As advocates for not just justice for those abused and neglected in nursing homes, but systemic improvements across all facilities, it often feels like we take two steps forward and three backward. Of course, our patience is needed, especially when dealing with government organizations bogged down in red tape. But it is disheartening to hear of real-life cases where improvements, though made, did not last. And that is exactly the case with the SFF program from the Centers for Medicare & Medicaid Services (CMS).

Special Focus Facility Program (SFF)

The Special Focus Facility Program (SFF) was launched in 2013 for the purpose of addressing failures in the lowest-performing nursing facilities. These facilities were repeat offenders, repeatedly failing to meet basic and larger requirements, putting the lives of residents at risk. 

These offending facilities were put into the program and evaluated every six months. Each time they failed their inspection, there were fines and other penalties for infractions. Those often increased as time passed and the problems were not solved. The essential idea being that the facilities would be inspired to not only make changes in general to their nursing practices, but maintain those changes and eventually “graduate” from the SFF program. 

The program did see improvements from some facilities, while others continued to fail their inspections. Another result was a “yo-yo” effect where facilities would briefly improve in compliance and quality but, after graduating, would regress.

“Between 2013 and 2022, nearly two-thirds of the nursing homes that were in the SFF program improved enough to graduate but soon afterward showed the type of quality problems that put them in the SFF program in the first place.” – Office of Inspector General, Department of Health and Human Services

Nursing Home Improvements Short-Lived

In October 2025, the Department of Health and Human Services released a report of their findings regarding the success of the SFF program. They found that a disheartening two-thirds of nursing homes that had graduated has then regressed, returning to their old ways of noncompliance and poor care.

“The SFF program is not working because most nursing homes that graduate from the program do not keep the improvements they made over the long term.”

This objective failure of the SFF program not only highlights some of the larger issues in the nursing home industry, but the degree of overhaul needed in order to even meet basic requirements across the board.

The Office of the Inspector General, along with their report, offered suggestions of how to improve the SFF and nursing home compliance in general. Some of these solutions include:

• CMS should impose more nonfinancial enforcement remedies that encourage sustained compliance.
• CMS should incorporate nursing home ownership information into the SFF program, such as in selecting SFFs and identifying patterns of poor performance.
• CMS should learn from individual State-run programs and initiatives that have proven slightly more successful.

Additionally, though not surprisingly, this study also found that improved staffing lessened a facility’s chances of full regression. The more successful cases maintain proper staffing standards.

Conclusion

Every attempt to improve nursing homes is a win. Though they may not be fully successful and changes may not have any longevity, it is a step towards better care. The SFF program should take the Inspector General’s advice and continue to improve the program so all facilities are held accountable.

If you or a loved one have been the victim of nursing home abuse or neglect, call Gharibian Law (866-747-1389) for a FREE consultation and the best legal representation.