Ownership Matters

When a state approves new owners for troubled nursing homes, it needs to do more than sign off on paper qualifications. It needs to protect the people living inside those buildings.

In Vermont this year, a longstanding ownership transfer process quietly moved six large facilities out of the hands of one operator and into the hands of several others — and within months, serious care failures followed. Residents suffered injuries, neglect, and at least one death shortly after the state approved the new ownership under rules that kept the public largely in the dark.

The facilities involved were previously owned by Genesis HealthCare, a private-equity-backed company with a checkered history in the state, including one of the largest nursing home-related settlements in Vermont’s history after neglect at three Genesis facilities contributed to hospitalizations and a death. Genesis had been trying to divest these homes for years. The state finally approved transfers in late 2024 to operators that did not have a strong track record of high-quality care, and within a matter of months, complaints from residents spiked and state inspections cited a range of deficiencies.

One of the new operators, iCare Health Network, took over a Bennington facility with an explicit mandate to serve people with complex needs, including former inmates. Within a year, a resident died from lithium toxicity after the facility failed to adjust medications, draw labs, or contact physicians when clear warning signs were present. Another operator, Allaire Health Services, saw multiple facilities under its control cited for chronic staffing shortages, lack of care planning, medication mismanagement, and breakdowns in communication between staff and physicians. Licensed staff ignored or misreported incidents, and residents waited extended periods for basic help.

These problems didn’t emerge in isolation. They surfaced at facilities that were large, formerly operated by a company with documented quality issues, and transferred through an ownership review process that happens behind closed doors, with no meaningful public participation. Advocates, including Vermont’s long-term care ombudsman, have raised concerns that regulators did not adequately consider the buyer’s care history before signing off. Even now, operators whose homes have been cited for systemic failures are being allowed to run those same facilities.

The ownership transfer process in Vermont is interim by law but has functioned as the de facto system for years. It places decision-making power with officials in the Agency of Human Services rather than a broader, more independent body, and it lacks transparency. Members of the public are excluded from hearings where approval decisions are made, and written comments from advocates carry little weight compared to private meetings with prospective owners.

This episode highlights a broader truth about corporate nursing home ownership: unless oversight includes a meaningful review of an operator’s care record and a transparent process that invites community and resident input, poor performance is all too likely to follow. Approving changes in ownership should be treated with the same level of scrutiny as approving a clinical staffing plan or a corrective action for abuse. When it isn’t, the result is predictable: weakened resident protections, repeat failures in care, and facilities that continue to struggle long after a transfer is supposed to have fixed the problem.