By Matthew Cunningham-Cook, The Intercept, September 4 2020
IN AUGUST OF 2018, the Department of Housing and Urban Development faced the biggest default in its history. Rosewood Homes, which operated a chain of nursing homes in Illinois, defaulted on a $146 million mortgage that was backed by HUD. The Greystone-backed owner had to pay over $3 million in fines to HUD and the Securities and Exchange Commission for failing to file financial statements and defrauding investors. The mortgage on the homes had been serviced by Greystone, the No. 1 lender in HUD-backed nursing homes.
Then HUD took them over and spent $30 million maintaining and upgrading the facilities, and appointed a receiver to administer the homes. When the homes were ready to go back on the market, the buyer was Greystone, which had already managed over 30 nursing homes in Florida. HUD has refused to disclose the asking price, according to the New York Times.
Greystone also apparently maintained close ties to President Donald Trump. On the same day that bids were due in a federal government auction of the troubled $95 million Rosewood nursing home chain — May 31, 2019 — Greystone’s CEO donated $360,600 to the president’s reelection fund, Trump Victory, using a shell company that omitted his name. Over the next few weeks, a Greystone managing director and his wife followed up with another $360,000 to the Trump Victory Fund, and in November, a Greystone executive donated $100,000 to the president’s Super PAC, America First Action, for a total of over $820,000.
Greystone’s nursing homes have now become epicenters of death in the coronavirus crisis. Federal data shows that 51 deaths have occurred at University Rehab at Northmoor in Peoria, Illinois, while 16 deaths have occurred at Greystone’s Apollo Health and Rehab in Saint Petersburg, Florida, putting both homes among the worst in the country for Covid-19 deaths. The Rockledge Health and Rehab Center in Florida has 24 deaths, the Lake Cook Rehab and Healthcare Center in suburban Chicago has 20 deaths, and the Riverside Rehab and Healthcare Center in Alton, Illinois, has 21 deaths. Despite the deaths, money from the federal government has flowed, as Greystone facilities have received at minimum $15 million in Covid-19 grants and loans since the pandemic began.
Rep. Lloyd Doggett, D-Texas, who chairs the House Ways and Means Committee’s Subcommittee on Health, described the donations from Greystone executives to Trump funds as “another tale from Trump’s corruption playbook. He again puts special-interest wealth over public health.”
“No-strings-attached relief money does not appear to be relieving the impact of the pandemic on nursing home residents. No oversight on how taxpayer dollars are spent, and little oversight on how our loved ones are treated in these facilities,” Doggett said. “Just more money to campaign donors while residents and staff, at deep daily risk, get faulty testing and PPE.”
STEPHEN ROSENBERG, Greystone’s CEO and owner, recalled in a podcast last year that when he founded the company in 1988, the only nursing homes that returned his calls to begin with were those that were at imminent risk of default. Thirty-two years later, Greystone is the No. 1 lender in the HUD space, which gives Greystone concrete benefits, namely the security of the guarantee of the federal government. If Greystone’s tenant defaults on a $146 million mortgage, Greystone is still going to be paid because the mortgage is backed by HUD.
That seems to be the case with the HUD-backed Illinois nursing homes. Despite servicing the mortgage and inspections showing numerous problems with the facilities, Greystone only cared about its bottom line. In 2016, Greystone sued Rosewood Homes owner Zvi Feiner for payment in 2016. When the $146 million default occurred, the federal government stepped in. Feiner, who Greystone was supposed to vet, has now been sued for defrauding investors in the Orthodox Jewish community in Chicago, including a Holocaust survivor, in addition to paying $1 million in fines to HUD for failing to file financial statements and paying $2.25 million to settle with the SEC for the same issue of defrauding investors.
The HUD nursing home lending program, called Section 232, was established in 1959 to expand nursing home construction in the U.S. In total, 15 percent of the country’s nursing home mortgages are backed by HUD. Because HUD is often a lender of last resort, the quality of nursing homes in the program are often poor. The New York Times found that dozens of HUD-backed nursing homes have “serious deficiencies,” candidates to be included in a special program for the worst nursing homes. HUD stopped inspecting nursing homes in the program in 2012, concluding that the inspections were redundant to state and federal nursing home inspections.
