Federal Watchdog Slams ‘Fix-It’ Program for Troubled Nursing Homes: Most Backslide Within a Year

Cedar Rapids, IA — A federal watchdog says the government’s flagship effort to turn around the nation’s worst-performing nursing homes isn’t delivering lasting results, with most facilities slipping after they leave heightened oversight.

In a report released September 25, 2025, the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded the Centers for Medicare & Medicaid Services’ Special Focus Facility (SFF) program “is not working as intended.” The program, created in 1998, targets a small group of chronically poor-performing nursing homes for tougher inspections, technical assistance, and escalating penalties that can lead to termination from Medicare and Medicaid.

OIG reviewed 38 facilities that exited the SFF program between October 2018 and March 2023. Within a year, 71% had regressed, the watchdog found, often racking up serious health and safety violations similar to those that triggered the extra scrutiny in the first place. While most homes improve while under the microscope, the gains typically fade once they “graduate,” the report said.

OIG calls for stronger follow-up

Investigators attributed the backsliding to weak post-graduation monitoring and persistent structural problems, including chronic staffing shortages and unstable ownership. The report urged CMS to track former SFF homes more closely for up to two years, keep pressure on staffing levels, and build in incentives that reward sustained improvements—not just short-term compliance during the program.

The watchdog also noted that several of its earlier recommendations, including those from 2019 and 2022, have not been fully adopted. Without stronger follow-through and resources, OIG warned, the SFF program risks becoming a revolving door that fails to protect residents from preventable harm.

CMS, industry push back—and point to staffing

CMS defended the SFF program as an important safety tool but conceded there is room to strengthen oversight once homes exit. “We agree more can be done and are reviewing OIG’s recommendations to enhance post-graduation oversight,” a CMS spokesperson said in a statement.

The nursing home industry says any reform must address financing and workforce shortages. The American Health Care Association, which represents thousands of facilities nationwide, argues that chronic underfunding—particularly through Medicaid—limits hiring and retention. “Without more federal dollars, no amount of monitoring will fix staffing shortages,” AHCA President Mark Parkinson said in recent comments.

Advocates counter that tougher, longer oversight is essential. They want former SFF homes monitored for at least 24 months and urge regulators to scrutinize ownership changes that can destabilize care. Graduation from SFF, they say, should not signal the end of accountability.

What it means for Iowa families

The OIG findings land as Iowa, like many states, faces an aging population and a tight labor market in long-term care. State listings show several Iowa facilities are currently in the SFF program, with recent additions in communities such as Des Moines and Harlan. Consumer groups say families should be cautious when a facility touts graduation from SFF; the designation means a home improved enough to exit the program, but not necessarily that issues won’t resurface.

Nationally, roughly 15,000 nursing homes care for more than a million residents. About 80 facilities at any given time are in SFF, according to federal data. OIG’s analysis underscores a broader concern: short-term fixes under intense enforcement do not always translate into safer care once the spotlight moves on.

The debate over how to repair the program now shifts to CMS and Congress. The watchdog’s prescription is clear—longer monitoring, stronger staffing expectations, and better tracking of owners—while the industry warns that reforms without added funding could force more closures. For residents and families, the stakes are immediate: whether improvements made under pressure can truly endure.