Aspire of Gowrie (Aspire) nursing home in Webster County, Iowa reportedly has been cited for 116 quality-of-care violations and has been the subject of 26 complaints since October 2022. Aspire is one of two Iowa nursing homes on CMS’ list of “special focus facilities,” a list of nursing homes that have a history of serious quality issues and are included in a special program to stimulate improvements in their quality of care.
In January 2024, a resident of the Aspire nursing home choked to death while eating dinner. The resident had been identified as being at risk for choking on food inasmuch as he had choked on food on three prior occasions at Aspire (once in December 2022, when he choked on French toast; in February 2023, when he choked on bread; and, when he choked on a tortilla in March 2023), during which the Heimlich maneuver was required to dislodge the food in his airway.
Because of his history of choking on food at the nursing home, the nursing home staff was instructed that the resident not be given bread during meals and that his food be cut into bite-sized pieces to avoid choking. Despite those instructions, during the January 5, 2024 incident, the resident reportedly was served bread along with uncut bone-in chicken for dinner. A certified nursing assistant, who was not trained in performing the Heimlich maneuver, saw the man choking and left to find a nurse, who attempted to remove food from the resident’s airway and then performed CPR when the resident became unresponsive. When the resident arrived at the hospital, a large piece of food was reportedly removed from his airway, and he died from lack of oxygen due to aspiration of food.
An investigation after the resident’s death reportedly determined that a cook at the nursing home relied on a “cheat sheet” for meal preparation and not the formal dietary cards, and that the cheat sheet did not state the requirement to cut up the resident’s food. The cheat sheet was never produced for the inspectors.
In 2023, Aspire of Gowrie had CMS’ lowest possible rating for overall quality, health care inspections, and staffing levels. Aspire of Gowrie currently has no CMS ratings because it is a special focus facility.
Special Focus Facility (SFF) Program
CMS’ Special Focus Facility (SFF) Program offers a list of nursing homes that have a history of serious quality issues and are included in a special program to stimulate improvements in their quality of care. Results from the last three standard health survey cycles and the last three years of complaint survey performance are converted into points based on the number of deficiencies cited, and the scope and severity (S/S) level of those citations. The more deficiencies that are cited, and the more cited at higher levels of S/S, the more points are assigned.
The facilities with the most points in a state then become candidates for the SFF program. The number of nursing homes on the candidate list is based on five candidates for each SFF slot, with a minimum candidate pool of five nursing homes and a maximum of 30 per State. State agencies (SAs) use this list to select nursing homes to fill the SFF slot(s) in their state. Additionally, since a facility’s staffing (staffing levels and turnover) is very important to residents’ care, CMS recommends that SAs consider a facility’s staffing information when selecting SFFs from the SFF candidate list.
Once a state selects a facility as an SFF, the SA, on CMS’s behalf, conducts a full, onsite inspection of all Medicare health and safety requirements every six months, and recommends progressive enforcement (e.g., civil money penalty, denial of Medicare payment, etc.) until the nursing home either (1) graduates from the SFF program; or (2) is terminated from the Medicare and/or Medicaid program(s). While in the SFF program, CMS expects facilities to take meaningful actions to address the underlying and systemic issues leading to poor quality.
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