Understanding the Medicare Survey Process and the Special Focus Facility (“SFF”) Initiative

By Attorney, Jeffrey J. Downey
A consumer advocate representing victims of elder neglect in Virginia
Maryland and Washington DC. Free consultations available.
Phone: 703-564-7318; email: jdowney@jeffdowney.com

This article explains the survey process for nursing homes and a new initiative by Medicare created to place poorly performing nursing homes under increased scrutiny.

In February 2014, the Office of Inspector General (OIG) published a report entitled Adverse Events in SNFs: National Incidence among Medicare Beneficiaries. The report can be accessed here. It explains that one out of every three nursing home patients  were harmed by an adverse event or temporary harm event within the first 35 days of their skilled stay. It also determined that nearly 60 percent of those events were preventable.

Residents entering nursing homes should screen such facilities to reduce their risk of injury or death.  One tool used for screening is the state inspection process. Nursing homes that receive federal funding are surveyed or inspected by state inspectors applying federal regulations found at 42 C.F.R § 483.10, et seq, along with the interpretive guidelines.  These inspections typically occur once a year or more frequently, if the surveyors are called upon to investigate specific complaints.

The special focus facility initiative (“SFF”) requires that nursing homes with recurrent problems face increased scrutiny, with at least two annual surveys a year.  CMS started to list poor-performing nursing homes in 2007, an important step forward in providing helpful information that consumers could use to screen nursing facilities.  Medicare’s Nursing Home Compare’s website currently provides information on most nursing homes in the country, or at least the ones who receive federal funding.

The SFF program takes enforcement one step further.  Facilities that fail to perform after being identified as a deficient facility will be subject to civil monetary penalties and in some cases, even exclusion from the Medicare and or Medicaid programs. More information on the SFF program can be found here.

This is an important step forward, explains nursing home abuse attorney, Jeffrey J. Downey.  As a practical matter, however, the states do not have the resources to adequately inspect nursing homes, and the inspections simply offer a snapshot of the facility on that particular day.  Often the facilities are aware that surveyors are in the area, and the facilities make special preparations. Equally important, the surveyors may not be able to fully examine the circumstances of a patient’s development of pressure wounds to understand whether a bed sore or a fall should have been prevented in a particular case.

However, there is still value in having the government identify specific under-performing nursing facilities.  On this website you will find more detailed survey information than is typically available on Medicare’s Nursing Home Compare website or other websites.  Today we identify the facilities in Maryland and/or Virginia that have been placed in the program or recently removed:

Facilities newly added to the SFF program (August 2018)

  • Envoy of Winchester Hills, 4403 Forest Hill Ave, Richmond, Virginia

Facilities that have shown improvement:

  • Ballenger Creek Center, 347 Ballenger Dr., Frederick, Maryland 21701

Facilities that recently graduated from the SFF program:

  • Fredericksburg Health and Rehab, 3900 Plank Rd, Fredericksburg, Virginia  22407

CMS recommends that if you are considering admission to a nursing home  you may want to:

  • Above all, visit the facility.  Speak to staff, residents, and other families.  You may request to see the results from the last State or CMS survey (it should be posted in a public place, easily accessible.)
  • Before your visit, look at the survey history of the nursing home on Nursing Home Compare to see what areas may be problematic.
  • Inquire of the facility staff what they are doing to improve the quality of care for residents in the nursing home. Ask to review their publicly posed surveys and responses.  Ask about staffing levels.
  • Ask to review the admission paperwork.  Are they trying to waive your right to file a lawsuit if your loved one is neglected?  If you see that they have a mandatory arbitration provision, ask if you have to sign it.
  • Contact the State survey agency or review nursing home compare to find out more about the nursing home. Look at the length of time that a nursing home has been on the SFF list.  This is particularly important if the nursing home has been an SFF nursing home for more than 18-24 months, since such nursing homes are closer to either graduating (due to improvements) or ending their participation in Medicare and Medicaid.
  • Call your local State Ombudsman, Administration on Aging, and local groups to find out more about the nursing home.
  • Once admitted, participate in any care plan meetings and be an advocate for quality care.  Make your expectations known to the staff.

Use the Nursing Home Brochure found at here and “Guide to Choosing a Nursing Home” both publications are available on Nursing Home Compare.

I hope you have found this information useful.  Feel free to search this website for specific information about the nursing home you are interested in investigating. For more information call the Law Office of Jeffrey J. Downey for a free consultation.

Tags: nursing home complaint, SNF complaint, nursing home survey, nursing home inspection, freedom of information, nursing home inspection report, skilled nursing facility negligence, selecting a nursing home, SFF, special focus facility initiate, pressure wounds, bed sores, decubitus ulcers, falls, hip fracture, Fredericksburg Health and Rehab, Envoy of Winchester Hills, Ballenger Creek Center

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