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.
On Monday, October 13th, Dan Goodman, Executive Director of Kansas Advocates for Better Care (KABC), delivered testimony before the Robert G. Bethell Joint Committee on Home & Community Based Services & KanCare Oversight. His remarks focused on the urgent need to strengthen Kansas’ long-term care system through sustainable funding and workforce investments. Goodman urged legislators to provide additional funding for the Home and Community-Based Services (HCBS) Frail Elderly waiver , noting projected shortfalls of $27 million in FY26 and $70 million in FY27. Without intervention, hundreds of older Kansans could face placement on a waitlist as early as this fall—delaying access to critical in-home services and increasing the risk of premature institutionalization. He also highlighted the need to support and stabilize the state’s long-term care workforce by exploring innovative approaches used in other states. For example, New Mexico’s Competitive Pay for Professionals program has helped attract and retain workers by linking higher wages to improved reimbursement rates and accountability measures. Goodman suggested Kansas consider similar models to strengthen its caregiving workforce and ensure providers can offer competitive pay. KABC remains committed to advocating for policies that promote quality care, protect older adults, and sustain a strong, well-supported caregiving system across Kansas. Read KABC’s full testimony here: View Testimony (PDF) Watch a full recording of the committee here: YouTube Link
On October 1st and 2nd, the 2025 Special Committee on Health and Social Services met, with the first day devoted to nursing home surveying and credentialing. The joint committee of both House and Senate members heard from the Kansas Department for Aging and Disability Services (KDADS), the Long-Term Care Ombudsman, industry representatives from Kansas and out of state, administrators, and contractors. Notably absent were the voices of consumers, their family members, and facility staff , the people most affected by long-term care policy. The committee heard information about: Survey Backlogs and Staffing Challenges KDADS contracts with the federal government to inspect adult care homes for health and safety compliance. KDADS has struggled for years to meet federal requirements, due in large part to recruiting and retaining nurse surveyor positions. More than half of the 60 approved positions were vacant earlier this year. As a result, Kansas currently averages 19.9 months between nursing home inspections , far beyond the federal requirement of 12-15.9 months. With just over 300 federally licensed facilities in the state, timely inspections are critical to protecting residents. To address this, KDADS eliminated 15 vacant positions and raised starting pay: up to $60,000 for multidisciplinary surveyors and $67,000 for RNs . The agency is also considering incentives to encourage more RNs to work as surveyors. Kansas has one of the highest rates of the most serious deficiencies, known as Immediate Jeopardy (IJ) deficiencies, in the nation , citations for situations where resident health and safety are at serious risk. The committee explored the possibility of privatizing the survey process. Resident Rights at Risk Testimony also revealed troubling practices in some nursing homes, including charging residents $200–$300 per month in “pharmacy provider” or “medication set-up” fees if they choose to use an outside pharmacy. This practice undermines residents’ right to choose their own providers and unfairly penalizes private-pay residents, already shouldering an average of $7,000–$8,000 per month in nursing home costs. Involuntary Discharges and the Ombudsman’s Recommendation The Long-Term Care Ombudsman urged lawmakers to expand discharge reporting requirements. As she noted: “Federal regulations require a notice to be sent to our office for a facility-initiated transfer (involuntary discharge) in federally licensed nursing homes, but that is not the case for state licensed homes, assisted livings, home pluses and residential health care facilities. With the help of our office, we can often help resolve the reason for the discharge notice to prevent a resident transfer or support the resident to ensure a transition occurs safely.” The committee heard concerns from representatives of the nursing home industry and decided to delay making a recommendation on this issue, noting that additional information is needed. KABC has advocated for not only strengthening the reporting requirements but also giving residents of assisted living facilities the same right to appeal an involuntary discharge that nursing home residents enjoy. Raising the Personal Needs Allowance The Personal Needs Allowance (PNA) for nursing home residents is a monthly stipend that Medicaid recipients can use for personal expenses. In Kansas, the PNA is just $62 per month. Many residents express concern that this amount is insufficient to cover basic personal expenses such as haircuts or undergarments. An immediate increase to the allowance is needed, along with an ongoing adjustment to keep pace with rising costs. The Long-Term Care Ombudsman recommended a PNA increase to the national average of $72 with an additional annual Cost of Living Adjustment. KABC’s Position KABC will continue to advocate for: • Strong oversight of nursing homes. • Resident rights protections, including freedom of choice in providers. • Central inclusion of residents and staff voices in all policy discussions. You can watch the hearing on the Kansas Legislature’s YouTube channel here . KABC will continue to monitor these conversations closely as the 2026 legislative session approaches.