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.
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.
Thanks to the dedicated advocacy of KABC and our coalition partners, Kansas has taken a major step forward in improving access to long-term care information. We’re thrilled to share that the Fiscal Year 2026 state budget includes $190,000 in dedicated funding for the creation of a comprehensive statewide senior resource directory , a direct result of our persistent efforts to ensure older adults and their families can navigate care options with confidence and clarity. Language in the approved budget bill reads: “That expenditures in an amount of not less than $190,000 shall be made by the above agency from such account during fiscal year 2026 to create a comprehensive statewide resource directory to provide essential information on long-term care options: And provided further, That such directory shall be accessible in an up-to-date online version as well as in a printable version.” This is a huge win for older Kansans, caregivers, and care professionals , and it builds directly on the success of local efforts like the Douglas County Senior Resource Directory . We know that when people have access to clear, trustworthy information, they are better equipped to make decisions that support dignity, independence, and well-being in aging. We are proud that our voice, and YOURS, was heard. From providing testimony, to meeting with legislators, to amplifying the call for this essential resource, this achievement belongs to all of us who believe that quality care begins with access to information. Next Steps: We’ll be working closely with the Kansas Department for Aging and Disability Services to support the development of this directory and ensure it meets the needs of Kansans statewide, both in print and online. T hank you for standing with us. This is advocacy in action and together, we’re making a difference.