Law-Den Nursing Home in Detroit spends its 31st month on the Special Focus Facility list

CMS created the “Special Focus Facility” (SFF) initiative to address the problem of nursing homes that have a repeated cycles of serious deficiencies. CMS identifies nursing homes that have had had a history of serious quality issues and places those homes in a special program to stimulate improvements in their quality of care. CMS requires that SFF nursing homes be visited in person by survey teams twice as frequently as other nursing homes (about twice per year). The longer the problems persist, the more stringent CMS is in the enforcement actions that will be taken. Examples of such enforcement actions are civil monetary penalties (“fines”) or termination from Medicare and Medicaid. Within about 18-24 months after a facility is identified by CMS as an SFF nursing home, we expect that there will be one of 3 possible outcomes:

(a) Improvement & Graduation: The nursing home graduates from the SFF program because it has made significant improvements in quality of care – and those improvements are continued over time;

(b) Termination from Medicare: The nursing home is terminated from participation in the Medicare and Medicaid programs. While such a nursing home may continue to operate (depending on State law), usually it will close once Medicare and Medicaid funding is discontinued. In such a case the State Medicaid Agency (and others) will assist all nursing home residents to transition to another residence that can provide a better and acceptable quality of care. This may include a variety of possibilities, such as another nursing home, a community-based setting, or apartment with good support services.

(c) Extension of Time: The nursing home is provided with some additional time to continue in the SFF program because there has been very promising progress, such as the sale of the nursing home to another owner with a much better track record of providing quality care.

The most recent list of SFF was released in November 2018. The report revealed that Law-Den Nursing Home in Detroit, which has been an SFF for 31 months, has not shown improvement. However, the report also revealed that Chalet Of Niles in Niles, which has been an SFF for 21 months, is showing improvement.

If you are considering admission to a nursing home included on this list you may want to:

Above all, visit the nursing home. Talk to staff, residents, and other families. You may request to see the results from the last State or CMS survey (it should be in a place that is easily accessible.)
Before your visit, look at the survey history of the nursing home on Nursing Home Compare to see what areas may be problematic.
Ask the nursing home staff what they are doing to improve the quality of care for residents in the nursing home.
Call the State survey agency (link to Nursing Home Compare) to find out more about the nursing home. Look at the length of time that a nursing home has been on the SFF list. This is particularly important if the nursing home has been an SFF nursing home for more than 18-24 months, since such nursing homes are closer to either graduating (due to improvements) or ending their participation in Medicare and Medicaid. • Call your local State Ombudsman, Administration on Aging, and local groups to find out more about the nursing home.
Use the Nursing Home Brochure found at and “Guide to Choosing a Nursing Home” – both publications are available on Nursing Home Compare.