Earlier this month, an international television news network aired a 25-minute report that focuses on a 184-bed nursing home owned by Brius CEO Shlomo Rechnitz. The news story — entitled “‘Where people come to wait to die’: COVID-19 in US nursing homes” — aired on Al Jazeera’s “Fault Lines” program on December 2 and is available at the link above.  

The report focuses on Kingston Healthcare Center in Bakersfield, California. As of early December, 104 residents at the facility had contracted COVID-19 and 19 residents had died. The California Department of Public Health reports that at least 87 staff at the facility have also contracted the coronavirus.

In interviews, Kingston caregivers describe a variety of care failures. 

“Christina DeWoody worked at Kingston as a cleaner until a few months ago. Before supervisors provided personal protective equipment (PPE) she and other workers would use brown paper bags, the kind schoolchildren use for their lunches, and tie them around their noses and mouths as makeshift barriers.

‘Their quality of care was pretty much none,’ DeWoody recalled, remembering elderly patients lying for hours without access to water, suffering from a combination of COVID-19 and dehydration. She described others sitting in their urine and faeces [sic], with no one to change them – potentially leading to deadly sepsis, a common condition in nursing homes when patients become infected from their own excrement. As workers stopped showing up, patients would cling to DeWoody’s arm, begging her not to abandon them. She cried on her drive home every day.”

According to public records, Brius’s Shlomo Rechnitz owns the nursing home and leases it to Dr. David Silver, who serves as the CEO of Rockport Healthcare Services. Rockport, which operates all of Brius’s nursing homes, was recently cited by state regulators for illegally evicting low-paying residents in order to replace them with higher-paying ones.

Reporters also interviewed the family member of a resident who died of alleged care failures at a second Brius nursing home, Country Villa Westwood in Los Angeles.

Dr. Michael Wasserman, the former CEO of Rockport, tells Al Jazeera he recently left Rockport when “he found some of the practices there untenable.” Dr. Wasserman states: “I was told that I would be running the company. The long and the short was: that wasn’t true.”

The investigative report also probes into the apparent failures of state officials to protect nursing home residents. For example, the California Department of Public Health has allowed the Kingston facility to operate without a regular license for at least three years. Meanwhile, the facility has racked up dozens of complaints and violations as well as fines and sanctions for substandard care. Thus far in 2020, patients and their families “have filed 192 formal complaints against it, compared with the state average of 21,” says Al Jazeera.

The Kingston facility has been cited for four times more care violations than the average US nursing home. For more than two years, the nursing home has appeared on the federal Centers for Medicare & Medicaid Services’ (CMS) short list of the nation’s poorest-performing facilities, showing no signs of improvement in that time. The facility is currently facing a $92,500 fine as a result of numerous violations detailed in a citation report issued by Cal/OSHA in October.

Molly Davies, a Long-Term Care Ombudsman for the City and County of Los Angeles County, says: “What we’ve seen is that the regulatory enforcement system favors the industry above consumers. And that is precisely the opposite of what it is designed to do.”  

The Al Jazeera report includes interviews with multiple Kingston caregivers, family members of nursing home residents, Tony Chicotel (an attorney with the California Advocates for Nursing Home Reform), Matt Feuer (Los Angeles City Attorney), two private attorneys who are suing Brius on behalf of residents and family members, and a researcher from the National Union of Healthcare Workers.

A Brius nursing home captured headlines in the Los Angeles Times after a “severe outbreak” of COVID-19 infected 60 residents and 20 staff at the facility and killed seven residents. The outbreak, which comes amid “a steady slide” in COVID-19 infections in California’s nursing homes, has prompted concerns, according to the article published on October 8.

The Brius facility—113-bed Windsor Redding Care Center in Redding, California—has a history of resident care violations. During the past three years, the facility has averaged approximately twice as many complaints and violations of state laws as the average California nursing home, according to the California Department of Public Health.

In February 2015, Brius submitted its license application to operate the facility with the California Department of Public Health. The state’s health department ultimately denied Brius’s application due to the company’s history of understaffing its facilities and violating residents’ rights.

