Consolidation of senior care homes uproots hundreds across Massachusetts

“I’ve never seen the dire conditions we have today, ever,” said Damian Dell’Anno, chief executive of Next Step Healthcare, a chain that is closing nursing homes in Dedham, Newton, Attleboro and Gloucester. while continuing to operate 18 other houses. around the state. “With this cost structure, it’s very difficult to keep these facilities open.”

The closures are a shock to vulnerable residents. David Groat, a 67-year-old retiree who uses a wheelchair, was among 80 residents told this summer that their assisted living facility, Landmark at Longwood, on Boston’s Mission Hill, would be closing in October.

David Groat is among residents looking for new homes amid the closure of Landmark in Longwood.John Tlumacki/Globe Staff

Fewer than 10 Landmark residents still live there and spend their days looking for affordable housing. Groat is waiting to hear if and when he can move into a facility near Ruggles station.

“It could be a day, it could be a week,” he said. “Who knows?”

Even as travel surges, Baker administration officials say they support “industry readjustment,” where occupancy rates were below historic levels even before the pandemic. A series of reforms that came into force last year aimed to increase long-term care staffing and improve infection control. MassHealth, the national Medicaid program, also increased its reimbursement rates for nursing home residents.

But nursing home operators say the higher rates aren’t enough, while other state actions, such as reducing the maximum number of beds allowed per room from four to two, have hurt their company.

With rising labor, food and fuel costs, Woburn-based Next Step is spending up to $270 a day for each resident, up from $240 a day before the pandemic, Dell said. ‘Anno. Most of its residents are insured by MassHealth, but the agency’s reimbursements have only increased to $215-220 a day from a pre-pandemic rate of $210, making many nursing homes unprofitable, did he declare.

Crippled by these finances, Dell’Anno said Next Step could not be sure it would be able to meet its lease payments – and its landlord calculated that the buildings housing the four nursing homes would have more than value if converted into housing or biotech research labs. .

Nursing home closures are having repercussions across the state. Even as residents scramble to find new homes, employees from certified nursing assistants to cafeteria workers must seek new jobs.

Twenty-one Massachusetts nursing facilities have closed or announced plans to close since the COVID-19 pandemic began in early 2020. But the contraction started earlier. The number of nursing facilities in the state fell 13% to 367 from 422 in 2014.

With each closure, there are fewer nearby options for residents and visiting family members. And there are fewer homes to which hospitals can refer patients they refer for rehabilitation services.

The latest wave of shutdowns has taken place outside the public eye. Despite the requirement that the state’s Department of Public Health provide timely notification of planned nursing home closures, none of the recent closure notices were posted on the state’s website until the late last week after The Globe asked state officials about the omissions.

A nursing home, Quincy Health & Rehabilitation Center, which plans to close Dec. 7, blamed a new post-pandemic limit of two beds per room. Many older homes had three or four beds in some rooms. The change was aimed at slowing the spread of infections. But that cost Quincy Health dearly, forcing it to cut capacity from 126 to 92 beds.

In a statement, Quincy Health said its closure was “difficult but financially necessary.” The statement included a note of hope, saying “excess capacity in nearby nursing homes and demand for staff at other facilities should ease the transition” for residents and workers.

Many of the challenges facing care for the elderly have accumulated over years. In January 2020, a task force convened by Mary Lou Sudders, Secretary of Health and Human Services, proposed measures to accelerate an industry consolidation already underway. The panel called for the closure of “poor quality, low occupancy” homes while increasing payments to surviving homes that met higher quality standards.

But senior care officials say the current wave of shutdowns is haphazard and disruptive, a far cry from the strategic and targeted approach envisioned by the task force. And the upheaval may be just beginning: The Massachusetts Senior Care Association has projected that more than 1,000 nursing home residents will be relocated in the coming year.

“Every care home is now under threat,” said Tara Gregorio, chair of the Waltham-based aged care charity. “The situation is precarious. We are witnessing the beginning of the dismantling of this sector.

Sudders, through a spokeswoman, declined a request for an interview. State officials acknowledged in a statement that “steps to increase accountability and improve quality of care may contribute to closures in certain circumstances.” But they suggested other factors are also at play.

The pandemic has overwhelmed Massachusetts nursing homes, reducing their resident count by 21% from 37,975 in 2019 to 30,065 last year, according to data from the Kaiser Family Foundation. Long-term care advocates believe the state’s official tally of 6,894 deaths in senior care homes understates the toll of COVID outbreaks.

Other residents moved from nursing homes to private homes, taking advantage of a waiver allowing the use of MassHealth payments for home care. As more seniors become wary of gathering places and the “aging in place” movement gains momentum, many empty beds have gone unfilled. (This year, as COVID recedes, the nursing home population has grown to just over 32,000, still well below 2019 levels.)

Nursing homes are also being squeezed by long-standing labor shortages that have intensified during the pandemic as some immigrant social workers have returned to their home countries. And the phasing out of loans from the pandemic-era Paycheck Protection Program, which temporarily supported many struggling homes, has made it more difficult to operate profitably.

“It’s changing the economy,” said Paul Lanzikos, coordinator of the Dignity Alliance Massachusetts, which advocates for seniors, people with disabilities and caregivers. “It has become more expensive to run nursing homes for the elderly. And consumer attitudes are also changing.

The situation is less dire for the assisted living sector, where about 90% of residents pay rent out of pocket, through long-term care insurance or proceeds from homes they own. sold. The number of assisted living centers in Massachusetts has risen from 227 to 268 since 2014, as wealthier residents moved away from nursing homes.

But finances have deteriorated for a subset of assisted living facilities: older, so-called “affordable” facilities, mostly in urban areas, that depend on payments from organizations such as MassHealth’s Group Adult Foster Care program. Many of these homes “need renovations and are less able to afford necessary upgrades,” said Brian Doherty, president of the Massachusetts Assisted Living Association.

Several have closed or plan to close, including Landmark, Connemara Senior Living in Brockton, Motif by Monarch in Beverly, and Zelma Lacey House in Boston, which transitioned to affordable housing this year. Wood Haven Senior Living, a memory care home in Tewksbury, moved residents on short notice and closed in January after water pipes burst.

Landmark was originally scheduled to close on October 5. Its remaining residents were granted a reprieve after officials from the Boston Center for Independent Living and the Northeast Justice Center urged seniors’ affairs officials in the state to pressure Landmark management to suspend evictions.

Greater Boston Legal Services also threatened to sue Landmark if it did not give residents more time to find housing. “These are vulnerable people who had no recourse,” said the group’s lead attorney, Betsey Crimmins. But we don’t know how much longer they will have. Landmark executives did not respond to emails and phone calls from The Globe.

Former fitness trainer Tyrone Stampley, 59, who uses a cane to recover from a stroke, said he and his brother Bryant, 65, are still at Landmark. Although they want to live independently, Stampley said, they worry about finding an affordable apartment in Boston.

“It causes a lot of anxiety and stress,” he said.


Robert Weisman can be contacted at [email protected]

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