Map: The worst nursing homes in America

Explore more of America Tonight’s special series “Aging America”

One hundred and sixty-three years and eight months.

It's a staggering length of time to comprehend, but that's the cumulative amount of time the Centers for Medicare and Medicaid Services have spent tracking 112 U.S. nursing homes with histories of poor care.

In 1998, CMS launched the Special Focus Facility initiative, to highlight and hopefully reform nursing homes with the worst care. When a state agency identifies a nursing home as troubled, CMS goes in and surveys residents and staff. If the problems are found to be severe or persistent enough, the home makes the list. Currently, there are 112 SFF nursing homes in 45 states, according to the recently updated SFF data for February 2014.

CMS hopes that through this public labeling and its regular check-ups, the facilities will improve and ultimately graduate out of the program. If a nursing home doesn't shape up, the federal government may disqualify it from Medicaid and Medicare, which is usually the death knell for any elder-care facility.

The program has helped turn around some of the worst nursing homes in America. Once they're identified, around half of SFF nursing homes show improvement within the first two to two and a half years, according to CMS. In the past month, around a third of the facilities on the list showed improvement, the latest data shows, and 41 percent improved significantly enough to graduate from the program entirely.

Sometimes, the turnaround takes longer. Legend Rehabilitation & Nursing Home in Gardner, Mass., stayed on the SFF list for 53 months before recently graduating. And a significant minority continue to chronically underperform. Twenty-six percent of the nursing homes on the most recent SFF list have either not shown improvement or been terminated from Medicare and Medicaid. In total, 16 percent of SFF nursing homes in the most recent data set have been terminated from Medicare and Medicaid, according to CMS. 

The SFF initiative plays into the larger conversation millions of American families struggle with every year: Should I put mom or dad in a nursing home?

In 2013, more than 3 million people spent at least part of their year in a U.S. nursing home. With almost one in five Americans expected to be 65 or older by 2030, it's a concern that many more sons and daughters will face in the coming decades.

While the SFF program’s initiative doesn’t provide a comprehensive list of all the nursing homes with poor track records, it reports the worst of the worst, in the hope of ensuring seniors at least a minimum quality of care.