This is the December 3, 2007, issue of Elder Law FAX, a free newsletter published by the Elder Law Practice of Timothy L. Takacs   Feds Post List of Worst Nursing Homes Last Thursday, November 29, the U. S. Centers for Medicare & Medicaid Services (CMS) released the first ranking of the nation's poor-performing nursing homes. CMS is the federal agency that administers the Medicare and Medicaid programs, including approving payments to health care facilities such as nursing homes. "Nearly three million Americans, most of who are enrolled in Medicare or Medicaid, depend on the nation's 16,000 nursing homes at some point during each year to provide life-saving care," said CMS Acting Administrator Kerry Weems. "Release of this national list of special focus facilities reinforces CMS' commitment to provide beneficiaries and their families the information they need when making long-term care choices." According to CMS, release of the national list of facilities, identified as special focus facilities (SFFs), is expected to offer people who are seeking long-term health care services powerful new information when choosing nursing homes. Calling it "yo-yo" compliance, CMS was prompted to release the list to single out facilities that were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). These improvements rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. If problems continue, the severity of penalties will increase over time, ranging from civil monetary penalties, denial of payment for new admissions and, ultimately, removal from Medicare and/or Medicaid. The CMS policy of progressive enforcement means that any nursing home, not just those identified as an SFF, that reveals a pattern of persistent poor quality is subject to increasingly stringent enforcement action. For example, recently a Nashville nursing home was suspended from participation in the Medicare and Medicaid programs. This facility was not one of those listed as an SFF, however. As of October 2007, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest five or 10 percent in each state. In Tennessee, one nursing home, in Memphis, was listed as an SFF. In addition to consulting the CMS list of SFFs found on http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp#TopOfPage, CMS recommends that individuals and their families looking for a nursing home should take other steps including: * Visit the nursing home.  Talk to staff, residents, and other families.  Request to see the results from the last state or CMS survey. * Prior to a visit, review the survey history of the nursing home on Nursing Home Compare to better understand any areas that may be problematic.   * Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home. * Call the state survey agency to learn more about the nursing home.  If the facility is in the special focus initiative, find out how long it has participated. Facilities in the program for 18-24 months are either close to "graduating" because of significant improvements to care, or ending their participation in Medicare and Medicaid. * Call your local state nursing home ombudsman, Administration on Aging, and local groups to learn more about the nursing home. * Use the Nursing Home Brochure, located at  http://www.medicare.gov/Publications/Pubs/pdf/nursinghome.pdf and "Guide to Choosing a Nursing Home" http://www.medicare.gov/Publications/Pubs/pdf/02174.pdf - both publications are available on Nursing Home Compare.