On the same podcast, referring to nursing homes serviced by Greystone that could not meet their obligations, Rosenberg said, “It’s really unfortunate. It’s really sad. It’s especially unfortunate when companies are not meeting their projections, and then they don’t have the cash flow to provide the services or the care to their residents. That’s who really suffers. Sure, people might lose some of their equity, but the people that are really suffering in those circumstances, when there just isn’t cash flow, are the residents.”
The podcast was released on June 3, 2019, just as Rosenberg and other Greystone executives were pumping cash into the Trump campaign — a total of nearly $1 million — and HUD was spending millions maintaining and upgrading the facilities that would eventually be handed over to Rosenberg’s company for an undisclosed price.
Rosenberg’s comments reflect “an attitude that applies to nursing homes and how they operate, which is profits over patients,” said Brian Lee, executive director of Families for Better Care, a Texas-based nursing home resident advocacy group. “This is all about the nursing homes maximizing their profitability. They find every possible loophole, and well, they can tap into just so they can make their coffers flush with cash” said Lee. From 2015 to 2019, Greystone’s loan portfolio doubled in size, from $15 billion to $30 billion. Because the company is privately held, it does not have to disclose its financial statements that would show how much profits its nursing homes generate for Rosenberg and other Greystone executives.
“What you see in these comments from Rosenberg is all about “equity,” “cashflow statements,” “profit projections.” It’s not about “care” and “safety,” argued Lee.”This is what happens when you corporatize nursing home care. It’s part of the larger problem. We have this whole system that is created to help the nursing homes suck as much of the taxpayer dollars from HUD, Medicaid, and Medicare and put it in their coffers. We pay as much as 80 percent of their money through Medicare or Medicaid reimbursables. We continue to accept the shoddy product they deliver. The owners make out like bandits, and the residents suffer and die.”
GREYSTONE RESPONDED to a request for comment that detailed The Intercept’s reporting by saying that the company has gone above and beyond. “As the Centers for Disease Control and Prevention (CDC), and Centers for Medicare and Medicaid Services (CMS) began providing protocols and guidelines for COVID-19, Greystone Healthcare Management’s communities have diligently followed them,” Greystone spokesperson Karen Marotta said. “In many cases, Greystone Healthcare has gotten out in front of public health guidelines, adopting even more stringent infection precautions than were recommended at the time. We did this because we knew we were facing an exceptional situation, and it is better to risk overreacting than to underreact in the face of a pandemic.” Greystone also argued that some of the federal data was incorrect. The numbers it provided were broadly similar, with the exception of University Rehab Northmoor, which Greystone claimed had just 13 deaths in contrast to the federal government reporting 51, and Lake Cook Rehab, which it claimed had just eight deaths in contrast to the federal government reporting 20. Greystone did not provide an explanation for the discrepancy.
Those assertions are contradicted by Greystone residents, their family members, inspection reports, and the company’s own senior staff members. The lack of resources at Greystone, while profits continued, meant that residents were put at risk and staffers felt unequipped to handle the coronavirus pandemic. At the end of March, as the pandemic spread in Apollo, the home’s director of nursing, Kevin Mimbs Jr., posted on Facebook saying, “We have burned our infection control manuals, thrown everything we were taught and practice out the window just to get by” due to the lack of personal protective equipment inside the nursing home. There were also high levels of staff turnover, family and residents say. While it is difficult to suss out, and there are discrepancies between state and federal data, it is likely that Apollo has had the most Covid-19 deaths of any nursing home in Florida.
Joyce Casbar, whose 87-year-old mother Gloria contracted Covid-19 at the facility and died in July, is outraged by what she perceives as failings by Apollo and Greystone. On June 23, Gloria tested positive for Covid-19. Soon after, Gloria was moved out of the room that she had been in for a year into another room, even though she didn’t have a roommate. The next day, she fell in the night and had a downward trajectory from there, dying in a hospital on July 11. Gloria’s experience in the nursing home was first reported by the Tampa Bay Times.
“I feel duped,” Joyce Casbar told The Intercept. “I feel guilty. I have nightmares. I have panic attacks. The nightmares are so vivid from my last visit with my mom that I’m afraid to go to sleep.”
