Tougher Scrutiny and Federal Penalties Being Planned for Failing Nursing Homes

White HouseQ. Last year, during his State of the Union address, President Biden discussed a major overhaul of nursing home quality, including minimum staffing levels and steps to beef up inspections. Since then, I haven’t heard about any of these quality measures being implemented. My mother will need nursing home care in the near future, and I want to make sure she is safe and will receive the best quality care. Do you have any information about the status of the president’s plans to make nursing homes safer? Also, how can I find out which nursing homes have violations? Lastly, how can we plan for the incredibly expensive costs of nursing home care? Thanks so much for your help!

A. Earlier this year, as you mentioned, President Biden outlined more than 20 separate actions to overhaul the quality of nursing home care. The main focus of his nursing home plan was a new requirement for minimum staffing levels and to order the Centers for Medicare and Medicaid Services (CMS) to conduct a study on staffing and publish proposed regulations within a year.

Plan Goes into Effect to Increase Scrutiny of Nursing Homes

As part of the Biden-Harris Administration’s continued commitment to improving the safety and quality of care for nursing home residents, CMS just recently announced that it is “increasing scrutiny and oversight over the country’s poorest-performing nursing facilities in an effort to immediately improve the care they deliver.” This new initiative by CMS fulfills the promise laid out in Biden’s State of the Union Action Plan to strengthen scrutiny over poor-performing nursing homes, improve care for the affected residents more quickly, and better hold facilities accountable for improper and unsafe care. Here are some more details about this new initiative:

In late October 2022, CMS announced new actions to significantly strengthen accountability for nursing homes in the Special Focus Facilities (SFF) Program, a watchlist program for the poorest performing nursing homes in the country. The SFF Program already provides more frequent inspections of these nursing homes, but more action is needed to ensure these nursing homes improve.

The actions in the President’s revised plan will apply to 88 nursing homes that are on the SFF list, making up fewer than 0.5% of U.S. nursing homes. These nursing homes are already designated as SFFs because of previous violations. Here are the details:

• SFF nursing homes will lose federal funding if they receive more than one dangerous violation — breaking of a rule that puts residents at risk for harm;
• CMS will now continue close scrutiny of the facility for at least three years — helping ensure these nursing homes consistently remain in compliance with safety requirements.
• CMS will be imposing more severe, escalating enforcement remedies for nursing homes that have continued to be out of compliance and have demonstrated little or no effort to improve performance;
• CMS is advising State Survey Agencies to consider a facility’s staffing level, in addition to its compliance history, when selecting candidates from their state for inclusion into the SFF watchlist program;
• CMS is also increasing its engagement with these poor-performing nursing homes, through direct and immediate outreach by CMS officials upon their designation as an SFF, to help these under-performing nursing homes understand how to improve and to access support resources like CMS Quality Improvement Organizations;
• While in the SFF program, CMS is encouraging facilities to make good-faith efforts (and provide evidence of these efforts) to improve quality and measurable changes, such as changes in staffing, leadership, or increased overall staffing;
• The Biden administration also plans to award $80 million in grants to health care organizations, trade groups, and labor unions to train and hire nursing staff;
• The actions are being taken to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes, and make them safer.
According to communications about the program, “(t)he changes CMS is implementing are designed to incentivize facilities to quickly improve their quality and safety performance, allow the SFF Program to scrutinize more facilities over time by moving facilities through the Program more quickly, and promote sustainability of facilities’ improvements to ensure they do not regress post-program.”

“Let us be clear: we are cracking down on enforcement of our nation’s poorest-performing nursing homes,” said HHS Secretary Xavier Becerra. “As President Biden directed, we are increasing scrutiny and taking aggressive action to ensure everyone living in nursing homes gets the high-quality care they deserve. We are demanding better, because our seniors deserve better.”

Finding the Right Nursing Home for a Loved One

When looking at potential nursing homes, be sure to check inspection reports and surveys conducted by state and federal nursing home regulators, among other things. You can find information about inspection reports, staffing, and quality of care for any Medicare and Medicaid-certified nursing home at Almost every nursing home in the country is rated by CMS each year using a five-star scale, with five stars being the best.

Again, you can also view the entire list of nursing homes on the SFF watchlist here.

Thankfully, there are only seven nursing homes in Virginia and seven nursing homes in Maryland that are currently on the SFF watchlist, and there are no nursing homes in the District of Columbia that are on the watchlist. Here are the ones that are on the SFF list:


● Envoy of Williamsburg, in Williamsburg.
● Envoy of Westover Hills, in Richmond.
● Birchwood Park Rehabilitation, in Virginia Beach.
● Hanover Health and Rehabilitation Center, in Mechanicsville.
● Henrico Health and Rehabilitation Center, in Highland Springs.
● Lynchburg Health and Rehabilitation Center, in Lynchburg.
● ProMedica Skilled Nursing and Rehab, in Richmond.


● Autumn Lake At South Haven, in Annapolis.
● Cadia Healthcare – Springbrook, in Silver Spring.
● Frederick Health and Rehabilitation Center, in Frederick.
● Hagerstown Healthcare Center, in Hagerstown.
● Meadow Park Rehabilitation and Healthcare Center, Catonsville
● Peak Healthcare at Caton Manor, in Baltimore.
● Westminster Healthcare Center, in Westminster.

District of Columbia:


If and when you are evaluating nursing homes for a loved one, please feel free to use our Nursing Home Evaluation Tool and also take a look at prior articles on this topic for detailed assistance in choosing the best nursing home for your loved one. If you are a Level 4 client of the Farr Law Firm, please keep in mind that our team of experienced professionals will help you find the best nursing home for your loved one if and when that level of care is needed.

Planning for Nursing Home Care

When it comes to finding the right nursing home for a loved one, a big concern for most families is the affordability of nursing home care. This is a huge concern, as nursing homes in the Metro DC Area cost $12,000 – $15,000 a month. To protect your family’s hard-earned assets from these catastrophic costs, please call us to make an appointment for an initial consultation to discuss your options:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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