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CMS Statement on Quality of Care in America’s Nursing Home Facilities

CMS Statement on Quality of Care in America’s Nursing Home Facilities

Dr. Kate Goodrich, Director, Center for Clinical Standards and Quality and CMS Chief Medical Officer                                                                                         

Improving safety and quality in America’s nursing homes is one of CMS’ top priorities. CMS welcomes the recent attention on nursing home quality of care that has amplified the important national dialogue. Administrator Verma began working on this issue at the beginning of her tenure in 2017.

CMS offers Americans a comprehensive, consumer-friendly quality hub, called Nursing Home Compare, which provides quality of care information for every nursing home that participates in Medicare and Medicaid. Nursing Home Compare includes an easy to understand overall star rating based on three factors: health inspections, staffing levels, and quality measures. The site also includes results of recent health inspections. In addition to this information, CMS will soon be posting a list of candidates for the Special Focus Facility (SFF) program. CMS urges all Americans to consult their physician, family, and Nursing Home Compare before choosing a nursing home for their loved ones.

Administrator Verma has made ensuring quality care in nursing facilities a priority and recently announced a five-part plan that focuses on strengthening requirements for nursing homes, working with states to enforce statutory and regulatory requirements, increasing transparency of nursing home performance, and promoting improved health outcomes for nursing home residents. CMS has already improved the way nursing homes are surveyed by implementing a robust, standardized survey process, strengthened the staffing requirements for nursing homes, updated the way nursing homes report their staffing to CMS, then targeting nursing homes with staffing problems for off-hours and weekend surveys; and we began to post all of the agency’s surveyor training online.


Background on Nursing Home Quality & Safety

Nursing Home Compare has a quality rating system that gives each nursing home a rating between 1 and 5 stars. Nursing homes with 5 stars are considered to have above average quality and nursing homes with 1 star are considered to have quality below average. There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three factors:

  • Health Inspections: Inspections include the findings on compliance to Medicare and Medicaid health and safety requirements from onsite surveys conducted by state survey agencies at nursing homes.
  • Staffing Levels: The staffing levels are the numbers of nurses available to care for patients in a nursing home at any given time.
  • Quality Measures: The quality of resident care measures are based on resident assessment and Medicare claims data.

CMS enters every nursing home approximately once a year and conducts an unannounced inspection survey. The agency also conducts inspections whenever a complaint is received about a nursing home. Consumers can find the results of all of these surveys on Nursing Home Compare. Not only does the Nursing Home Compare website provide these survey results, it also includes information about staffing levels and performance on quality measures by facilities. All of this information is presented in an easy-to-understand star rating, with facilities receiving a rating from one to five stars. The more stars, the better the quality.

There are 15,000 nursing homes in the country, and almost 3,000 of these have a one-star rating on their health inspections. By contrast, there are only 88 Special Focus Facility (SFF) program slots, and only about 400 candidates for the program. CMS regularly helps states narrow down the list of poor performers to identify nursing homes that are candidates for the program.

CMS has many levers for quality improvement in nursing homes, and the SFF program is just one. The SFF program was created in 1998 to target low-quality facilities for additional scrutiny. Candidates for the SFF program have low star ratings which any consumer can easily find on the CMS Nursing Home Compare website. The methodology for identifying facilities for the SFF program is based on the same methodology used in the “health inspection” component of the Five-Star Quality Rating System on Nursing Home Compare.

In 2008, CMS began posting an icon for identifying SFFs on the Nursing Home Compare website, and revised the methodology for identifying SFF candidates to be harmonized with the methodology used in the Five Star Quality Rating System ( The results of each facility's surveys for three cycles of inspection are converted into points based on the number of deficiencies cited and the scope and severity level of those citations. The more deficiencies that are cited, and the more cited at higher levels of scope and severity, the more points are assigned. The facilities with the most points in a state then become candidates for the SFF program. Consumers and stakeholders can see which facilities could be candidates by accessing the website and downloading the ''Provider Info" file. By sorting the column named, "Total Weighted Health Survey Score,'' in descending order, the facilities with the highest survey scores, which could be SFF candidates, appear at the top of the list. Using this methodology provides transparency so that stakeholders can understand how facilities become SFFs, and also determine which facilities are candidates.

CMS released additional information about the SFF program in 2010 ( In 2014, the number of SFFs was reduced due to sequestration, and has remained unchanged since that time (

For more information about Special Focus Facilities, please visit:


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