An inspection report from the Florida Department of Health, done on May 15, details the many infection control violations at the home. “The facility did not maintain a prevention and control program related to not properly maintaining and implementing best practice for COVID-19,” the inspection report says. The report identified medical devices that were not properly cleaned, staff not washing their hands after leaving resident care areas, staff not donning proper PPE or properly storing used N95 masks for reuse, leaving a resident’s tubing and a drainage bag on the floor, and not having PPE available.
Previous inspections had also shown problems at the facility, like a resident waiting 45 minutes after soiling himself before being changed, putting him at risk for a dangerous urinary tract infection, and a dishwashing machine that failed to properly sanitize dishes.
Casbar said there has been significant turnover at the facility, which was corroborated by another resident who wanted to remain anonymous for fear of retaliation. They also both described a failure to test residents; staff told them, they said, that if employees desired to be tested, they would have to do it themselves.
“My mom caught Covid from a worker,” said Casbar. “They tested my mom because a fill-in [certified nursing assistant] was working for my mom’s regular CNA, and the next day she was tested.”
“I think they need to be accountable,” said Casbar. “If I had known things were going to go so badly inside Apollo, I would have taken her out of there and isolated her in the home, had I known. We were provided with false information. They didn’t have it under control. They weren’t taking the proper steps” to contain Covid-19, she said.
The University Rehab at Northmoor in Peoria has been similarly troubled, rated one out of five stars by the Center for Medicare and Medicaid Services. An inspection in March 2019, when the home was under HUD receivership, found the nursing home to have insect infestations and had failed to track employee illnesses, which is an integral part of an infection control program. Another inspection from March 2017, when Greystone was servicing the loan but the home was owned by Zvi Feiner, the nursing home was cited for failing to treat for pressure ulcers, which resulted in the patient’s severe injury and hospitalization. Greystone’s direct ownership of the home, since January, does not seem to have improved conditions inside the facility. On March 11, as the pandemic began, the nursing home was inspected. A resident had frequently missed essential medical treatment (likely dialysis), the report noted, which put them at significant risk for infections and thus, the entire nursing home at risk of an infectious disease outbreak. The inspector also found a nurse’s aide disposing of a resident’s bodily fluids on the floor instead of putting it in the trash, in violation of state and federal infection control guidelines. Now University Rehab at Northmoor has reported 51 deaths.
REVELATIONS REGARDING THE dangerous practices of nursing homes during Covid-19 come as the industry is seeking a wide-ranging shield from liability for its actions. Forty-five percent of the 179,000 Covid-19 deaths in the U.S. are related to nursing homes. Prior to the pandemic, as many as 380,000 nursing home residents were killed annually from infections. Over $5 billion in Covid-19 relief funds have gone to nursing homes already, and the Trump administration has announced another $2.5 billion distribution — again with no strings attached to ensure that homes use the money only for care. Liability shields are the pinnacle of decades of lobbying by the industry to avoid accountability as residents have been killed, maimed, abused, and sexually assaulted in their facilities.
New York passed a legal shield for nursing homes in May and partially walked it back in August. Tennessee’s governor signed a law on August 20 to make it more difficult to sue nursing homes for their Covid-19 actions, and Idaho’s governor signed a similar bill into law on August 27. California’s Supreme Court on August 17 capped damages at $500 per lawsuit for all nursing home cases, not just coronavirus-related ones. Disputes between the House and the Senate over Senate Republicans’ desire for a liability shield broke down negotiations over a Phase 4 coronavirus relief package. McKnight’s Senior Living, a trade publication, reports that liability protections for nursing homes have additionally been expanded in Alabama, Arizona, Connecticut, Georgia, Iowa, Illinois, Indiana, Louisiana, Kentucky, Massachusetts, Maryland, Michigan, Mississippi, New Jersey, Nevada, Rhode Island, Vermont, Virginia, and Wisconsin since the pandemic began.
Experts have panned these moves, arguing that they put nursing home residents at further risk. “There can’t be immunity across the board here,” said Toby Edelman, senior staff attorney at the Center for Medicare Advocacy. “It’s really not an acceptable thing to do. Nursing home residents have rights.”
Rose Wong of the Duke Chronicle contributed reporting. This reporting was supported by NursingHomeCrisis.org, a project of Social Security Works.