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Out-of-state chains expanded from 12 Massachusetts nursing homes in 2019 to 61 in 2025, according to a Boston Globe investigation. Eight of nine chains examined saw average federal star ratings fall after acquisitions; the report also documented staffing cuts and higher payments to affiliated companies at a RegalCare facility. State oversight and the effects of a newer law remain key questions.
Out-of-state nursing home chains increased their Massachusetts holdings from 12 facilities in 2019 to 61 in 2025, while eight of nine chains examined saw their facilities’ average federal star ratings decline after acquisition, according to a Boston Globe Spotlight investigation. The findings raise questions about care quality, staffing and state oversight as the chains came to own about one-fifth of the state’s nursing homes.
The Globe’s investigation identified nine chains based in New York and New Jersey that bought at least five Massachusetts nursing homes apiece between 2020 and 2025. The report drew on federal ratings, state and federal records, financial reports, lawsuits, inspections and interviews with workers, residents and families. Its findings describe a broad ownership shift and a pattern of declining ratings after purchases; they do not establish that every acquisition led to worse care.
RegalCare and CEO Eli Mirlis acquired 12 nursing homes in Massachusetts and at least 29 across five states, the report said. Several facilities had high ratings before the purchases. A Taunton home and a Quincy home each fell from five stars to one star; the Taunton decline occurred within three years, according to the Globe.
At the Taunton facility, the Globe reported that overall operating spending fell 19% after the 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 company owned by Mirlis rose to $522,000. In 2025, the facility paid $1.6 million to related companies, about 16% of its operating expenses, the investigation found.
Staffing and Spending After Takeovers
The findings matter to residents and families because staffing levels and care quality can affect daily support in nursing homes. The Globe documented substantial reductions in nurse hours at the Taunton facility alongside lower operating spending. Those figures describe the facility’s reported finances and staffing; by themselves, they do not establish the cause of every change in care or show that all acquired homes followed the same pattern.
The investigation also points to a financial oversight concern: payments to companies connected to an owner can make it harder to assess how facility resources are being used. The Globe’s figures show that related-company payments formed a sizable share of the Taunton home’s operating expenses in 2025. Readers should distinguish that finding from a legal determination that those payments were improper.
For Massachusetts, the scale of the ownership shift puts attention on how regulators assess buyers and monitor facilities after a sale. The state oversees about 340 nursing homes and has authority to reject buyers it considers unsuitable, the report said. Whether its review powers and enforcement practices can address concerns raised by the investigation remains unresolved.
Massachusetts Ownership Shift
The post-pandemic nursing home market in Massachusetts provided an opening for new owners to acquire facilities, the Globe reported. From 2020 through 2025, the nine chains in its review expanded their combined holdings as the state’s nursing home sector changed hands. By 2025, those chains owned 61 facilities, compared with 12 in 2019.
The Globe reported that New Jersey permanently revoked Mirlis’ nursing home administrator license in 2018 after finding that he committed fraud involving continuing education requirements. The investigation said the revocation was not mentioned on applications for Massachusetts nursing homes. That history is a reported finding about the applications and license action; the source material does not provide the applications themselves.
RegalCare and two executives also agreed more recently 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. The payment resolves allegations and should not be described as a finding that the claims were proven. A related therapy company previously settled for $315,000, the Globe said.
What Regulators Can Establish
The investigation reports associations between acquisitions, lower average star ratings and changes in spending or staffing, but the material provided does not establish that ownership changes alone caused each decline. The figures also do not show whether every facility’s staffing or care outcomes changed in the same way. Facility-level variation and the reasons behind particular rating changes remain important to understanding the broader pattern.
The Globe found that Massachusetts had not denied a nursing home acquisition application or revoked a nursing home license in seven years. Health Commissioner Robbie Goldstein told the newspaper that state law historically did not let regulators consider an operator’s out-of-state record. He said a law enacted two years ago expanded that authority. The report does not specify how often the expanded power has since been used or whether it has changed approval decisions.
It is also unclear from the supplied reporting what follow-up action, if any, the state will take in response to the investigation’s findings. The settlement concerning therapy billing resolves allegations, while the details and consequences of the state’s review of individual facilities are not fully described here.
How the New Law Is Applied
The next measure will be how Massachusetts regulators use the expanded authority described by Goldstein when reviewing future buyers. The state Department of Health can reject buyers it considers irresponsible or unsuitable, according to the Globe. Public information about later applications, approvals, denials and enforcement actions could show whether reviews now account for operators’ records outside Massachusetts.
Residents, families and workers will also be watching for changes in staffing, inspections and federal star ratings at acquired facilities. The investigation’s data covers acquisitions through 2025, so later operating results are not established by the source material. Further reporting or state disclosures would be needed to show whether the patterns continued and what, if anything, regulators required owners to change.
Key Questions
How many Massachusetts nursing homes did the out-of-state chains own?
The nine chains identified by the Globe owned 61 facilities in 2025, up from 12 in 2019. Together, they accounted for about one-fifth of the state’s nursing homes.
Did ratings fall at every acquired facility?
No. The Globe reported that eight of the nine chains saw their facilities’ average federal star ratings decline after acquisition. That finding does not mean every facility’s rating fell.
What changes did the Globe report at the Taunton home?
The investigation reported a 19% drop in overall operating spending, a reduction of more than half in registered nurse hours, and a reduction of more than a third in licensed practical nurse hours. It also reported increased payments to companies connected to the owner.
What did Massachusetts change about buyer reviews?
Health Commissioner Robbie Goldstein told the Globe that a law enacted two years ago expanded regulators’ authority to consider an operator’s out-of-state record. The supplied reporting does not say how often the state has used that authority since the law passed.
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