On January 28, 2026, the Centers for Medicare & Medicaid Services (CMS) revised the Special Focus Facility (SFF) Program for nursing homes, replacing staffing with “prevalence of falls” as the factor that CMS and states should emphasize as they identify SFFs. CMS, “REVISED: Revisions to the Special Focus Facility (SFF) Program,” QSO-23-01-NH REVISED (Jan. 28, 2026). CMS has downplayed the importance of staffing in other recent actions, most notably, in its intended repeal of the final nurse staffing rule, which was enacted in 2024 after a lengthy public rulemaking process. Staffing is universally recognized as the key indicator and predictor of nursing home quality.
In support of the January 2026 revision, CMS cites a September 2025 report by the HHS Office of Inspector General, Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents, OEI-05-24-00180 (Sep. 2025). This report documents that many nursing homes fail to accurately report 43% of resident falls with major injury in their resident assessments. While inaccuracies in resident assessment are a serious concern, the OIG report documenting this issue in no way supports shifting the emphasis from staffing to the prevalence of falls in the selection of SFFs.
The January 2026 revision to the SFF Program also does not respond to the recommendation made by the Inspector General in an October 2025 report, CMS’s Special Focus Facility Program for Nursing Homes Has Not Yielded Lasting Improvements, OEI-01-23-00050 (Oct. 2025), that CMS incorporate ownership information “in selecting SFFs and identifying patterns of poor care.” CMS did not concur with this recommendation.
The SFF Program, first implemented by CMS thirteen years ago, is intended to identify 88 of the most poorly performing nursing homes in the country, which CMS defines as facilities that have (1) more problems than other nursing homes, (2) more serious problems, and (3) a pattern of serious problems over a several year period. The SFF program requires a second health inspection survey at each SFF each year and greater enforcement actions.
Nurse staffing at nursing homes has not returned to pre-pandemic levels. A recent research paper, analyzing Payroll Based Journal (PBJ) data from April 1, 2018 through December 31, 2024, finds that staffing did not return to pre-pandemic levels until the fourth quarter of 2024 and may not continue, as public health emergency funding to nursing homes ended. The researchers find that nursing homes associated with private equity or real estate investment trusts had greater declines in staffing in the pre-pandemic and late pandemic periods. They suggest that building staffing to pre-pandemic levels “may require a multilevel approach that entails improvement in wages and benefits and using immigrant labor to meet worker shortages.” Deepon Bhaumik, et al, “Staff Conditions In US Nursing Homes Before, During, And After The COVID-19 Pandemic,” Health Affairs 45, No. 2 (2026); 193-199,
Five hundred fifty “C-suite executives, administrators and nurse leaders” who responded to a survey by McKnight’s Long-Term Care News reported troubling staffing data. Only 12.9% of respondents described their staffing levels as having returned to pre-pandemic levels. Moreover, “only another 21% think they’ll be there by the end of 2026” and 55.2% do not expect to return to pre-pandemic staffing levels until 2028 or later (20.1%) or never (35.1%). Kimberly Marselas, “McKnight’s 2026 Outlook Part 2: Staffing ‘desperation’ on collision course with growing demand,” McKnight’s Long-Term Care News (Jan. 7, 2026).
February 5, 2026 – T. Edelman