals look appetizing and meet special dietary needs? Is assistance with eating provided promptly and respectfully? Also ask about field trips, volunteer involvement, and whether there is an active activities room or calendar of events. 4. What do current residents and families say about their experience? Talking to those already living in or visiting the facility can give you valuable insight. Ask residents: Do staff respond quickly when you call for help? Do you enjoy your meals and feel your privacy is respected? Are you involved in decisions about your care? Ask families: Are you promptly notified of any accidents or health changes? Do you feel comfortable raising concerns? Is there a Family Council and does the facility listen to it? 5. How transparent and responsive is the administration? A responsive leadership team is key to resolving issues and maintaining quality. When meeting with the Administrator or Director of Nursing, ask: How do you handle complaints? How are staff trained and how long do they typically stay? What’s your policy on resident rights, such as refusing treatment? You can also ask to review the admission contract, learn about costs and refund policies, and understand how care decisions are made if the resident is unable to speak for themselves. Want more questions to ask? Visit our full guide: Is This the Nursing Home to Choose?  It includes detailed sections on services, nursing care, residents' rights, and conversations to have with administrators, staff, and families. At Kansas Advocates for Better Care, we believe everyone deserves compassionate, dignified, and person-centered long-term care. Asking the right questions is the first step to getting it.