Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Tracey Gendron

Second Advisor

Leland Waters


The Special Focus Facility Program is an intensive program meant to rapidly support 88 of the lowest quality nursing homes in the United States, as determined by the Five-Star Quality Ranking system. There are also 435 facility candidates which are similarly low performing but not enrolled in the program. Academic literature has largely ignored this program, and the existing grey literature is more than a decade old and does not include COVID-19 data. Applying a political economy of aging framework and using a case matching methodology, Special Focus Facilities (SFF), Special Focus Facility Candidate (SFFc) nursing homes, and 5-star nursing homes were compared on various organizational, structural, and COVID-19 outcomes. The results showed that SFF and SFFc are significantly more likely to be larger and for-profit than 5-star facilities. SFFc have improved staffing as compared to SFF and SFF and SFFc have nearly identical deficiency scope and severity. The intent of this research is to increase understanding of the efficacy of the Special Focus Facility program. More research is needed to understand if the SFF program ultimately increases quality of care. This research supports quality improvement in nursing homes.


© Annie Rhodes

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Date of Submission