As anyone who's been around him can attest, Larry Minnix is an incurable optimist. The American Association of Homes and Services' for the Aging's president and CEO likes to say there will be two kinds of nursing homes in the years ahead: the excellent and the non-existent.

I'm more ambivalent. But I have to admit that such a future did appear to inch a bit closer last month. In an unprecedented move, the Centers for Medicare & Medicaid Services released the names of 54 facilities that continually fail to meet federal health and safety regulations.

Each has been designated a “special focus facility,” which is sort of the “Animal House” equivalent of being put on double-secret probation. These communities deserve their own wing in long-term care's Hall of Shame: They are the worst of the poorest performers.

To be eligible, facilities must be among the poorest 5% to 10% in each state. Once on the list, they are subject to inspections every six months, rather than once a year. There are 128 such facilities out of about 16,000 active nursing homes, according to CMS.

Collectively, these facilities are known as yo-yos, as they have a history of providing consistently poor care, while instituting just enough improvement to scrape by their next inspection. They also tend to ignore the underlying systemic problems that keep landing them in trouble.

In theory, if these facilities do not show continued improvement, they can lose Medicaid and Medicare payments. In practice, however, the government has been extremely reluctant to carry out this death sentence. In fact, more than a third of the 54 facilities have spent at least 34 months – or nearly three years – parked on the list.

It might be risky to hail the public humiliation of nursing homes as a joyous occasion. But that really is the case here. In fact, the disclosure should come as welcome news to the more than 16,000 facilities trying to reputably serve this nation's eldercare population.

And the list may just be a beginning. It's a safe bet that consumer groups are going to pressure CMS for additional names, and do everything possible to make substandard operators shape up.
At a minimum, public release of the list might force these facilities to do something most have been reluctant to do: make sustained improvements. Perhaps a little exposure will get some of these operators to rethink their approach to delivering eldercare services. 

As I've said before, the work that has to be done in long-term care
is too important for operators who are unwilling to do it well. The sooner they are gone, the sooner the industry will not be seen as a bunch of yo-yos.
There's hope yet, Larry.