Last week I wrote “For-profit hospice is a vast crime scene, and private equity is holding the knife,” about a November article in The New Yorker article. I emphasized: “Good hospice can be immensely valuable. But there are predators.”
It doesn’t stop at hospice: in August the magazine also published When Private Equity Takes Over a Nursing Home, a superbly reported piece by Yasmin Rafiei. It’s a nasty story, with the same lesson: when for-profit investors take over a care industry, and they don’t get punished for poor “care,” the cared-for can wind up in danger. Or dead.
I believe that we as consumers need to be aware that some heartless people have gotten into the care industry. Here’s how Rafiei’s article starts:
When St. Joseph’s Home for the Aged … was put up for sale, in October, 2019, the waiting list for a room was three years long. The owners, the Little Sisters of the Poor, were the reason. For 147 years, the nuns had lived at St. Joseph’s with their residents, embodying a philosophy that defined their service: treat older people as family, in facilities that feel like a home.
When the pandemic hit, buyers for the home didn’t show up. Then a seeming white knight arrived, with just the right promise:
In the spring of 2021, an offer materialized from the Portopiccolo Group, a private-equity firm based in Englewood Cliffs, New Jersey, which then had a portfolio of more than a hundred facilities across the East Coast. “They said they like to keep things the way they are,” Sister Mary John told me.
The deal was finalized that June – just 14 months before this article was published – so you can tell, things went downhill fast:
At an early town hall, Kim Morrow, Accordius Health’s chief operating officer, repeatedly said the company wouldn’t institute significant changes. … [But then] Celia Soper, Accordius Health’s regional operations director, told St. Joseph’s staff, “We see that you all work hard. But it’s time we start working smart.” … Within two weeks, management laid out plans to significantly cut back nurse staffing.
Some mornings, there were only two nursing aides working at the seventy-two-bed facility. A nurse at the home, who spoke on condition of anonymity for fear of retribution, told me, “It takes two people just to take some residents to the bathroom.”
When reached by e-mail, a Portopiccolo spokesperson said, “We never made any staffing cuts during the transition.”
It wasn’t just cutbacks in staff; at the same time, Portopiccolo moved to increase their income, and further cut back on long-time amenities:
The new management filed for a license to admit higher-needs residents, who can be billed at higher rates through Medicare. The aquarium on the second floor disappeared. So, too, did the aviary. Residents’ crafts were removed from the gift shop.
So much for the Sisters’ philosophy: “treat older people as family, in facilities that feel like a home.” As I said in Saturday’s post about hospice, the essence of this kind of private equity company is to identify exactly what’s required to get paid, and get rid of everything else. Then there’s this:
Debbie Davidson, St. Joseph’s administrator, said that when she challenged staffing cutbacks Soper responded, “This isn’t about the nurses and residents. This is a business.”
It can be positively heartless to the point of being disgusting and dehumanizing:
At a Portopiccolo facility in North Carolina, a resident called for help after urinating in her briefs. According to inspection records, she waited, “miserable and embarrassed,” for nearly six hours to be changed. The resident’s nurse aide was caring for more than fifty residents that day.
What kind of person would take over a care facility, say “this is a business,” and do that?
Private equity does not belong in care services.
Things like this are systemic – and I mean systematically gruesome. From another Portopiccolo facility:
In one case, medical treatment was delayed because of concerns about insurance coverage. Inspection records from a facility in Randallstown, Maryland, indicate that a resident with a gangrenous foot was held back from three appointments with a vascular surgeon. Staff voiced concerns, but the nursing-home administrator wanted “to give the resident’s insurance a chance to kick in,” an inspection report states. The resident wasn’t consulted on the appointment changes, and was eventually taken to the emergency room, where a surgeon removed the resident’s legs.
If you’re horrified by this, good. I hope you’ll read the whole article.
Before considering an assisted living facility, do what you can to find out whose money is managing it. Is it people whose hearts are in the business, or people whose priority is to withhold care until the insurance “kicks in,” or who says “This isn’t about the … residents. This is a business.”
And then there are the COVID deaths:
In just four months under Portopiccolo, there had been 17 infections and six deaths due to COVID … among the worst one percentile in the U.S.
But don’t blame COVID:
Non-COVID deaths went from seven in the year before the home was sold [July 2020 to June 2021] to seven in the first four months under Portopiccolo’s ownership. (Emphasis added.)
There are sad, sad stories in the article about family members who watched care for their loved ones decline rapidly, even to the point of death. Because – who knew?? – good care requires enough attentive humans to pay attention to all the humans.
These people must be stopped.
The investors and executives who do this stuff are heartless bastards. They will happily take whatever money is available and they don’t give a shit whether they’re doing what people expect in an industry, or whether anyone gets hurt or dies … much less what the soul of an industry used to be. The New Yorker piece tells many more anecdotes, at this chain and elsewhere.
Informed consumers (that’s you and me) are our only recourse.
In closing I’ll repeat what I said in my previous post: Please, spread the word.
And don’t just spread the word in your personal circles: tell people in your communities to watch out. Do what you can to find out which facilities in your area are owned by big chains that are trying to climb the status ladder in their own predatory worlds:
In just six years, Portopiccolo has amassed a nursing-home portfolio that ranks among the top chains in the country: more than a hundred and thirty facilities, comprising fifteen thousand beds, dotting across nine states, from Florida to Maryland. “They always had a vision of being the biggest, the largest, making the most money,” the former manager said.
Don’t depend on the government to protect you – these guys have enough money to pay for powerful lobbyists:
a minimum staffing requirement was included in President Joe Biden’s Build Back Better Act. But the nation’s largest nursing-home lobbying group, the American Health Care Association, came out strongly against the measure, saying that nursing homes, amid a staffing shortage, couldn’t afford it without more federal funding. Minimum staffing was subsequently dropped from the bill.
Learn what you can, and spread the word.
[…] Healthcare’s moral crime scene, part 2: private equity takes over a nursing home […]