Guest columnist James A. Lomastro: Sustained attention works; try it on nursing homes

In January 2002, investigative reporters in Boston revealed that a Catholic archdiocese had kept moving a priest, John Geoghan, from parish to parish after learning what he had done. What followed taught Massachusetts something that applies far beyond churches. A single exposé did not change the institution. Sustained attention did: roughly 600 stories that year, a cardinal’s resignation by December, and, just as important, a public that stopped treating the problem as one bad actor.

This fall, Massachusetts has a second chance to apply that lesson, this time to nursing homes. Last month, a Boston Globe investigation reported that Eli Mirlis’ RegalCare chain cut nursing spending at its Taunton home by about $530,000 while the rent it paid to a company Mirlis owns rose to $522,000. The home fell from five stars to one. Nine chains from New York and New Jersey now control 61 Massachusetts nursing homes, nearly one in five, up from 12 in 2019. And the state Department of Public Health, which can reject a buyer who is not “responsible and suitable,” has not denied an acquisition or revoked a license in at least seven years.

I do not want to overstate the comparison. Nursing home neglect is not clergy abuse, and the payments described in that reporting are not shown to be unlawful. RegalCare’s $1 million settlement resolved allegations, not convictions. But the structure is familiar. The question in 2002 was what the institution did after it knew. The question now is what the Department of Public Health did after the records, the ratings and the complaints told it what was happening. A man named Liberation Iannillo moved from New York to Medford to watch over his father in a RegalCare home and twice begged the department to “thoroughly investigate this place.” He never heard back.

Dignity Alliance Massachusetts has seen what happens when money leaves the bedside, whatever the route it takes. In May, our statement to a federal judge at the sentencing of the former administrator of the Edgar P. Benjamin Healthcare Center in Roxbury described residents reportedly wrapped in towels for lack of supplies, at least 20 residents losing weight without a dietitian, and caregivers working through missed paychecks. That case involved personal misuse of more than $190,000 and a six-month prison sentence. It is not the RegalCare story. It does show the same chain: when resources are diverted, the residents absorb the shortfall.

One newspaper cannot carry this alone, and it should not have to. Every region of Massachusetts has nursing homes, and almost none of the ownership questions the recent reporting raised have been asked locally. Who owns the home on the edge of your town? Who collects its rent, and who is paid to manage it? How have its staffing and star ratings moved since the last sale? The federal ratings data are public, and the state’s new ownership and affiliated-entity reporting give reporters and residents a trail to follow. Local papers, selectboards, councils on aging, ombudsman volunteers and families are the people best placed to follow it.

The department also has work to do, and soon. The Public Health Council is expected to vote this month on rules implementing the 2024 law that explicitly lets regulators weigh a buyer’s out-of-state record. The legal expert quoted in that reporting saw nothing in the old law that barred that review, yet the commissioner would not commit to a deadline for acting on the new one. This was the same opinion Dignity Alliance submitted in its February testimony. Three tests should be applied to the rules. They should require the department to say publicly what it reviewed and why it approved each sale. They should look at the whole enterprise, not one building’s books, so that rent and fees flowing to affiliated companies are visible. And they should plan for continuity of care, so that the threat of a closure cannot become a permanent veto over accountability.

None of this depends on labels. The reporting found that the nine chains disclose no private equity backing, and RegalCare says it is not private-equity backed. The issue is control: who holds the money, what it buys, and what happens to residents when the answers are unwelcome. Owners who say recent inspections show improvement deserve to have that tested, rather than assumed in either direction.

Reporting mattered because it kept the question alive until institutions answered it. Nursing home residents cannot press that question themselves. Their families, their workers and every newsroom and community that cares about them can. The first story has been written. The follow-through belongs to all of us.

James A. Lomastro, Ph.D., is a retired nonprofit healthcare administrator, a national CARF International surveyor, and an advocacy associate with Dignity Alliance Massachusetts. He lives in Conway. This is his own commentary, not an adopted Dignity Alliance statement.