As nursing homes close, residents scramble to find alternatives

Judith Brown did not learn her nursing care facility was closing
until she went to a hospital for cancer treatment.

Hundreds of frail nursing home residents have been forced to move as a growing number of Massachusetts facilities have been bought, sold, and closed over the past two years, state records show.

But the public has had virtually no say in the process. A Massachusetts law passed last summer was designed to provide public comment about the closing or sale of nursing homes, yet state officials have not put that into effect. Regulators say they are still working on rules to implement the law.

Since the public-input law passed, 10 nursing homes have been sold and one closed, and none received a public hearing.

The upheaval in the state’s nursing home industry, which mirrors national trends, has left families with fewer choices, and forced them to scramble to find alternative facilities.

Industry leaders say they are forced to close homes because Medicaid reimbursements from the state do not cover the true cost of care, a gap the Massachusetts Senior Care Association calculates at $34 a day, per patient. For the average nursing home, that translates into a loss of $750,000 a year, the industry group said.

Nursing homes have been closing and changing hands at a rapid rate; since January 2013, 57 have been sold, and nine have closed.

“Families would not be able to place a loved one in a facility in over one-third of the state’s cities and towns if just one facility in that city or town were to close,” said Ann Marie Antolini, a vice president at the Massachusetts Senior Care Association.

Families who dealt with recent closings do not cite reimbursements or regulations when they describe their experiences. Instead, they speak of unsettling situations and confusion.

Scott Brown, a 37-year-old from Attleboro, said his family received abrupt notice in November 2013 that his mother was losing her spot at Kindred Nursing and Rehabilitation-Goddard in Stoughton.
“It was shocking,” he said.

Brown said the family found out the facility was closing when his 66-year-old mother, Judith, was being transferred from Kindred to the hospital for cancer treatments, and Kindred officials told the family she would not be allowed to return because the facility was closing.

“She was getting wonderful care, she was comfortable with it, and it had to all change,” Brown said. Kindred was just 3 miles from the home of Brown’s father, Kenneth, so the 71-year-old could easily drive to visit his wife.

When Judith, a diabetic who was battling bone cancer, was discharged from the hospital about a week later, the family had to find another nursing home, and chose one in Canton, more than twice the distance from the elder Brown’s home.

“She had to deal with all new staff,” people who didn’t know how to take care of her as well, Brown’s son said. Judith Brown, a longtime special education teacher’s aide at Stoughton High School, died two months later, in January 2014.

Her son said he hopes the new law will provide other families an opportunity his did not receive. “The public,” he said, “should have some sort of input” in nursing home closings.

State rules require nursing homes to notify regulators at least 60 days before they intend to sell or close a facility, and to provide families at least a 45-day warning. The homes must also try to find “appropriate alternate placements” for each patient within 25 miles of the facility or the patient’s family and friends, under state rules.

Advocates say families need more time and more say in how the closing and sale of nursing homes is handled. Until now, regulators’ decisions about nursing home sales and closings have been conducted behind closed doors — unlike the review for hospitals, which are required to undergo public scrutiny, even for renovations or expansions.

State regulators have been meeting with advocates and industry leaders to hear their concerns, and plan to release proposed new rules for a public hearing process soon, said Deborah Allwes, director of the health department’s Bureau of Health Care Safety and Quality, which oversees nursing homes.

“Our number one priority is to make sure that closures happen in a systematic and safe way for families and residents,” Allwes said.

But Allwes said that when nursing homes are being sold or closed, the agency does not have the authority to require that enough facilities will exist in a region, especially areas with low-income patients. A 2011 study by Brown University researchers found that nursing homes nationwide were more likely to close in areas with higher proportions of black, Hispanic, and poor residents.

The union that represents nursing home workers, 1199SEIU United Healthcare Workers East, said those sorts of concerns should be scrutinized. The union is lobbying for creation of a special commission to study the problems and propose recommendations “to help ensure a rational and compassionate approach to the ongoing market consolidation, one that prioritizes the interests of nursing home residents, families, and caregivers,” said Veronica Turner, the union’s executive vice president.

The frenetic pace of sales and closures is expected to continue, given that about 5,000 beds are unused among the state’s roughly 420 nursing homes. At the same time, large nursing home chains are buying up smaller ones, and elders are increasingly choosing to remain in their homes.

Paul Lanzikos, a former state Elder Affairs secretary, said Massachusetts has lacked a coherent strategy for nursing homes for years.

“We have not set a vision as a Commonwealth to say how we want to create these environments. That is being left to the [industry],” said Lanzikos, who is now a member of the Public Health Council, an appointed state panel that adopts health policy. “I am not being anti-[industry]. But this process is knee-jerk.”

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As nursing homes close, residents scramble to find alternatives