State public health officials are about to gain expanded oversight authority for the nursing home licensure process, including vetting whether certain owners or management companies are suitable to run long-term care facilities.
More than two years after Gov. Maura Healey signed a long-term care oversight law, the Public Health Council on Wednesday approved a suite of regulations tied to licensure and suitability requirements, as well as care standards, the role of certified medication aides, outbreak response plans and requirements for small house nursing homes, among other provisions.
The updated regulations are now headed to Secretary of State William Galvin’s office for promulgation, which Public Health Commissioner Robbie Goldstein said is expected to happen in early November. After that, nursing home applicants and those seeking license renewals will be subject to enhanced suitability reviews, as the Department of Public Health places new scrutiny on potential operators, license transferees and management companies that want to enter into contracts with long-term care facilities.
“That said, the department has the ability to review suitability at any moment when someone is operating, and so we are developing the procedures by which we have active engagement with facilities that are performing poorly, have significant complaints against them, have quality concerns,” Goldstein said during a Public Health Council meeting. “And to understand … when we use various tools for those concerns — so a temporary manager, implementation of a consultant with a corrective action plan, evaluation of suitability of the owner, operator and other companies.”
The regulatory push gained new urgency after a Boston Globe Spotlight report exposed how DPH enabled RegalCare CEO Eli Mirlis of New Jersey to keep buying nursing homes in Massachusetts despite worsening quality standards at his existing properties. DPH on Tuesday filed a notice to revoke the licenses of all 12 RegalCare homes in Massachusetts, arguing that Mirlis is “neither suitable nor responsible to operate a long-term care facility.”
Mirlis slashed nursing staff hours and spending on patient care, as he funneled money into his other real estate and management businesses, the Globe reported. Council member Stewart Landers asked how DPH staff were reviewing “red flags” when it comes to the financial structures at nursing homes.
“It seemed to me that we were hitting some parallels in the current situation with some of what we saw in Steward, in terms of the lifting and raising of exorbitant rents and essentially the sucking out of resource,” Landers said, referencing the Steward Health Care bankruptcy fueled by private equity deals.
Goldstein replied that health regulators are “certainly increasing the evaluation of management companies and individuals with financial stakes within the facility.”
The new regulations define a management company as a person “engaged by a licensee to manage the operations of a long-term care facility for compensation” and incorporate a definition for a private equity company. Long-term care facility applicants, potential license transferees and licensees must report changes in “financial status” to DPH under the new rules. Facilities can also be hit with bigger penalties for non-compliance, according to a staff presentation.
Jaclyn Gagné, DPH’s chief deputy general counsel for healthcare licensure, said the department has sent out a survey to long-term care facility owners to identify where management companies are utilized.
Kahoney Anderson, a council member and executive director of a skilled nursing facility in Framingham, said it was “reassuring” to see DPH focus on ownership suitability.
“That’s very, very important in long-term care,” Anderson said. “In [the] recent past several years, there’s been a lot of ownership from out of state not familiar with Massachusetts laws, and they’ve made some decisions that compromise resident safety, as well as quality of care.”
Under the regulations, applicants, potential transferees or licensees would be deemed “neither suitable nor responsible” to establish or maintain a long-term care facility as a result of failing to demonstrate legal capacity; acting in a manner that jeopardizes the health, safety or welfare of residents; failing to maintain “sufficient” financial resources to provide services; maintaining a “substandard” level of care; and having at least 50% interest or corporate ties to a facility that has had its license suspended, denied or revoked.
Criteria that would have a “significant bearing” on suitability include failure to demonstrate “competence and experience” operating a long-term care facility; failure to report resident abuse, mistreatment or neglect to DPH; conviction or a guilty plea; obtaining a license by fraud or misrepresentation; and being the subject of litigation related to the operation of a long-term care facility.
Goldstein said officials will also evaluate staffing changes and quality metrics in Massachusetts and other states where an applicant may be operating.
“The regulations are not the beginning or the end of our work,” the commissioner said. “They strengthen the tools available to a team that is doing this work every day with one goal: protecting residents and promoting the safe, high-quality care they deserve.”
Source: www.wbur.org
