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In nursing home investigations, a small tip can lead to an iceberg of problems Date: 06/14/16

By Kay Lazar

A story I wrote in early 2015 about a spate of nursing home sales and closings in Massachusetts prompted lots of e-mails, but one in particular caught my attention.

It was from the chief of public relations for a New Jersey company. The e-mail announced that Synergy Health Centers had just bought two more Massachusetts nursing homes, and described the company as a “fast-growing nursing home consortium with a vision of ‘rehabilitating healthcare.’ ”

Wait – two more nursing homes? I had never heard of Synergy Health Centers. I began calling elder advocates, elder law attorneys, and the union that represents nursing home workers.

A picture soon emerged of a company, with no track record of owning nursing homes, that had been buying up facilities around Massachusetts at a rapid clip, assembling a portfolio of 11 nursing homes in less than three years. In one month alone it had acquired four.

But getting anyone from Synergy to speak with me proved difficult. The one interview I was granted with Synergy’s director of acquisitions and mergers was not terribly insightful. And so began my journey, hunting for the proverbial windows and back alleys, to gain insight into this company and learn how its reported cost-cutting was profoundly hurting residents and the nurses hired to care for them.

I started at the beginning, speaking to the first person in Massachusetts who sold a nursing home to Synergy in late 2012. He gave me the name of a former staffer who had worked for Synergy through the sale and during its first year. That former employee had a keen memory, and a deep anger about the changes that Synergy made to what was once a gem of a nursing home. He gave me the names of a few families who had relatives in that facility.

But the former employee – like so many other current and former Synergy staffers I would eventually interview – was too afraid to speak publicly. Most still worked in the industry and feared professional repercussions.

My first story about the company’s earliest Massachusetts nursing home used information from two former employees and several families, without quoting them by name. That’s something I don’t like to do because I think readers are often skeptical of anonymous sources. But at least in that story, I was able to back up their accounts of bad care with information from state inspection reports and from the company’s own Medicaid financial reports. A retired state ombudsman who had mediated some problems at the facility went on the record, which also helped.

The story hit a nerve with readers and some frustrated Synergy employees, who started contacting me. It also helped convince a nurse who had worked in the second nursing home that Synergy acquired to go on the record, sharing the story of how she placed her own mother in that nursing home, believing she would be safe because the daughter worked there.

But her mom was injured during the daughter’s days off and received questionable care in the immediate aftermath. She soon died from her injuries.

We realized this was not an anomaly. I began filing public records requests for state inspection reports at other Synergy facilities. I also requested incident reports, which nursing homes are required to file with state regulators regarding injuries from abuse, neglect, mistreatment, or injuries of unknown origin.

In addition, I filed public records requests for copies of the Medicaid cost reports the company filed with state regulators. Nursing home companies are required to file these reports annually. Many companies fail to submit complete reports, as was the case with Synergy. But even with holes, these documents indicated Synergy’s owners were sucking a lot of money out of their nursing homes.

Over the summer and into the fall, we continued to publish stories about questionable deaths and other problems in Synergy nursing home. I continued to collect more string, conducting interviews with current and former staffers, families who had relatives in Synergy nursing homes, even a couple of retired state regulators who had become so disgusted with the lack of state oversight that they agreed to talk with me.

I flew to New York and New Jersey and knocked on the doors of Synergy’s owners, who didn’t answer. I went to the company’s headquarters, and was told no one was available to speak with me. While there, I attended a court hearing in which the company’s former director of acquisitions and mergers – who still wouldn’t speak with me!! – was suing Synergy over a pay dispute. The company’s lawyer also declined to speak with me, but the court records proved a valuable insight into the company’s financial dealings.

Back in Massachusetts, I continued digging through documents, scouring court records and registry of deeds records to track the dates and purchase prices of Synergy acquisitions, mortgages, loans and tax liens, and property assessment records. All of these records provided a strong spine for the story, since few people wanted to be quoted.

The Synergy coverage concluded in December with a story that documented how the company’s owners were profiting handsomely as complaints climbed. It found that state regulators had failed to perform the most basic checks on company executives and company finances before granting licenses.

The state health commissioner, whose agency grants nursing home licenses, acknowledged the state’s system needed to be overhauled. Massachusetts regulators in February moved to significantly strengthen oversight of nursing homes, creating a unit that will conduct additional unannounced inspections and promising to impose fines on problem-plagued facilities.

Kay Lazar is a Boston Globe health reporter who focuses on aging, sports medicine, and public health. Her experience combines more than two decades of print and broadcast reporting. Lazar previously worked as a news writer and producer at ABC and CBS radio networks. She and her colleagues were honored by AHCJ this spring for the coverage of serious problems in nursing homes purchased by Synergy Health Centers.