A series of troubling incidents at Vermont’s largest nursing homes previously owned by Genesis HealthCare – ranging from neglect and injuries to a resident death – has exposed deep flaws in how the state oversees nursing home ownership transfers.

That’s according to a report in VTdigger, which stated that the recent spike in violations in these skilled nursing facilities (SNFs) under new ownership is raising questions about transparency, accountability, and the adequacy of Vermont’s regulatory process for vetting prospective nursing home operators, which currently does not place the approval of sales under public review.

Genesis HealthCare sold six of its nine Vermont facilities between 2023 and 2024 before filing for bankruptcy. The new operators took over these facilities under a long-standing “temporary” state process that allows for ownership transfers to be approved quietly by the Agency of Human Services (AHS), according to the story in VTdigger.

“[V]ery serious and egregious problems” have arisen at the six nursing homes in less than a year of new ownership, according to Richard Mollot, executive director of the Long Term Care Community Coalition.

Under the current system, which has been in place since 2018, ownership approvals occur in private administrative hearings without public input or legislative oversight, the story states.

“The fact that these operators have been allowed to enter Vermont and operate facilities which have been found to have substandard care is very alarming,” Mollot told the VTDigger. “Vermont should be doing a much better job – even under its own current written processes – to ensure high-quality care and the absence of abuse and neglect.”

Originally meant to be an interim measure after regulatory duties shifted from Vermont’s Green Mountain Care Board to AHS, the arrangement has now persisted for seven years without being codified into permanent law. As a result, Vermont’s nursing home review process operates under temporary rules that lack transparency and robust accountability mechanisms, critics of the transfer process noted in the story.

The consequences have been significant. Since the new operators took over, resident complaints have risen by roughly 25%, and state investigators have documented severe deficiencies such as lack of infection control, poor supervision, and resident-on-resident violence. Although the state has since brought these facilities back into regulatory compliance through corrective plans, advocacy groups for residents warn that the violations reflect systemic weaknesses.

These groups also point out that the state’s vetting process focuses mainly on an operator’s finances and high-level federal data, rather than conducting thorough, public evaluations of their care records in other states.

This pattern reflects a national trend of for-profit, private-equity-backed nursing home operators prioritizing financial extraction over resident well-being – an issue Vermont’s opaque review process has failed to guard against, these resident advocates said.

For their part, officials from the Division of Licensing and Protection told the VTDigger that they investigate all complaints and impose corrective measures promptly.

Yet resident advocates such as Kaili Kuiper of Vermont Legal Aid argued that post-violation enforcement is not enough given that unsafe operators are allowed to acquire facilities and harm residents before the state intervenes.

Part of the challenge, Kuiper noted, is structural.

Shortage of buyers for nursing homes

Vermont faces a shortage of potential nursing home buyers, leaving regulators to choose among a small pool of for-profit companies. Genesis’ facilities sat on the market for years, Kuiper said, with few bidders willing to take on the financial and staffing challenges, especially in rural areas of the state. This scarcity may pressure the state to approve less-qualified operators simply to keep facilities open, even when their past performance elsewhere raises red flags.

Advocates and policy experts are now calling for sweeping reform. They support codifying a permanent, transparent ownership review process – potentially with public hearings and mandatory disclosure of operators’ track records. Meanwhile, others suggest returning oversight authority to the Green Mountain Care Board or creating a hybrid system that combines financial and quality-of-care reviews.

In addition, advocates argue that representatives of long-term care residents should have a formal role in the ownership review process to ensure that decisions prioritize safety and quality of life.

Over the long term, Vermont must also reconsider its reliance on large, for-profit chains and explore smaller, community-based or nonprofit ownership models, these resident advocates suggest. Kuiper said that the staff in Vermont’s nursing homes can only do so much.

“[T]he system that they’re working under is dysfunctional,” Kuiper said.

Vermont must build a process that includes representatives of long-term care residents, Kuiper said. It should be guided by, as she put it, “the best interest of residents and the best interest of the long-term care system,” rather than simply keeping troubled facilities afloat under new names and new owners.