A Livingston County nursing home is among hundreds nationwide identified in a report as having poor care.

According to a U.S. Senate report released Monday, nearly 400 facilities nationwide had a "persistent record of poor care" as of April. However, they were not included along with a shorter list of homes that get increased federal scrutiny and have warning labels. Ten of the nursing homes in question were in Michigan, including Medilodge of Livingston, which is located at 3003 West Grand River in Howell, just east of M-59. According to documents and interviews, budget cuts appear to be contributing to the problem by reducing money available for the focused inspections that are required for nursing homes on the shorter list.

The report was released by Pennsylvania Senators Bob Casey, a Democrat, and Pat Toomey, a Republican. They say the secrecy undermines the federal commitment to ensure transparency for families struggling to find nursing homes for loved ones and raises questions about why the names of some homes are not disclosed while others are publicly identified. The senators released a list provided to them by the Centers for Medicare and Medicaid Services, or CMS, of nursing homes with documented problems whose names were not publicly disclosed by the government, including 83 nursing homes that are getting special scrutiny to help them resolve documented quality problems. They're in what's called the Special Focus Facility program. Medilodge of Livingston is among that group and the only one of the Michigan nursing homes so designated. Nursing homes that don't improve can be cut off by Medicare and Medicaid. When contacted for a response, Bill Gray, Media Director for Medilodge, said they had no comment on the report.

Consumers can identify special focus facilities on the government's Nursing Home Compare website by looking for an icon shaped like a small yellow triangle that resembles a traffic "caution" sign. The website does not display starred quality ratings for the special focus facilities. Usually, nursing homes receive from a low of one star to the highest quality score of five stars. The nearly 400 facilities that are candidates for the shorter list "qualify for the program because they are identified as having a 'persistent record of poor care' but are not selected for participation as a result of limited resources at (CMS)," said the report from Casey and Toomey. "Despite being indistinguishable from (special focus nursing homes) in terms of their qualifications, candidates are not publicly disclosed," the report added.

In a letter last month to Casey, CMS Administrator Seema Verma singled out federal budget problems as a factor. "The total number of (special focus) slots and total number of (special focus) candidates nationally are based on the availability of federal resources," Verma wrote. She added that as recently as 2010, there was room for 167 nursing homes in the special focus program and 835 candidates. That's now down to as many as 88 special focus slots and up to 440 candidates. She said federal budget cuts in 2014 reduced the number of available slots. Verma said her agency is evaluating whether it can publicly release the list of "candidate" nursing homes. The Trump administration has asked Congress for more money for health care inspections, but the final amount and how it will be distributed remain unclear.

In a statement, CMS said its starred ratings on the Nursing Home Compare website are already the best yardstick "for consumers to understand and use." About 2,900 nursing homes have the lowest one-star overall rating.

But consumer groups say such ratings are not enough, and greater disclosure is overdue. "It might help (consumers) avoid facilities that the government is acknowledging are very, very troubled," said Toby Edelman, a senior policy lawyer with the nonprofit Center for Medicare Advocacy. A nursing home industry group says it generally supports transparency and takes no position on release of the list. David Gifford, vice president for quality with the American Health Care Association, said the inspection reports on which the CMS lists are based are only one measure, and people should also consider other factors such as staffing levels and clinical outcomes.

The Associated Press contributed to this report. (JK)