“I have never seen the dire conditions we have today, never,” said Damian Dell’Anno, chief executive of Next Step Healthcare, a chain that’s closing nursing homes in Dedham, Newton, Attleboro, and Gloucester while continuing to operate 18 other homes around the state. “Under this cost structure, it’s very hard to keep these facilities open.”
The closures come as a shock to vulnerable residents. David Groat, a 67-year-old retiree who uses a wheelchair, was among 80 residents told this summer that their assisted living center, Landmark at Longwood, on Boston’s Mission Hill, would be shuttered in October.
Fewer than 10 of Landmark’s residents are still living there, and they spend their days looking for housing they can afford. Groat’s waiting to hear if and when he can move into a facility near Ruggles Station.
“It could be a day, it could be a week,” he said. “Who knows?”
Even as displacements multiply, Baker administration officials say they support “right-sizing the industry,” where occupancy rates ran below historic levels even before the pandemic. A set of reforms that took effect last year sought to boost long-term care staffing levels and improve infection control. MassHealth, the state Medicaid program, has also raised its reimbursement rates for nursing home residents.
But nursing home operators say the higher rates aren’t sufficient, while other state actions, such as reducing the maximum number of beds allowed per room from four to two, have harmed their business.
With labor, food, and fuel costs on the rise, Next Step, based in Woburn, spends as much as $270 a day for each resident, up from $240 a day before the pandemic, Dell’Anno said. Most of its residents are insured by MassHealth, but the agency’s reimbursements have only increased to between $215 and $220 a day, from a pre-pandemic rate of $210, making many nursing homes unprofitable, he said.
Hamstrung by those finances, Dell’Anno, said Next Step couldn’t be certain it would be able to meet its lease payments — and its landlord calculated the buildings housing the four nursing homes would be more valuable if converted to housing or biotech research labs.
The nursing home closings are sending ripples throughout the state. Even as residents scramble to find new homes, employees, from certified nursing assistants to cafeteria workers, must search for new jobs.
Twenty-one Massachusetts nursing facilities have closed, or have announced plans to close, since the start of the COVID-19 pandemic early in 2020. But the contraction began earlier. The number of nursing facilities in the state has fallen 13 percent to 367, from 422 in 2014.
With each closure, there are fewer nearby options for residents and family members who visit them. And there are fewer homes to which hospitals can refer patients they discharge for rehab services.
The latest surge of closures has taken place outside of the public eye. Despite a requirement that the state Department of Public Health give timely notice of nursing homes planning shutdowns, none of the recent closing notifications were posted on the state’s website until late last week after the Globe asked state officials about the omissions.
One nursing home, Quincy Health & Rehabilitation Center, which plans to close Dec. 7, blamed a new post-pandemic limit of two beds per room. Many older homes had three or four beds in some rooms. The change was meant to slow the spread of infections. But it was costly to Quincy Health, forcing it to reduce its capacity from 126 to 92 beds.
In a statement, Quincy Health said its closing was “difficult but financially necessary.” The statement included a hopeful note, saying “excess capacity at nearby nursing homes and demand for staff at other facilities is expected to ease the transition” for residents and workers.
Many of the challenges confronting senior care have been building for years. In January 2020, a task force assembled by Mary Lou Sudders, the state’s secretary of health and human services, proposed steps to accelerate an industry consolidation already underway. The panel called for shutting “low quality and low occupancy” homes while boosting payments to surviving homes that met higher quality standards.
But senior care leaders say the current wave of closures is haphazard and disruptive, a far cry from the strategic and targeted approach envisioned by the task force. And the upheaval may be just beginning: the Massachusetts Senior Care Association has projected more than 1,000 nursing home residents will be displaced in the coming year.
“Every nursing home is under threat now,” said Tara Gregorio, president of the Waltham-based senior care association. “The situation is precarious. We’re seeing the start of the unraveling of this sector.”
Sudders, through a spokeswoman, declined a request for an interview. State officials acknowledged in a statement that “measures to increase accountability and improve quality care may contribute to closures in some circumstances.” But they suggested other factors are also in play.
The pandemic overwhelmed Massachusetts nursing homes, reducing their census of residents by 21 percent from 37,975 in 2019 to 30,065 last year, according to data from the Kaiser Family Foundation. Long-term care advocates believe the state’s official count of 6,894 deaths in senior care homes understates the toll from COVID outbreaks.
Other residents moved from nursing homes back to private homes, taking advantage of a waiver allowing use of MassHealth payments for in-home care. With more seniors leery of congregate settings, and an “aging in place” movement gaining strength, many empty beds haven’t been filled. (This year, as COVID recedes, the nursing home population has ticked up to just over 32,000, still well below the 2019 level.)
Nursing homes are also being squeezed by longstanding labor shortages that intensified during the pandemic as some immigrant care workers returned to their native countries. And the phasing out of pandemic-era Paycheck Protection Program loans, which propped up many struggling homes temporarily, has made it harder to operate profitably.
“It’s changing economics,” said Paul Lanzikos, coordinator of the Dignity Alliance Massachusetts, which advocates for older adults, people with disabilities, and caretakers. “It’s become more expensive to run senior care homes. And consumer attitudes are also changing.”
The situation is less acute for the assisted living sector, where about 90 percent of residents pay rent out of pocket, through long-term care insurance or from the proceeds of homes they’ve sold. The number of assisted living centers in Massachusetts has climbed from 227 to 268 since 2014, as more wealthier residents have gravitated away from nursing homes.
But finances have deteriorated for a subset of assisted living homes: older and so-called “affordable” facilities, mostly in urban areas, relying on payments from organizations such as MassHealth’s Group Adult Foster Care program. Many of these homes “need renovations and are less able to afford the needed improvements,” said Brian Doherty, president of the Massachusetts Assisted Living Association.
Several have closed or are planning to, including Landmark, Connemara Senior Living in Brockton, Motif by Monarch in Beverly, and Zelma Lacey House in Boston, which transitioned to affordable housing this year. Wood Haven Senior Living, a Tewksbury memory care home, moved residents on short notice and closed in January after water pipes burst.
Landmark was initially slated to close on Oct. 5. Its remaining residents got a reprieve after officials from the Boston Center for Independent Living and the Northeast Justice Center urged state elder affairs officials to press Landmark’s management to hold off on evictions.
Greater Boston Legal Services also threatened to sue Landmark if it didn’t give residents more time to find housing. “These are vulnerable people who had no recourse,” said the group’s senior attorney Betsey Crimmins. But it’s not clear how much longer they’ll have. Landmark executives didn’t respond to the Globe’s e-mails and phone calls.
Former fitness trainer Tyrone Stampley, 59, who uses a walking stick as he recovers from a stroke, said he and his brother Bryant, 65, are still at Landmark. While they want to live independently, Stampley said, they worry about finding an apartment they can afford in Boston.
“It’s causing a lot of anxiety and stress,” he said.
Robert Weisman can be reached at firstname.lastname@example.org.