In just the last two weeks, the state Department of Public Health has abruptly adopted a far more aggressive approach toward troubled nursing home operators, rejecting a California chain’s bid to buy 11 facilities in Massachusetts and swarming another chain’s homes with unannounced inspections after filing plans to revoke its 12 licenses.
The actions mark a striking shift for an agency that had not denied a nursing home license application or pulled an operator’s license in at least seven years. They follow a Boston Globe Spotlight Team report, published on Sept. 28, that exposed lax state oversight of troubled out-of-state operators who have been on buying sprees in Massachusetts since the pandemic.
Sweetwater Care’s application to permanently acquire 11 of 14 nursing homes, formerly operated by Next Step Healthcare, seemed headed for success. The Carlsbad, Calif., company, which was already managing the facilities under a receivership arrangement, even sent party hats for a planned celebration as they anticipated gaining a strong foothold in Massachusetts.
But on Tuesday, in what seemed an abrupt about-face, the state blocked Sweetwater’s efforts to become a permanent operator of these homes that house about 1,000 residents. Regulators cited its history of serious safety violations and poor care in other states. In July, California authorities secured a $15 million settlement from Sweetwater and its affiliates over allegations of widespread understaffing and resident neglect.
Meanwhile, over the past week, state inspectors have been conducting regular, unannounced visits to nursing homes run by New Jersey businessman Eli Mirlis, whose chain, RegalCare, was the focus of the Globe report. He faces the loss of all 12 of its Massachusetts facilities due to the state’s enforcement actions issued Oct. 13, and said then he plans to appeal.
At RegalCare at Taunton — a facility that plunged from a top five-star rating to a one-star after Mirlis bought it — the arrival of state inspectors last week triggered a flurry of urgent messages from the facility’s director of nursing to staff to quickly check different areas.
“DPH IN THE BUILDING,” read a message sent at 10:28 a.m., followed by one at 10:54 am saying, “coming on the floor now.”
“Check dirty utility room pls,” read another at 10:57 a.m., followed by “medroom,” at 11 a.m., and “bathrooms,” at 11:05 a.m., according to the messages shared with the Globe by an employee.
At RegalCare at Worcester this week, staff was absorbing news that state inspectors issued an “immediate jeopardy” finding on Oct. 14, meaning they found conditions that put residents at risk of serious injury or death. The facility was ordered to not admit any new residents until conditions improved.
Among the concerns: staff had not realized an elderly resident with dementia wandered out of a locked unit and was not found until hours later miles away. Worcester police said the resident was located at a restaurant and was brought to the hospital.
Mirlis, whose 12 homes serve about 1,200 residents in Massachusetts, did not respond to requests for comment sent to his lawyers. A lawyer for Sweetwater did not return a request for comment.
The Globe’s reporting on RegalCare found rapidly deteriorating care in many of Mirlis’s facilities and financial dealings that steered millions in operating funds to affiliated real estate and management companies that he owned. A Quincy facility that was rated five stars dropped to one star under Mirlis’s ownership. Another home in Greenfield fell last month from four to two stars. Even as the state has deemed Mirlis unsuitable to run nursing homes long term in Massachusetts, he continues to operate the sites for now.
Mirlis’s RegalCare was among nine out-of-state chains, mostly from New York and New Jersey, that have bought up nearly one in five Massachusetts nursing homes, with quality of care declining at most facilities. Yet the Globe story showed how regulators kept approving their acquisitions, prompting growing calls for the Healey administration to crack down on substandard operators.
On Wednesday, unionized workers at RegalCare at Wakefield plan to go public with their grievances about what they say are dire conditions. Workers there say severe staffing shortages have forced some nurses to work multiple 24-hour shifts. The union, 1199SEIU United Healthcare Workers East, represents about 90 nurses and other employees.
“Since May, workers have dealt with worsening staffing levels, broken equipment, and violation of labor laws that have put care at risk for our most vulnerable,” the union said in a statement.
Elder advocates say they’re hopeful the state’s moves in the past two weeks show that the days of lax state supervision are over.
“The Commonwealth realizes it has a critical role to play to be vigilant and thorough in their oversight of the facilities, instead of laissez faire,” said Paul Lanzikos, a cofounder of Dignity Alliance, and a former state elder affairs secretary.
Massachusetts health commissioner Dr. Robbie Goldstein said his department would now hold nursing home operators to higher standards.
“Owning a nursing home is an extraordinary responsibility and a privilege,” he said in a statement. “The Department is strengthening its oversight of the long-term care industry, identifying problems earlier, and holding operators accountable for providing the high-quality care and services that residents and their families deserve.”
Sweetwater is still managing the facilities but Goldstein’s office said it is working with the court-appointed receiver “to address management of these facilities on an ongoing basis.”
The state’s letter to RegalCare announcing revocation plans also indicated that authorities will let the license for the Lowell facility expire on Oct. 31. The state has not said how that facility — which has about 60 residents — will be run after that license expiration date.
Lanzikos said the state’s recent actions to start cracking down on problematic nursing home operators is encouraging, but a lot more work needs to be done to ensure this is a permanent get-tough stance, and not temporary crisis management.
“It needs to be sustained,” he said. “It cannot be one and done.”
Neena Hagen can be reached at neena.hagen@globe.com. Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.