Certain nursing home operators and politically connected investors have profited through financial schemes, chronic understaffing and weakened federal oversight, according to a new Senate Finance Committee minority report released Thursday. Meanwhile, the nursing home industry appears divided over transparency requirements and federal staffing standards.
The report alleges that while the Trump administration rewarded some industry figures with pardons, political appointments and regulatory rollbacks despite histories of fraud and abuse, cases of severe neglect in nursing homes rose amid untreated infections, preventable deaths and the inappropriate use of antipsychotic drugs due to inadequate staffing.
The four Democratic senators backing the investigation are calling for sweeping federal reforms to strengthen accountability and protect nursing home residents.
The investigation identifies five major problems: corporate profiteering, opaque ownership structures, underfunded oversight, political favoritism and chronic understaffing. It concludes that comprehensive federal reforms are needed to improve accountability, strengthen protections and ensure taxpayer funds support resident care.
“[T]he Trump administration has accelerated a crisis that was already years in the making–rewarding investors who put profits over people and abandoning nursing home residents and workers,” the senators wrote in a letter introducing the report. “[This report] documents the bad actors, the backdoor deals, and the human cost when Trump is in charge of America’s long-term care.”
The report blames the Republican Whitehouse and congressional Republicans as having worsened the problems in nursing homes by rolling back regulations such as the staffing mandate and transparency rule, which had required nursing homes to report full corporate or private equity structure details by a Jan. 1, 2026 deadline. The deadline was indefinitely postponed and facilities were allowed to operate and receive federal funding without disclosing this information.
“Through all of these changes that are undermining the quality of care in America’s nursing homes, the Trump administration has falsely claimed to be running a ‘full-scale war on fraud’ in the Medicare and Medicaid programs,” senators wrote, noting how the Trump administration eliminated staffing standards altogether while nursing home executives reportedly contributed millions to Trump’s super PAC.
According to the report, private equity firms, real estate investment trusts and other investment entities contribute to the problem by using complex financial arrangements to extract money from nursing homes while reducing resources available for staffing and resident services.
One study cited in the investigation found that nursing home owners funnel 68% of profits through related-party arrangements. These arrangements can also make it difficult for regulators and families to identify facility owners and hold them accountable. Some owners further use bankruptcy proceedings to avoid financial liability, the report notes.
The report also identifies serious weaknesses in federal oversight. Nearly one-third of nursing homes are behind on annual inspections, while long-term care ombudsmen face increasing workloads and declining resources. The Special Focus Facility program, which targets nursing homes with serious quality problems, covers fewer than one-tenth of 1% of facilities, the report states. Approximately two-thirds of facilities that graduate from the program return to serious noncompliance within three years.
For Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit and mission-driven providers of aging services including nursing homes, the stories detailed in the report are “reprehensible,” and LeadingAge is backing the senators’ call for greater transparency of ownership, she said.
“The actions of bad actors hurt the entire nursing home sector. They undermine public trust, threaten the viability of an essential care infrastructure, and cast a shadow over the compassionate work happening every day in nursing homes across the country,” Smith Sloan said. “It should not be as hard or as complicated as the report makes clear to determine ownership and understand whom to hold accountable. We support transparency so that all can know information about owners, operators, and management.”
Political favoritism
Political favoritism is another central concern. The report highlights three nursing home owners who received presidential clemency despite criminal convictions involving financial misconduct. Joseph Schwartz, Philip Esformes and Paul Walczak were collectively sentenced to 294 months in prison and ordered to pay nearly $15 million in restitution for health care fraud, tax fraud and other financial crimes. Trump pardoned Schwartz and Walczak and commuted Esformes’ sentence.
“This is not a war on fraud. It appears to be a reward system for Trump’s allies, paid for by the nursing home residents in their care,” the senators state in their letter.
The investigation also examines the involvement of certain nursing home owners who earned political favor. It notes Benjamin Landa, for example, who was nominated by Trump to serve as ambassador to Hungary approximately two months after contributing $5 million to Trump’s super PAC. Landa has faced multiple New York state lawsuits alleging fraud, neglect and abuse. A federal audit also identified $31 million in Medicare overpayments to one of his nursing homes.
Clif Porter, President and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) pushed back against some of the claims made in the Senate Finance Committee Minority report.
“AHCA/NCAL has never lobbied the Administration for clemency for individual providers found guilty of wrongdoing, and we fully support efforts to root out bad actors from the long term care profession,” he said. “They have no place in caring for our nation’s seniors and individuals with disabilities, and they tarnish the majority of our caregivers who are firmly dedicated to delivering the highest quality care.”
LeadingAge’s Smith Sloan criticized efforts to tone down policies in favor of profits, adding that attention on bad actors need to be further explored.
“Any effort to use personal relationships or political influence to secure favorable policy decisions at the expense of nursing home residents and the public interest deserves serious scrutiny,” she said.
‘Rehashing red herring arguments’
The report details the consequences of inadequate nursing home staffing and oversight, highlighting cases of residents who died after wandering away from their facilities.
The investigation also examines the use of antipsychotic medications as chemical restraints in understaffed nursing homes. The report cites examples of residents being unnecessarily medicated, including one man who became so overmedicated that he could not press his call button after being left sitting in his own waste for hours. Consumer advocates argue that inadequate staffing encourages facilities to rely on medication instead of providing appropriate care.
Porter said the real reason behind nursing home quality issues had to do with financial and operational challenges.
“It’s unfortunate that a select group of lawmakers are focused on sensationalizing our advocacy efforts and misconstruing the facts about the skilled nursing profession,” Porter said. “Rehashing red herring arguments or failed, antiquated policies is a disservice to our nation’s seniors and those who commit their careers to serving our most vulnerable.”
Most nursing homes operate on “shoestring budgets,” he said, identifying chronic Medicaid underfunding as a contributor to instability in the long-term care industry and called for more predictable funding.
“The best way to drive quality and uphold accountability across the sector is to incentivize providers—no matter their profile—to deliver on the metrics that matter for residents,” Porter said. “It’s time to put politics aside and collaborate on finding a better way forward for our nation’s growing elderly population. We stand ready to work with Congress on bipartisan, commonsense solutions that promote quality, strengthen our workforce, and target accountability.”
The investigation was led by four Democratic U.S. senators: Ron Wyden, Sheldon Whitehouse, Andy Kim and Elizabeth Warren. They worked through the Democratic minority of the Senate Finance Committee, which oversees federal health care programs, including Medicare and Medicaid.
