By: Clark Kauufman
The long-running federal program that publicly identifies the nation’s worst nursing homes appears to be suspended under the Trump administration’s ongoing policy of limiting the flow of information from federal agencies.
For 17 years, the federal Centers for Medicare and Medicaid Services has published a monthly, national list of so-called Special-Focus Facilities. The list is comprised of nursing homes that have experienced the most serious recurrence of major regulatory violations related to quality of care.
Once a home is designated a Special-Focus Facility, it receives assistance from the government that’s intended to improve resident care. At any given time, no more than two nursing homes per state are designated a Special Focus Facility, although the federal list also includes hundreds of other nursing homes whose quality-of-care violations have made them eligible for that designation.
After Donald Trump took office as president in January, CMS and other federal agencies barred their staff from issuing any statements or reports to the press or public that hadn’t first been cleared by the White House.
While there was some indication that order would be lifted six weeks ago, no updates to CMS’ Special-Focus Facilities list have been made for the months of January, February or March 2025. As a result, the most recent version of the list includes an Iowa nursing home that was shuttered five months ago.
The Iowa Capital Dispatch made six phone calls and written inquiries to CMS’ Office of Communications this week to inquire about the status of the Special-Focus Facilities list. The written inquiries were acknowledged with automated emails on Tuesday and Wednesday, but no one from the agency responded to questions about the list, presumably because the freeze on communications to the press and public remains in effect.
Toby Edelman, senior policy attorney for the nonprofit Center for Medicare Advocacy, said CMS also appears to have canceled or put on hold other initiatives, including its monthly Open Door Forum with citizens and industry officials to discuss nursing home care and oversight.
CMS has also delayed the guidance it intended to provide state nursing home inspectors on how to conduct inspections and cite violations under federal rules that were revised last year, Edelman said.
In February, Skilled Nursing News reported that the freeze on CMS communications was creating problems for the operators of nursing homes, in part by delaying updates to the federal agency’s five-star rating system for care facilities.
Those ratings, published on the CMS Care Compare website, are supposed to offer consumers the latest information on whether nursing homes are meeting minimum care standards and staffing recommendations. Some nursing home operators have complained the website shows their facilities are currently considered Special-Focus Facilities, even though they graduated from the program months ago.
CMS said pause on communications would be ‘short’
CMS’ Special-Focus Facilities list appears to have last been updated on Dec. 4, 2024, with the online publication of its November 2024 list.
That list showed Garden View Care Center in Shenandoah and the Aspire of Lake Park nursing home had just been added to the group of Iowa facilities whose quality-of-care issues made them eligible for special-focus status. However, the Aspire facility had been shut down six weeks earlier, on Oct. 16, 2024, in the wake of the home being cited for dozens of regulatory violations.
In January 2025, the Capital Dispatch asked CMS why a closed facility had been added to the list. In response, Catherine Howden, director of CMS’ Media Group, stated that because of the pause on all communications with the public and media, she could not answer the question. “This is a short pause to allow the new team to set up a process for review and prioritization,” she said.
Elements of the Special-Focus Facilities program have long been the source of controversy, in part because the list has included closed facilities, but also because the number of designated facilities in each state is capped. That means additional facilities — even those that have earned CMS’ lowest ratings for quality — cannot be enrolled in the Special-Focus Facility program until other special-focus facilities in that same state have either shut down or improved.
That’s a process that can take four years or more. As a result, there are several homes in each state that are designated “eligible” for special-focus status due to their ongoing quality-of-care issues, but they are unable to benefit from the government assistance that a formal designation would offer.
Currently, three Iowa nursing homes have been eligible for special-focus assistance for more than a year without actually receiving it, including Des Moines’ Greater Southside Health and Rehabilitation Center, which had been deemed eligible for 29 months as of December 2024.
At that time, the two Iowa nursing homes that were actually designated Special-Focus Facilities were the Aspire care facility in Gowrie, and the Arbor Court facility in Muscatine. Aspire of Gowrie had been a special-focus facility for 14 months as of December, while Muscatine’s Arbor Court had the designation for 20 months.
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