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Last year, New Jersey-based Skyline Healthcare abandoned more than 100 nursing facilities nationwide, forcing multiple states to seek receiverships in court in order to protect residents and make sure they received food, medications, and care.[1] States had allowed Skyline to take over the facilities, many from the nursing home chain Golden Living, even as Skyline’s failures to meet payroll and pay vendors rapidly emerged elsewhere. Skyline’s abandonment of facilities continued in 2019. In late April, Skyline surrendered its licenses for five nursing facilities in southeast Massachusetts, forcing the facilities’ 245 residents to find new homes in less than a month.[2] On April 29, a Massachusetts court approved the state Attorney General’s Petition for Receivership over the five Skyline facilities, which had been operated by a management company since last year.[3]

In response to the crises for residents, their families, and states, at least one state has taken action to assure that operators of facilities are qualified to provide, and capable of providing, care to vulnerable nursing home residents.

Last year, Kansas took over 22 nursing facilities, including 15 facilities owned by Skyline Health, when the facilities failed to pay their bills and endangered residents’ health and safety.[4] The Kansas City Star reports, “when Kansas issued the 15 licenses to Skyline in 2016, the company was already missing payments to vendors for things like laundry, housekeeping and food for its facilities in other states.”[5]

Kansas has now passed legislation to require more financial information from people applying for licenses and to streamline the receivership process. Senate Bill No. 15,[6] was approved by the Governor on April 22, 2019. Among other provisions, the bill makes it clear that an applicant for a license for a nursing facility (among other categories of health care providers) must provide a detailed budget for the first 12 months of operation, demonstrate evidence of sufficient capital to operate the facility, and list all current or previously licensed facilities, in Kansas and elsewhere, in which the applicant “had any percentage of ownership in the operations or the real property of the facility.” An applicant or licensee is ineligible for a license for 10 years if a prior facility in Kansas was subject to receivership.

Similar actions by other states – and more – are necessary to protect residents from reckless operators. The federal government also has a critical role.

Under the 1987 Nursing Home Reform Law, the Secretary of the Department of Health and Human Services has “a duty and responsibility” to assure that federal standards of care, and their enforcement, “are adequate to protect the health, safety, welfare, and rights of residents” and “to promote the effective and efficient use of public moneys.”[7] The Secretary must use this broad statutory authority to do more than rubber-stamp states’ licensure decisions. The Secretary must exercise independent judgment and determine applicants’ suitability to receive reimbursement under the Medicare and Medicaid programs for the care of residents.

A staff member for 25 years at Bedford Gardens, one of the Skyline facilities in Massachusetts, told WPRI that “she wants the state held accountable since Skyline’s troubles in other states was known about already.”[8]  She said, “‘These are nursing homes these aren’t stores. You don’t just let anyone run your nursing home. I hope they learn from that because all these people have to find new homes. It’s not a store.’”[9]

The Center for Medicare Advocacy agrees. States and the federal government must make sure that owners and operators of nursing facilities and their real estate are qualified and competent. Residents, families, and taxpayers deserve no less.

May 16, 2019 – T. Edelman



[1] “Buying and Selling Nursing Homes: Who’s Looking Out for the Residents?” (CMA Alert, May 23, 2018),
[2] Jennette Barnes, “‘It’s an absolute nightmare’: New Bedford nursing homes among 5 closing,” South Coast Today (Apr.24, 2019),
[3] Petition at; Court Oder, at
[4] Andy Marso, “Kansas cracks down on nursing home operators with shaky finances,” Kansas city Star (Apr. 23, 2019),
[5] Id.
[7] 42 U.S.C. §§1395i-3(f)(1), 1396r(f)(1), Medicare and Medicaid, respectively.
[8] Sarah Doiron, Kim Kalunian, Alexandra Leslie, “Skyline Healthcare to voluntarily close short-staffed nursing homes,” (Apr. 25, 2019),
[9] Id.


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