At the Maplewood Center in Amesbury, administrators in May acknowledged to inspectors that they were so short of certified nursing assistants, they had to use an activities director and an admissions executive to help feed patients.
In November, administrators at Meadow View Center in North Reading agreed to pay a $56,000 federal fine after a resident with a high fever, “delirious, and talking about monsters,” died from massive inflammation following an untreated urinary tract infection, according to a state report.
The three nursing homes are owned by Genesis HealthCare, a Pennsylvania company that has grown into a behemoth in the past four years, more than doubling in size, to become the largest owner of nursing homes in Massachusetts and nationwide. Genesis, which as of July was partly owned by a private equity firm, counts nearly 500 nursing homes, including 32 in Massachusetts, in its portfolio.
But with rapid expansion has come an erosion in quality of care, federal and state data show. Nearly half of the nursing homes owned by Genesis have seen their ratings by federal regulators decline since 2010, a Globe analysis shows. And most of those whose ratings remained the same were ranked as below average in quality.
At the same time, health and safety problems have climbed. Federal regulators assign a score to each nursing home based on the severity and extent of problems discovered in facilities. A Globe analysis of those numbers found that Genesis homes had strikingly worse scores than the state as a whole.
The analysis suggests that problems at Genesis facilities worsened over time, and by early this year, the score for Genesis homes was twice as bad as the statewide number.
In a statement issued to the Globe, Genesis said it is “committed to providing quality care to each and every patient in the centers it owns and operates across the United States.”
The statement, which did not address specific questions about the company or the Globe’s findings, acknowledged some hurdles.
“The integration of centers, and the improvement of quality and performance in an incredibly difficult operating environment, is a challenging and long-term effort,” the statement said.
The Genesis experience underscores the growing turbulence in an industry that cares for some of the nation’s most frail residents. Across the country, nursing homes are being bought and sold at a rapid pace, analysts say, as companies vie for facilities that attract more higher-paying patients.
This year alone, companies have notified Massachusetts regulators about plans to sell 58 nursing homes. That’s 14 percent of the state’s roughly 400 nursing homes.
Just a few years ago, Genesis nursing homes were considered to be respected long-term care facilities, say lawyers who routinely field calls from distraught families about nursing home injuries and deaths.
That has changed.
“Now, I get a lot of calls on Genesis,” said David Hoey, a North Reading attorney who specializes in nursing home-related cases.
Hoey said the problems reported by families, such as pressure sores and broken bones from falls, are typically seen when nursing homes do not have enough staff to monitor and care for residents.
Hoey said his office has litigated about a half-dozen cases involving Genesis homes in the past few years. But he said he could not discuss specific cases because Genesis, reflecting widespread industry practice, typically requires confidentiality agreements in legal settlements with families, barring them or their lawyers from discussing a case.
Saul Gruber, a New Jersey lawyer and executive board member of the Nursing Home Trial Lawyers Association, reports similar experiences with Genesis.
“We have seen more abuse cases, more cases that simply come from not paying attention, and not watching the resident, which is surprising for Genesis,” Gruber said.
“In the past couple of years, people are choking and dying because someone allowed them to have food they weren’t supposed to. Who does that, unless you are understaffed?” Gruber said.
Staffing shortages in nursing homes are not unusual. But the Globe analysis found more pronounced gaps in nurse staffing levels in Genesis homes in Massachusetts compared with median levels statewide.
Federal data for this year show registered nurses at Genesis homes spend roughly 19 percent less time caring for patients than federal regulators expected, based on the severity of patient illnesses. Nursing assistants spent 14 percent less time.
However, Genesis licensed practical nurses — who provide more specialized care than nursing assistants but less than RNs — spent more time than expected.
The Globe analyzed data collected by the Centers for Medicare & Medicaid Services, the federal agency that regulates nursing homes. The data included information about health and safety problems uncovered at each Massachusetts nursing home and nurse staffing levels.
That information was used to compare the performance of Genesis homes with others statewide, a methodology suggested by university researchers. (Click to continue reading)
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A nursing home giant stumbles amid expansion
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