Care quality drops as investors buy up Florida nursing homes, report finds
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Private equity investors are buying up Florida nursing homes, according to a new report.
Why it matters: The trend is often linked to a decline in quality of care, researchers found, and the complex, often anonymous ownership structures make it difficult to pinpoint who or what to hold accountable.
By the numbers: 425 nursing homes — more than 60% of the state's total — changed owners between 2019 and early 2024, per AARP Florida's Change of Ownership and Quality in Florida Nursing Homes report.
- Of the facilities that changed hands, researchers linked at least 156 to private equity ownership groups.
- Those owners often had ties to each other, suggesting "that dozens of Florida nursing homes were purchased in the past five years by a relatively small group of private investors."
Threat level: The portion of top-performing nursing homes in that group was cut in half, from 28% to 14%, while the share of worst-performing facilities more than doubled from 10% to 21%.
- The report took into consideration quality indicators such as the Centers for Medicare & Medicaid Services (CMS) star rating system.
State of play: The shift took hold during the pre-vaccine years of the pandemic, when nursing home residents were dying at alarming rates, said University of South Florida professor Lindsay Peterson, who worked on the report with AARP Florida.
- Facilities also couldn't take in new patients due to concerns about bringing in the disease.
- "You need to have most of your beds filled in order to keep all the lights on," Peterson told Axios. "Many decided to sell because of that stress."
- The number of nursing homes filing changes of ownership accelerated each year, doubling from 29 in 2019 to 61 in 2020 and rising to 138 by 2023, the last full year of data included in the report.
Zoom in: As Peterson tried to learn more about the new owners, she ran into opaque layers of corporations and trusts.
- "What that comes with is a lack of transparency," Peterson said. "You really don't know who's running a place."
The other side: A spokesperson for the Florida Health Care Association, an advocacy group for long-term care providers, said some facilities experienced declines in ratings because of a 2022 change in state law governing staff time with patients.
- "For residents and their families, what matters most is personalized, hands-on care focused on their specialized needs — not ownership structures," senior director of strategy and communications Kristen Knapp told Axios in a statement.
Yes, but: The two are often linked, Peterson said, although she emphasized there are some exceptions.
What's next: For residents and caregivers trying to make decisions about long-term care, Peterson recommended looking up nursing homes via Florida Facility Finder and checking the owner/licensee.
- You can also check the "since" date, indicating how long the current owner has run the facility. "The longer the better," Peterson said. That signals more stability.
- Meeting with an administrator to suss out how long they've been there and how involved they are with residents can also help.
Go deeper: A private equity firm bought a Virginia nursing home, and deaths doubled