In denying Brius’s request for a license, the California Department of Public Health cited Brius’s track record of violating federal and state laws, including 265 federal violations at homes owned or managed by Brius during the previous three years. Thirty-nine of those violations put the health of a resident in “immediate jeopardy.”

Brius CEO Shlomo Rechnitz appealed the state agency’s licensure denial, and state officials have allowed Brius to continue operating the facility, along with four other nursing homes that Brius acquired from Windsor in 2015, on a provisional basis for half a decade. Brius has since renamed the facility and is currently doing business as River Valley Healthcare & Wellness Center, according to California’s Office of Statewide Health Planning and Development.

Since the COVID-19 pandemic, California’s nursing home residents have experienced much higher mortality rates than the general public. According to The Times, “Nursing homes and senior facilities have accounted for 7% of California’s coronavirus cases and 36% of its deaths.”

In May, California officials implemented mandatory COVID-19 testing rules that have helped to reduce infections at the state’s nursing homes, according to The Times. On September 29, Gov. Gavin Newsom “signed a law requiring skilled nursing facilities in California to report disease-related deaths to health authorities within 24 hours during declared emergencies.” According to The Times, “The law was written in response to concerns that health agencies were slow to respond to outbreaks because they did not receive timely information about the facilities.”

The former CEO of Rockport Healthcare Services, which manages Brius’s nursing homes, told the New York Times that internal orders were given at some Brius facilities to illegally evict the “least profitable patients” in order to replace them with higher-paying patients who have COVID-19.

The article, entitled “‘They Just Dumped Him Like Trash’: Nursing Homes Evict Vulnerable Residents,” cites an internal email from a Rockport executive that apparently was leaked to a journalist. Dr. Michael Wasserman, who served as the CEO of Rockport until 2018, interprets the email for the Times.

In California, Rockport Healthcare Services, which manages the state’s largest chain of for-profit nursing homes, has repeatedly been cited by state regulators for illegal evictions.

On March 31, with Covid-19 cases soaring, a Rockport executive wrote in an email to colleagues that they should begin “discharge planning immediately,” noting that any discharges should be done safely.

Dr. Michael Wasserman, who was the chief executive of Rockport until 2018, said that was code to kick out the least-lucrative residents. “You are looking to replace the poorest, least profitable patients with the highest paying ones,” said Dr. Wasserman, who resigned after clashing with the chain’s owner.

This spring, Los Angeles County designated three of Rockport’s nursing homes as preferred destinations for Covid-19 patients. Since then, one of them has tried unsuccessfully to evict at least two residents against their will, according to a lawyer who was contacted by the residents’ families.

David Silver, the chief executive of Rockport, said the company was trying to be a good partner to the state by making room for an expected surge of Covid-19 patients. “This has absolutely nothing to do with money,” he said. He declined to comment on individual residents, citing confidentiality.

A registered nurse blew the whistle on a Brius nursing home outside Los Angeles, triggering a state investigation that revealed management failing to report serious falls and a choking death, asking workers to alter their records to avoid trouble with state regulators and leaving patients unsupervised for extended periods of time.

Following the nurse’s complaint, California’s Department of Public Health launched an investigation into Lakewood Healthcare Center in Downey. In February, state officials hit the nursing home with six Class A citations, four Class B citations and $156,000 in fines.

Responding to the complaint, investigators arrived unannounced at the facility at 5:45 a.m. Nov. 5, 2018, to a grim scene.

“The floors were observed with black stains, call lights were ringing without staff responding, a foul strong ammonia odor permeated throughout the hallways, residents’ were yelling and there were no staff members around,” investigators wrote.

Following an interview with one nurse, the investigators learned that: 

1. Recurrent falls not reported timely to the physician and care not provided.
2. The nurse-patient ratio did not meet the criteria to care for residents’ needs.
3. Reports of incidents, body assessments, and nurses’ notes were being removed from the clinical record by the director of nursing.
4. Residents with difficulty swallowing were provided with a honey bun causing one choking death and a second resident hospitalized after choking on the honey bun.
5. Residents were left unsupervised, wet, and soiled for extended periods of time.
6. The director of nursing had asked the licensed nurses to change their documentation because she did not want to get in trouble with the department of health.

