You asked, we answered: Who is regulating nursing homes?

Nov. 06--Buffalo News reporter Lou Michel and Watchdog Team editor Mike McAndrew spent six months investigating nursing homes in Erie and Niagara counties. The resulting stories began appearing in The Buffalo News on Oct. 21, and more are on the way.

They found that out-of-town investors had bought 16 of the 47 nursing homes in the two counties in the past 11 years, and many of them are among the worst-rated facilities in the region. The News is publishing a series of stories about nursing homes and the vulnerable Western New Yorkers residing in them.

Digital Engagement Editor Qina Liu collected these questions from our readers. Here's what Michel and McAndrew know.

From Clay Forsberg (@clayforsberg/Twitter): Could it also be that the "profit motivation" is being pursued by out-of-town firms -- with no local connections or accountability? Couldn't local ownership, nonprofit or profit standing, go a long way to better care? Should that be a community and civic priority? Just a thought.

Answer: Some of the Buffalo-area nursing homes bought by downstate investors had been run for years by local nonprofits. Some of the nonprofits, like Presbyterian Senior Care of Western New York, said they were losing money every year on the nursing homes. Because nursing home care costs so much, Medicare or Medicaid, which are taxpayer-supported, wind up paying the bills for most of the residents. Some nursing homes charge residents more than $400 per day. But the Medicaid program often pays about half of that daily rate.

Some local nonprofits didn't want to continue running the homes, or couldn't afford to continue operating them, because they were losing money. So the New York City investors and their for-profit companies bought the nursing homes. And now these companies are complaining that the government reimbursements are too low and they are losing money.

It is a difficult situation.

But, as Tony Szczygiel, a retired University at Buffalo expert in elder law, pointed out in our first story, there are some locally owned Buffalo area nursing homes, both for-profit and nonprofits, that are providing residents with very good care. And they are operating in the same difficult business environment. While there is an exception or two, the Buffalo area nursing homes run by for-profit, out-of-town investors are poorly rated.

On the other hand, there are one or two Buffalo area nursing homes operated by local nonprofits that are also poorly rated by the federal government.

----From @buffalovebirds/Instagram: Who is regulating this?! Are there not proper checks?

From Denise Balon: Why are they not state-regulated?

The Health Department issues licenses to companies allowing them to operate nursing homes. It may reject applications for licenses. Advocates for nursing home residents have been raising questions about why the Health Department has allowed operators of poorly rated nursing homes to buy more nursing homes. The Health Department also annually inspects the nursing homes. The Health Department issues fines, on occasion, when it finds violations, but the maximum state penalties are pretty low.

----Michel and McAndrew took questions from readers live on Facebook. Watch the segment:

Because the federal government is paying most of the nursing home bills, the federal Medicare and Medicaid programs also can issue fines for violations and, in the most serious cases, may make a nursing home ineligible to receive future federal reimbursements for the care of its residents.

----From Stuart Charney (@sixdegreesus/Twitter): Are these practices typical for this group of investors?

Well, poor ratings are typical in the Buffalo area nursing homes that are run by companies owned by some of the downstate investors, but there is an exception or two. For instance, Lockport Rehab and Health Care Center was purchased in 2015 by a company owned by five New York City investors, and it is a five-star rated facility, the best possible rating. Some of these out-of-region operators do own nursing homes elsewhere in the state that are also poorly rated.

----From @qumij26/Instagram: Is just our area suffering? Or is this a problem countrywide?

Our investigation focused on nursing homes in Erie and Niagara counties, but we know that there are low-rated nursing homes in other parts of the state. Some are operated by for-profit companies. Some are not. Out-of-region investors who bought nursing homes in the Buffalo area are also buying nursing homes elsewhere.

----From @nora.suzanne/Instagram: So upsetting and wrong. Aren't there state mandates on how many staff for how many people? If not there should be?

There is no required staff/resident ratio in nursing homes in New York State.

----From @chris315/Instagram What can be done? This is awful and unacceptable. Bravo for Daniel's bravery in exposing the story. Kudos to BN for covering it. Let's fix this.

I think you are referring to Daniel Tracy, one of the residents of the Emerald South nursing home. He is the man who has Lou Gehrig's disease, can barely talk and can't feed himself. He has sent Facebook messages to friends complaining that the nursing home staff had forgotten to feed him. He also sent The Buffalo News a message complaining that the staff and owners of Emerald South don't care how the residents are treated.

----From Jessica Marie: What is it going to take to get this place shut down?

After Emerald South resident William Strasner fell to his death out of a third-floor window at the nursing home in June, the state Health Department launched an investigation. It has recommended that the federal government fine Emerald South's operators. No fines have been issued yet. But the state has appointed a receiver to at least temporarily take over running Emerald South and Emerald North nursing homes from a company owned by Long Island resident Judy Landa. The company run by Jeremy Strauss, another New York City area resident, is now running the nursing homes as the receiver. Strauss said he plans to apply for the license to operate Emerald North permanently, but has not decided yet about Emerald South.

----From Cynthia McKinnon: This is a tragic situation. ... Is there an adult protective services department to which there could be a complaint? ... Where is the human rights protection for disabled individuals? Contact the courts! Is there an ombudsman for nursing home patients?

There is a nursing home ombudsman program in New York State. It is run by the state Office of Long Term Care Ombudsman. You can find out who the ombudsman is in every county by going to www.ltcombudsman.ny.gov. In Erie and Niagara counties, the ombudsman contact is Lisa Newman, who can be reached at (716) 817-9222 or 1-844-527-5509.

----From Skye Temple: Just awful. Where are the authorities?

The New York State Attorney General's Office has investigated nursing homes in the past and prosecuted staff members. In some instances, the state AG's office has installed hidden cameras in nursing home rooms to gather evidence.

----From @guszkowski/Instagram: So sad ... how can I help?

From @b_mckeown28/Instagram: Is there anything people can do to volunteer or help him [Daniel Tracey]?

From @angelamarie0528/: What can we do about this? This is unacceptable. There has to be something done.

From Carissa Denee Au: These homes are an absolute disgrace (to put it mildly). I've had one relative neglected and heard so many more stories from others. I would love to work in one, but I have zero tolerance for what happens in them (which results in dismissal). What's our next step?

Well, The Buffalo News is trying to raise public awareness about the problem. The state Health Department has proposed a bill that would increase the potential fines on bad nursing homes. Some state lawmakers are talking about the nursing home issue, but they have not recently voted to pass reforms.

----From @clmason4565/Instagram: I'm sorry, but I hear "understaffed" with ALL facilities, be it a nursing home, assisted living or memory care facility. These places make a ton of money. Have you seen how much the monthly cost to live any these? How about raising both the pay and the requirements of staffing levels? These are very important positions for our loved ones.

From @krissy4591/Instagram: Why don't you do an article on the nursing homes who are not owned by out-of-towners and do an article on the five-star facilities in the area like Channel 7 is?

The Buffalo News published on Oct. 21 information about every nursing home in Erie and Niagara counties, including how each home is rated by the federal government, who owns the home, and whether they have been fined for violations. The News plans to publish more stories about nursing homes in the coming weeks. Stay tuned.

----From @jjadema/Instagram: Find a good story about senior carer in Buffalo. They're out there.

Stay tuned.

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