Sen. Charles Grassley (R-IA)

Nearly 450 nursing homes should be added to the federal government’s Special Focus Facility (SFF) program, which monitors consistently problematic nursing homes, say the authors of a new report from the Government Accountability Office.

The GAO report recommends expanding the SFF program to include 580 of the poorest performing facilities nationwide—more than four times as many as the 136 facilities currently singled out by the program. The report and recommendations were released Monday by Senate Special Committee on Aging Chairman Herb Kohl (D-WI) and Finance Committee ranking member Charles Grassley (R-IA).

To arrive at their conclusions, GAO researchers included data from the government’s five-star rating system for the first time. They also added emphasis on deficiencies that led to resident harm, and considered a more long-term look at facility performance history. They found that poorest performing nursing homes were more likely to have for-profit status and were a part of a chain. They also had more beds and residents, and had an average of almost 24% fewer registered nurse hours per resident day. Researchers said a national comparison model would more accurately identify troubled nursing homes than the current statewide comparisons. The GAO has suggested that the Centers for Medicare & Medicaid Services implement such a model. While CMS says it would consider allowing a national comparison to carry some additional weight, the agency balked at the notion of relying solely on such a model.

In a statement accompanying the report’s  release, Kohl said the discovery of so many more nursing homes with the bleakest conditions is reason enough to consider expanding the SFF program. Operators land on the list after consistently poor performance. The GAO made a similar recommendation two years ago but officials said the resources to implement the changes were not available.

Kohl and Grassley reintroduced their Nursing Home Transparency and Improvement Act in March. Among other more restrictive actions for providers, it calls for more information to be made public about nursing home ownership and business structures. Sen. Max Baucus included their proposal in his recently released Senate healthcare reform bill.