Three Missouri nursing homes show up on a list of the nation’s poorest performing nursing homes.

The Centers for Medicare and Medicaid says the Senior Estates in Kansas City, the St. Elizabeth Healthcare and Rehabilitation Center in Florissant, and West Village Manor in Columbia are among the 52 nursing homes that consistently provide poor quality care. The agency says all three of the homes have been considered as Special Focus Facilities for 19 months.

The designation starts a progressive system of enforcement that could, in time, take Medicaid and Medicare certification away from the home and clear the way for state action.

Washington and Florida are the only other states with three nursing homes on the list.