In the Elder Justice Newsletter, we highlight citations, including deficiencies related to abuse, neglect, and substandard care, that have been identified as not causing any resident harm. The goal of this brief newsletter is to shed light on the issue of so-called “no harm” deficiencies, which typically result in no fine or penalty to the nursing home.
This Issue: Focus on Special Focus Facilities
Across the country, far too many nursing home residents live in facilities with long histories of serious noncompliance. To help address this problem, CMS created the Special Focus Facility Program. The Program was established to address facilities with “yo-yo compliance,” i.e., a pattern of being cited for failure to comply with minimum standards, ostensibly correcting their deficiencies in order to continue to receive taxpayer funds, only to fall out of compliance again. The basic goal is that a facility either adopts meaningful corrections to its persistent problems or is terminated from federal funding. This issue of the Elder Justice Newsletter takes a close look at what SFF status really signals for residents and families, and why repeated deficiencies in these homes remain one of the clearest warning signs of risk to health, safety, and dignity.
An October 2025 HHS Office of Inspector General (OIG) analysis underscores the stakes. Reviewing SFF outcomes from 2013-2022, the OIG found that the program has not produced lasting improvement: nearly two-thirds of facilities that “graduated” from the SFF program later slipped back into the same kinds of quality failures that harmed residents and put the nursing homes on the list in the first place.
The current list of SFFs is available here. In addition, LTCCC’s Provider Data Report includes information on whether a facility is a SFF, SFF Candidate, or Problem Facility.
This newsletter focuses on the following “no harm” violations:
- Repeated sexual touching and escalating threats: Facility failed to protect residents from abuse.
- Going viral: Facility staff filmed and shared abuse on social media.
- Weeks without shower: Residents left without basic hygiene care.
- Unaddressed wounds: Resident’s pressure injuries worsen without timely assessment or treatment.
- Left without support: Resident repeatedly observed without prescribed range of motion device.
- Months without glasses: Resident left waiting for essential vision care due to repeated delays.
Do YOU think these deficiencies caused “no harm”? Click to download the newsletter or read it in the PDF below.
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