Special Focus Facilities
CMS designates these 87 nursing homes as Special Focus Facilities — the most serious, persistent quality failures in the country. SFF status triggers mandatory federal oversight and an accelerated inspection cycle.
87
Facilities
49
States
0
≤ 2 Stars
What is an SFF? A Special Focus Facility has had repeated cycles of serious deficiencies over at least 3 years. CMS requires them to undergo inspections twice as often as normal and can terminate their Medicare/Medicaid participation if they fail to improve.
Common questions about Special Focus Facilities
For the data source, refresh cadence, and full classification rules, see our data-sources methodology.
What is a Special Focus Facility (SFF)?+
A Special Focus Facility is a nursing home that CMS has identified as having a long-standing pattern of serious quality and safety failures. SFFs are subject to enhanced federal oversight: they are surveyed approximately twice as often as a standard SNF and face termination from Medicare and Medicaid if they fail to demonstrate sustained improvement, typically within a 24- to 30-month window.
How does CMS choose Special Focus Facilities?+
CMS ranks every nursing home in each state on a composite score derived from the past three years of health inspection results, weighted by survey cycle. The lowest-ranked facilities in each state become candidates; from that pool, CMS selects a fixed number per state to enter SFF status. Selection is governed by capacity (the SFF program has a ceiling on participants nationally) and state-by-state quotas.
What is the difference between an SFF and an SFF Candidate?+
An SFF Candidate is on the federal watchlist — among the lowest-ranked nursing homes in their state but not yet enrolled in the formal program. SFF status is the active designation, which triggers the doubled inspection cadence and termination risk. Both designations are flags worth taking seriously when evaluating placement.