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Nine chains based in New York and New Jersey expanded from 12 Massachusetts nursing homes in 2019 to 61 by 2025, according to a Boston Globe investigation. Eight of the nine saw average federal star ratings decline after acquisitions; the findings raise questions about ownership oversight and care quality.
A Boston Globe investigation found that nursing home chains based in New York and New Jersey expanded their Massachusetts holdings from 12 facilities in 2019 to 61, while average federal star ratings declined at facilities owned by most of the chains. The findings put scrutiny on the state’s oversight of acquisitions and on whether ownership changes have affected care.
The Globe identified nine out-of-state chains that bought at least five Massachusetts nursing homes each between 2020 and 2025. Together, the chains now own about one-fifth of the state’s nursing homes, according to the investigation. Eight of the nine saw their facilities’ average federal star ratings decline after acquisition. The report does not establish that ownership changes alone caused those declines.
One chain examined in detail was RegalCare, led by CEO Eli Mirlis. Mirlis and the company acquired 12 homes in Massachusetts and at least 29 across five states, the Globe reported. A Taunton home’s rating fell from five stars to one over three years; a Quincy home also fell from five stars to one.
The Globe reported that operating spending at the Taunton facility fell 19% after acquisition. Registered nurse hours dropped by more than half and licensed practical nurse hours by more than a third. Between 2021 and 2025, nursing services spending decreased by $530,000, while rent paid to a separate Mirlis-owned company rose to $522,000. In 2025, the facility paid $1.6 million to related companies, about 16% of its operating expenses, according to the report.
Ownership Growth and Care Ratings
The findings matter because nursing home acquisitions can affect who makes decisions about staffing, spending and resident services. Falling ratings and reported reductions in nursing hours after acquisitions raise questions about whether changes in ownership have been accompanied by changes in care at some facilities. The figures cited by the Globe describe specific facilities and chains; they do not show that every acquisition led to lower quality.
State regulators have authority to reject buyers considered unsuitable, but the investigation found the Massachusetts Department of Public Health had not denied an acquisition application or revoked a nursing home license in seven years. That record raises questions about how the state evaluates buyers and responds when ratings or staffing fall. The department oversees about 340 nursing homes.
How Massachusetts Oversight Applies
The Globe based its investigation on federal ratings, state and federal records, financial reports, lawsuits and inspections, as well as interviews with employees, residents and families. Its findings describe a post-pandemic period in which out-of-state ownership expanded, with the nine chains’ combined Massachusetts holdings growing fivefold from 2019 to 2025.
The report also detailed concerns about Mirlis beyond the Massachusetts facilities. New Jersey permanently revoked his nursing home administrator license in 2018 after finding fraud involving continuing education requirements, the Globe reported. The report said that revocation was not disclosed on applications for Massachusetts nursing homes.
Separately, RegalCare and two 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. A related therapy company previously settled for $315,000, the Globe said. The payment resolves allegations; it is not described here as a court finding that the allegations were proven.
“State law historically didn’t authorize regulators to consider an operator’s out-of-state record.”
— Massachusetts Health Commissioner Robbie Goldstein, speaking to The Boston Globe
What the Ratings Do Not Show
The investigation reports a pattern of falling average ratings at facilities owned by eight of the nine chains, but the available material does not establish that the acquisitions caused those declines or explain how much other factors contributed. It also does not provide a facility-by-facility account of care outcomes across all 61 homes.
The Globe reported that Massachusetts regulators had not denied an acquisition application or revoked a nursing home license in seven years. It is not clear from the source material how the state has applied its expanded authority to weigh an operator’s record elsewhere, or whether it plans additional action in response to the investigation.
Massachusetts has broader authority under a law enacted two years ago to consider prospective operators’ records outside the state, Goldstein told the Globe. The next test will be how regulators use that authority when reviewing buyers and whether they take action when a facility’s staffing, finances or ratings deteriorate.
The source material does not identify a scheduled state review or a specific enforcement decision. Further developments could include regulatory responses, new acquisition filings or changes at the facilities highlighted by the investigation.
Key Questions
How many Massachusetts nursing homes do the out-of-state chains own?
The nine chains identified by the Globe collectively owned 61 facilities by 2025, up from 12 in 2019. The report said that represented about one-fifth of the state’s nursing homes.
Did ratings decline at every chain’s facilities?
No. The investigation found average federal star ratings declined after acquisition at eight of the nine chains. It did not report a decline at all nine.
What happened to the Taunton facility’s staffing?
The Globe reported that registered nurse hours fell by more than half and licensed practical nurse hours by more than a third after acquisition. It also reported that overall operating spending fell 19%.
What can Massachusetts regulators do?
The Department of Public Health oversees about 340 nursing homes and can reject buyers it considers irresponsible or unsuitable. A law enacted two years ago expanded the state’s authority to consider an operator’s out-of-state record, according to Goldstein’s comments to the Globe.
Have state regulators announced new action?
The source material does not identify a new enforcement action or scheduled review in response to the investigation. The state’s response remains unclear.
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