A just released report from the Government Accountability Office signals that the 136 nursing homes cited as “special focus facilities,’’ and subject to more frequent inspections because of their living conditions, are perhaps only a fraction of the real number of troubled facilities that should be identified and monitored. GAO reported that over four times as many facilities could be classified as among the worst performing nursing homes in the country. GAO also proposed new criteria to identify the worst offenders. Current special focus facilities are defined as the worst within their state rather than compared against national criteria. It’s not an apples-to-apples comparison because each state has different quality guidelines. The bottom line: People need to do their own homework, including on site visits, to properly assess a facility for a loved one who is not in the position to do it himself.