Massachusetts health officials approved new regulations this week that give the state more power to decide who may own and operate long-term care facilities. The vote came a day after the state moved to revoke the licenses of a dozen nursing homes run by a single operator. For families choosing a facility or planning for long-term care, both developments show why ownership and oversight deserve attention.
What the State Approved
On October 14, the Public Health Council approved new regulations carrying out a long-term care oversight law that Gov. Maura Healey signed more than two years ago. The rules cover licensing, owner suitability, care standards, certified medication aides, and outbreak response plans. They are expected to take effect in early November, and new applicants and license renewals will then face enhanced suitability reviews.
Under the regulations, the state can find an owner or operator unsuitable for any of the following reasons.
- The operator’s conduct jeopardizes residents’ health, safety, or welfare.
- The facility lacks the financial resources needed to provide services.
- Residents receive a substandard level of care.
- The owner holds at least a 50% interest in a facility whose license was suspended, denied, or revoked.
Licensees must also report changes in their financial status, and the rules now define management companies and private equity firms.
The RegalCare Action
On October 13, the Department of Public Health issued a notice finding RegalCare owner Eliyahu Mirlis unsuitable to operate long-term care facilities in Massachusetts. Mirlis operates 12 RegalCare homes in the state, and they remain under enhanced monitoring. He has 30 days to request a hearing, and RegalCare has indicated it will challenge the decision.
The department found that Mirlis misrepresented his licensure status in another state and allowed substandard care. Over the past three years, state inspections at RegalCare facilities produced four immediate jeopardy findings.
What Families Can Do
Many families choose a nursing home under time pressure, often after a hospital stay. A few steps can make that decision more informed.
Research Ownership and Inspection History
Inspection reports are public, and families can ask a facility who owns it and whether an outside company manages it. Some families also compare nursing homes with assisted living, which offers less medical care but may suit a parent who mainly needs help with daily tasks.
Plan for the Cost
Families typically pay for long-term care through a mix of savings, insurance, and Medicaid. Long-term care planning works best before a crisis, when there is still time to decide which of those sources will cover what.
For families who expect to rely on Medicaid, the rules have shifted. Recent federal Medicaid changes affect how far back coverage can reach and how often eligibility must be renewed, so an application that would have worked a few years ago may need more preparation today.
The family home raises its own questions. Medicaid generally excludes a primary residence from the asset test, but a new home equity cap will limit how much equity an applicant can hold and still qualify for long-term care coverage.
Keep Decision-Making Authority in Place
A resident who can no longer advocate for themselves needs someone with legal authority to act. A health care proxy and a power of attorney allow a trusted person to speak with staff, review records, and make decisions if care falls short.
Settling the Details Before Admission
Choosing a facility is only one part of the process. Paying for care, protecting a spouse’s income, and naming who will make decisions should all be settled in writing. An elder law lawyer can work through those questions with the family before an admission date is set rather than after.
Families comparing care options for a parent or spouse can bring their questions to Estate Planning Pros. An elder law lawyer on our team will review the documents already in place and identify what is missing.