Avoiding the Special Focus Facility List: A Wake-Up Call for Senior Care Providers
If your senior care facility is struggling with survey performance, you may already be on CMS's radar. The Special Focus Facility (SFF) designation is more than just a label. It's a warning with real operational, financial, and reputational consequences.
The AssuredPartners Senior Living team is seeing an increase in clients concerned about SFF status, particularly in a tightening regulatory environment. Here's what you need to know and what you can do to protect your community.
What Is the SFF Program?
CMS created the Special Focus Facility program to identify nursing homes with a history of serious quality issues. Facilities on the SFF list face intensified scrutiny, frequent surveys (every six months), and increased risk of fines, admissions freezes, and even termination from Medicare and Medicaid programs.
Even being on the SFF candidate list, which is publicly available, can negatively impact your census, financing, and staff retention. These lists are updated monthly and reviewed by CMS, state agencies, ombudsman programs, and other stakeholders.
Concerned about your facility's survey performance? Let’s build a plan to protect your community—contact us today.
Why the SFF List Matters
Being placed on the SFF list impacts more than just survey scores. Here are the real-world effects facilities experience:
- Staff morale tanks: Survey fatigue, public scrutiny, and fear of job loss often trigger a wave of resignations.
- Occupancy drops: Hospitals pause referrals. Families move loved ones. Online reviews worsen.
- Expenses increase: You may need legal help, external consultants, crisis PR, and higher staffing costs.
- Regulatory risk skyrockets: Once you’re on the list, you’re on a clock. You must improve or risk termination.
How to Stay Off the SFF List
We work closely with operators across the country to help them spot risks early and build resilience. Here are the key strategies we recommend:
Know Where You Stand
Start by reviewing your CMS survey score and comparing it with state-specific candidate lists. If you're anywhere near the top, you’re at risk. Tools like CASPER reports, CMS Provider Data Sets, and QCOR can give you insights.
Don’t Wait to Be Reactive
If you’re on the candidate list or close to it, take action now. Bring in external help to conduct mock surveys. Review your Quality Assurance & Performance Improvement (QAPI) program. Ensure your internal audits align with the surveyors' standards.
Invest in Staff Retention
Your frontline team is your best defense. Support them with transparent communication, low-cost recognition programs, and leadership that shows up and listens. Burnout and turnover create gaps in care, and that's where survey issues begin.
Communicate Proactively
If something goes wrong, don’t let the media tell your story. Create a plan to communicate with families, staff, and referral partners. Regular updates through newsletters, family forums, and your website build trust and reduce the risk of public backlash.
Strengthen Financial Resilience
Surveys cost money. Rebuilding census takes time. Facilities on the SFF list need strong cash reserves, disciplined expense management, and open lines of communication with lenders, vendors, and insurers.
Prepare for Surveys Like It's Your Job Because It Is
When you're on the SFF list, two clean surveys with no serious deficiencies are your path to graduation. That means constant readiness. Use CMS's survey tools to train staff and audit your processes. One oversight can restart the clock.
What Success Looks Like
Graduating from the SFF list is possible. Facilities that invest in leadership development, tighten their systems, and take control of the narrative often come out stronger. We’ve seen clients recover census, rebuild community trust, and turn negative PR into a story of transformation.
How We Help
We support senior care providers not just with insurance but with risk consulting, claims management, and strategies to mitigate reputational and regulatory fallout. If you're worried about your survey trends or want to prepare before issues escalate, let's talk.
You don’t have to wait for CMS to make the first move. A proactive plan can be the difference between a crisis and a comeback.
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