A wave of nursing home acquisitions by out-of-state chains has coincided with declining care quality in Massachusetts.
The state’s post-pandemic nursing home market has allowed aggressive new owners like RegalCare to acquire facilities, reduce costs and redirect substantial sums to affiliated businesses while star ratings declined, according to the Boston Globe’s Spotlight nursing home investigation.
RegalCare and CEO Eli Mirlis acquired 12 nursing homes in the state and at least 29 across five states, several of which had high star ratings; one nursing home in Taunton went from 5 stars to 1 star within three years, and another nursing home in Quincy fell from 5 to 1 star.
The Globe also found that New Jersey permanently revoked Mirlis’ nursing home administrator license in 2018 after finding he had committed fraud regarding continuing education requirements. Mirlis’ revoked license wasn’t mentioned on applications for Massachusetts nursing homes.
The trend extends beyond RegalCare, the Globe found, with nine chains from New York and New Jersey buying at least five Massachusetts nursing homes between 2020 and 2025. Collectively, these out-of-state chains went from owning 12 facilities in the state in 2019 to 61, making up about one-fifth of the state’s nursing homes. Eight of the nine nursing home chains saw their facilities’ average federal star ratings decline post-acquisition.
The Globe pointed to aggressive cost cutting after acquisition, with overall operating spending dropping by 19% at the Taunton building. Registered nurse (RN) hours fell by more than half and licensed practical nurse hours fell by more than a third.
Meanwhile, funding was shifted to companies connected to Mirlis. As nursing services spending fell by $530,000 between 2021 and 2025 at the Taunton property, rent paid to a separate Mirlis-owned company rose to $522,000, and in 2025, the Taunton property paid $1.6 million to related companies – about 16% of its operating expenses, according to the Globe.
And more recently, RegalCare and two of its executives agreed to pay $1 million to resolve allegations that the company submitted false claims to Medicare and Medicaid for medically unnecessary rehabilitation therapy, Skilled Nursing News reported last week.
A related therapy company previously settled for $315,000, the Globe said.
Oversight from the state has failed to prevent or constrain such acquisitions, the Globe found, when reviewing CMS ratings, state and federal records, financial reports, lawsuits, inspections and interviews with employees, residents and their families.
The state Department of Health oversees about 340 nursing homes and can reject buyers they deem irresponsible or unsuitable. But the agency hasn’t denied a nursing home acquisition application or revoked a nursing home license in seven years, the Globe found.
Massachusetts Health Commissioner Robbie Goldstein told the Globe that state law historically didn’t authorize regulators to consider an operator’s out-of-state record, but a law enacted two years ago expands that authority.
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