BRISTOL, Tenn. (WJHL) — Sam Goldner and Goldner Capital Management have cut a fairly wide swath across the nursing home industry — and a good number of their facilities, including Viviant Healthcare in Bristol, have closed or are in court cases with creditors.
News Channel 11 reported Nov. 10 that the federal Centers for Medicare and Medicaid Services (CMS) would quit reimbursing Viviant for resident care effective Dec. 10. Several dozen families are now seeking new residences for their loved ones.
While Tennessee’s long-term care ombudsman said a transition team is there to help with that process, a healthcare consumer advocate told News Channel 11 there’s a bigger problem: for-profit nursing home chains, particularly those affiliated with private equity, gaming the system.
“Private equity didn’t create the system, they saw it — it’s like sharks on blood,” said Sam Brooks, Director of Public Policy for The National Consumer Voice for Quality Long Term Care.
“You come get your millions of dollars and you have no repercussions. There’s, there’s really nothing to prevent them from doing it.”
Records related to Viviant, which Goldner purchased in late 2020, show a trail of unpaid vendors, including a medical staffing company that a Sullivan County judge has ordered Goldner Capital Management to pay more than $300,000. That’s in addition to everything from food and detergent providers to pharmacy and dialysis vendors, with the known unpaid bills alone approaching seven figures.
“The human cost is a decrease in staff a decrease in food, a decrease in therapy, and so what you’re likely seeing in those facilities is just suffering and harm,” Brooks said.
CMS records show Goldner affiliated with at least three nursing homes that have received termination notices this year.
Two of them in Ohio, Solivita of Stratford and Solivita of Echo Manor, were noticed in May and June with letters that cited more than 30 violations of participation requirements. They ranged from requirements to be “free from abuse and neglect” and “protection/management of personal funds” to “quality of care” and “sufficient nursing staff.”
The CMS payment system isn’t particularly rigorous when it comes to how a nursing home operator spends its reimbursements from Medicare and Medicaid, Brooks said. That leaves an opportunity for a couple of things, including a phenomenon his organization has reported on called “related party transactions.”
“I buy a nursing home … then I immediately sell it to a shell company I own,” Brooks said of what he describes as nothing less than a grift.
“Then I open a management company, then I open all these other companies, and I start doing business with my nursing home,” Brooks said. “But as soon as that money passes to me, again, as soon as that my nursing home pays me rent, or pays me management fees, CMS has no idea where that money goes.”
In the case of at least several Goldner-owned homes, vendors simply didn’t get paid. In one case in Ohio, a pharmacy company suing Goldner claims that once it began pressing for payment, his company violated their contract and said it was moving to a different vendor.
“Some of these actors, and I’m not saying this one in particular, are very unscrupulous,” Brooks said. “They just don’t care. You know, all that millions of money that that should have been going to vendors. Where’s it going?”
Often, he said, local staff even up to the administrative level have no idea of what’s going on. They may sense things aren’t perfect when vendors leave notices on the door and they can’t get soap to wash dishes or emergency food supplies, which was the case with Viviant according to a CMS report. But they’re not in the know.
“The facilities themselves and the workers in them are rarely in on the grift of pulling the money out. They’re not even privy to it. They get paid, you know, poor wages, they work in these horrible conditions and we know that a lot of them are providing amazing care.”
Brooks said administrators are sometimes given a flat budget and incentivized to come in under it, even if that budget isn’t enough to keep resident care at adequate levels.
“This dysfunction that’s occurring that we’re talking about in the finances happens way back at the corporate office or even beyond that because most administrators think there isn’t enough money,” Brooks said. “And then they tell everyone else and everyone else thinks there isn’t. But you know, people are buying yachts.”
Brooks thinks there’s a way to cut way down on situations like Viviant’s: staffing level requirements – and financial transparency. His organization has recommended a list of changes, including requiring at least 4.2 hours of direct resident care per day.
“That’s like an indirect way to do it. The most direct way to do it is require them to document in detail the transactions that occur between these companies,” he said, adding that his organization has discovered “related party transactions” up to 1,200% of actual value.
“You have to show that what you got and how you paid for that was reasonable. It’s what you would have paid for if you went out on the open market.”
He hopes more attention will bring change. CMS released a final rule just last week that should make it easier to learn who owns each nursing home.
“Sunlight will sanitize a lot of this because people will not believe what’s going on here, you know, how the millions and billions are really being siphoned off.”
Right now, he said, CMS often doesn’t put real teeth in an order until harm has been done.
“They’re seeing the writing on the wall, but they’re waiting until the crisis occurs, which is happening right now. But in that space, residents are suffering and residents are dying and then you have these very traumatizing events where you have to leave…
“It’s all chaos, and it all falls on residents and their families one way or the other.”
Ombudsman’s office: calm in the chaos
Teresa Teeple is Tennessee’s long-term care ombudsman. Under her leadership, ombudsmen in each of Tennessee’s development districts work with residents and families about any concerns they may have, even at top-flight facilities.
“Any time a facility is closing … the facility really is required to ensure that there are plans in place for each one of those residents that are based on their choices unique to their needs to find a new home.”
After notice is provided, “we’re tracking on what’s happening so that we’re able to move any barriers that might impact resident care negatively during this process.”
That includes provision of a resident transfer team comprised of Teeple’s office – including the local representative – as well as TennCare, the state’s mental health and substance abuse department and others.
“We really are ensuring that as best we can all these things are happening at the local level.”
The initial CMS letter alerting residents and families of a pending closure provides contact information for local ombudsman’s offices.
Teeple’s local ombudsman, Karrie Erick, has been coordinating plans with several families since Viviant’s announcement, Teeple said.
“There hasn’t been an overwhelming demand for assistance at the moment. We’re still early in the closure process.”
CMS will continue reimbursing Viviant for Medicare and Medicaid patients (the vast majority of most nursing home residents) until about Dec. 11 – 30 days after the announcement. While that may seem like a short window, Teeple said the transition teams know the process well and stay on top of things as families grapple with the situation.
“They’re in the position of having to meet and learn a whole new team of caregivers, so there are a lot of extra things to consider when it comes to transfers between nursing homes for these folks.”
Teeple said the closing home and any receiving one can do much to minimize or even prevent transfer trauma.
“One thing we recommend is that residents have a very clear picture of the home that they’re moving to,” she said. “If they can’t make a visit, pulling up pictures so they can kind of see what it will look like.”
Residents also want to know whether they’ll have a roommate or not, that their belongings will be taken care of and a host of other concerns. Families can often visit at multiple times of day and get a sense of staffing and the general feel of a facility, she said.
Quite a few residents have cognitive difficulties, which she said puts an additional layer of complexity that must be addressed.
“It’s sort of common sense and making sure that the process is planful and we’re paying attention to the details.”