Moreover, one nursing assistant told investigators that the director of nursing and administrator told staffers that they would lose their jobs if they spoke to state authorities.

The citations were hardly the first black mark for Brius or the Lakewood Healthcare Center.

Since 2016, the California Department of Public Health has received 315 complaints and facility reported incidents on Lakewood, while issuing it 164 deficiencies and 29 citations (state fines), according to research by California Advocates for Nursing Home Reform.

Last year, a California state audit found that Brius had the worst patient care record among California’s three largest nursing home chains, racking up .52 citations per 100 nursing home beds – nearly double the company’s two leading competitors.

Four of the Class A violations at Lakewood involved residents who were injured from falls. One resident who needed one-on-one care fell and his head on the headboard of his bed while left unattended. The impact resulted in a broken nose and bleeding in his brain, resulting in a four-day hospital stay. The other two involved the residents who choked on the honey buns. Management didn’t report either choking incident to state authorities.

Regulators also cited Lakewood for impeding their investigation. Investigators claimed that management denied them access to facility records and that key notes about the falls and choking episodes could not be found.

The facility was also cited for actively impeding the DPH investigations. Investigators were denied requested records for hours. The DON stated that facility incident records, IDT progress notes and the nurses’ notes about the fall incidents and choking episodes were not in the residents’ clinical records and were nowhere to be found.

Nearly one year after California State Auditor Elaine Howle issued a scathing report criticizing state regulators for failing to safeguard nursing home patients from unscrupulous operators, only one of her recommendations has been fully implemented.

In a status report released this month, Howle found that of her 12 recommendations to improve nursing home care, five had been partially implemented and six had not been implemented at all.

The only recommendation that lawmakers or regulators have acted upon was legislation requiring nursing home operators to submit profit-and-loss statements for related businesses that service their nursing homes.

The audit was requested by State Sen. Mike McGuire and Assemblymember Jim Wood after they reviewed data compiled by the National Union of Healthcare Workers showing that in 2015 Brius Healthcare owner Shlomo Rechnitz had his nursing homes pay for $67 million worth of goods and services from 65 companies also controlled by Rechnitz.

The audit focused both on whether state agencies were effectively monitoring the financial dealings of nursing home operators and protecting nursing home patients from serial patient care violators.

Howle found that Brius had the worst patient care record among California’s three largest nursing home chains, racking up .52 citations per 100 nursing home beds – nearly double the company’s two leading competitors.

Although Howell said that oversight failures “increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents, very little has been done to follow up on her recommendations.

The legislature has so far failed to implement the following recommendations:

1) Redistribute quality assurance fee payments from nursing homes that do not demonstrate adequate quality-of-care improvements to those that do.

2) Require the Department of Public Health to develop by Nov. 2018 a proposal for legislative consideration that outlines the factors it will consider when approving or denying applications from nursing facilities based on each applicant’s ability to provide quality patient care.

3) Require the Department of Public Health to conduct state and federal inspections concurrently by aligning federal and state timelines and require that state inspections occur every 30 months.

4) Require the Department of Public Health to increase citation penalty amounts annually by – at a minimum – the cost of inflation.

5) Require that the Office of Statewide Health Planning and Development, Department of Public Health and Department of Health Care Services collaborate to assess the information that each collects from nursing facilities and to develop a proposal by May 2019 for any legislative changes that would be necessary to increase the efficiency of their collection and use of the information.

6) Require a state agency to develop, implement and maintain for consumers by May 2020 an online dashboard that includes at a minimum information about nursing facilities’ net income and quality of care.

The following recommendations for state agencies are listed as pending:

1) The Department of Public Health should take the steps necessary to ensure that its oversight results in nursing facilities improving their quality of care by amending its application licensing reviews by developing a defined process that specifies how an analyst will determine whether an applicant has demonstrated its ability to comply with state and federal requirements.

2) The Department of Public Health should take the steps necessary to ensure that its oversight results in nursing facilities improving their quality of care by ensuring that it issues citations in a timely manner, especially for immediate jeopardy deficiencies.

3) To ensure that it provides the public with nursing facility information that is accurate and comprehensible, the Office of Statewide Health Planning and Development should update its regulations.

4) To improve the availability and transparency of information, the Department of Public Health should upload all inspection findings to Cal Health Find and review ownership data by May 2019.

5) The Department of Healthcare Services should use current data to revise and update the peer groups it uses to set Medi-Cal rates. In doing so, it should take into consideration the consolidation of the nursing facility industry.

To see the full auditor’s report, click here.

Dozens of Brius nursing homes, including several that have been fined for understaffing, are asking to be exempted from a new California regulation requiring them to spend more time directly caring for patients.

The new rules, which went into effect last July, but still have not been enforced, require nursing homes to provide at least 3.5 hours of direct care per resident per day — up from 3.2 hours of care previously.

State records show that Brius homes across California are seeking waivers to avoid the new staffing rule claiming either that it’s unnecessary or that there are too few available workers to implement the requirement. In many cases, Brius, the state’s largest nursing home operator, sought waivers based on both criteria. State officials have not yet ruled on the waiver requests.

One home where Brius has sought a waiver is the 99-bed Eureka Rehabilitation and Wellness Center, which was fined $160,000 by the California Department of Public Health in 2017 in part for failing to provide adequate staffing to prevent falls. The report quoted an unnamed worker who said company officials increased staffing levels when state inspectors were present in an apparent effort to conceal the facility’s understaffing.

In Marin County, Brius sought a waiver for the San Rafael Healthcare and Wellness Centre even though the facility was fined $15,000 for understaffing.

In nearby Novato, Brius is seeking a waiver for its Novato Healthcare Center, even though state investigators found that the 181-bed facility was “woefully understaffed” in a 2018 report. Residents were forced to go weeks without shower and sit in the own excrement for hours waiting for assistance, according to the report.

Patient advocates say low pay is the primary reason nursing homes struggle to find workers.

“If they paid them better, they’d have plenty of staff,” even in remote parts of California, Suzi Fregeau, long-term care program manager in Humboldt and Del Norte counties, told Kaiser Health News. The mean hourly wage for certified nursing assistants in California was $16.13 in 2017, according to federal labor data.

The California Department of Public Health, which oversees nursing homes, is expected to announce in later this month which — if any — facilities it will exempt from the new regulations, according to Kaiser Health News. But some patient advocates don’t like the nursing homes’ balking.

 “We’re appalled by the waiver system. Mike Connors of California Advocates for Nursing Home Reform, told the publication. “It’s sending the worst possible message to California nursing homes that it’s OK to staff at levels that endanger residents.”

Caregivers at Brius-operated River Valley Healthcare andWellness Centre in Redding, CA, held a two-day strike in late November 2018 toprotest understaffing, according to media reports.

Caregivers – including Certified Nursing Assistants and LVNs – say the quality of care at the facility has nosedived since Brius took over the 113-bed nursing home in November of 2014. Caregivers’ criticisms will be familiar to Brius observers. Nursing staff at the Redding facility say they are so short staffed that CNAs must care for as many as 20 patients during some shifts.

Meanwhile, the nursing home is having a tough time holding onto its staff. From 2015 and 2016, the facility’s annual staff turnover rate jumped from 31 percent to 61 percent, according to public records held by California’s Office of Statewide Health Planning and Development. This means that three of every five staffers left her job at the nursing home during 2016.

Although conditions at the facility have reportedly declined, its profits have soared, according to public records. From late 2015 (the first full reporting period with Brius as the facility’s operator) through 2017 (the most recent year for which data is available), the nursing home pocketed a staggering $2.3 million in profits. The facility’s operating profit margin has gone from -6 percent in 2014 to 12 percent in 2017. At the same time, the nursing home has entered into costly contracts with various businesses owned by Brius CEO Shlomo Rechnitz and his family members.

It’s unclear why Brius is still permitted to operate the facility. On July 8, 2016, the California Department of Public Health denied Brius a license to operate the nursing home based on Brius’s record of substandard care and legal violations. Brius appealed the health department’s decision, but it’s unclear why the state has failed to resolve the appeal more than two years later.