November 19, 2019

Senators Warren, Brown and Rep. Pocan Investigate Role of Private Equity in Declining Quality of Nursing Home Care

Research Shows Facilities Owned by Private Equity Firms Provide Worse Care

Text of Letters (PDF)

Washington, D.C. - United States Senators Elizabeth Warren (D-Mass.) and Sherrod Brown (D-Ohio), Ranking Member of the Senate Banking Committee, along with Representative Mark Pocan (D-Wis.), sent letters to four private equity firms -- Carlyle Group, Formation Capital, Fillmore Capital Partners and Warburg Pincus -- that currently invest, or have recently invested in, companies providing nursing home care and other long-term care services. The lawmakers' letters cited reports that show private equity investment has played a role in the declining quality of care in nursing homes and requested information about the firms' management of the nursing home and long-term care facilities they own.

Nursing homes provide a wide range of important medical and personal care services to a growing and vulnerable elderly population, with 1.3 million residents in the United States currently receiving care in over 15,000 facilities. The majority of nursing facilities - almost 70% - are for-profit, and over half are chain-affiliated. Two decades of research has shown that for-profit and chain-affiliated companies often provide a lower quality of care and experience more serious health and safety deficiencies than non-profit facilities.

"We have concerns about the rapid spread and effect of private equity investment in many sectors of the economy, especially industries that affect vulnerable populations and rely primarily on taxpayer-funded programs such as Medicare and Medicaid, like the nursing home industry," the lawmakers wrote in their letters. "We are particularly concerned about your firm's investment in large for-profit nursing home chains, which research has shown often provide worse care than not-for-profit facilities."

Private equity investment in the nursing home sector has increased over the last few decades and appears to exacerbate the problems faced at chain-affiliated, for-profit nursing homes. Studies show that private equity-owned facilities generally "deliver poorer quality of care" than other chain-affiliated, for-profit facilities; are likely to try to reduce costs by "substituting expensive but skilled RNs with cheaper and less-skilled nurses"; and "report (a) significantly higher number of deficiencies" that increases with more years of private equity ownership.

Moreover, while the quality of care in private equity-owned nursing homes declines, the complicated ownership and operating structure of these investments "limit legal remedies available to aggrieved residents." Shifting funds to other affiliated entities, or to the private equity firm itself to immunize itself from liability for judgments against a target company, is a widespread practice in the private equity industry.

In July, Senators Warren, Brown and Representative Pocan, along with a number of Democratic colleagues, introduced the Stop Wall Street Looting Act, a comprehensive bill to bring greater responsibility to the private equity industry by holding private equity firms responsible for the liabilities of companies under their control and requiring greater transparency in private equity firms' practices.

In their latest letters, the lawmakers asked the private equity firms to provide the disclosure documents and information required under the Stop Wall Street Looting Act, and to explain their role in the serious deficiencies found in nursing homes across the country. The lawmakers asked the firms to respond by no later than November 29, 2019.

Senator Warren has been a vocal critic of private equity abuses throughout her time in the Senate and is fighting for reforms that protect students, workers, communities, and investors:

  • Senator Warren and Representatives Pocan and Lloyd Doggett (D-Texas) wrote last month to five private equity firms with investments and physician staffing and emergency transport companies, questioning the role these companies play in patients receiving exorbitant surprise bills for out-of-network medical treatment.
  • Senator Warren and Representatives Pocan and Alexandria Ocasio Cortez (D-N.Y.) recently wrote to five private equity firms that own companies providing support services to prisons, including health care, food service, and telephone services, noting how private equity firms deliver poor-quality food and services at exorbitant prices, making huge profits off of incarcerated people, their families, and taxpayers.
  • Senator Warren and Representative Pocan wrote to six private equity firms with current or recent holdings in for-profit colleges, citing research about private equity's destructive role in for-profit colleges and student outcomes.
  • Senator Warren and Representative Dave Loebsack (D-Iowa) opened an investigation into private equity firms behind some of the country's largest manufactured housing communities to obtain information about their use of predatory practices to boost profits in the communities they own.
  • Senator Warren and Representative Ocasio-Cortez questioned Treasury Secretary Steven Mnuchin on his involvement in dubious financial engineering and other managerial decisions that enriched investment company executives while decimating Sears' long-term growth and sustainability -- ultimately resulting in Sears' bankruptcy and the loss of tens of thousands of jobs.
  • Senator Warren requested answers from Vornado Realty Trust and five major hedge funds on their role in the liquidation of Toys "R" Us, which resulted in 30,000 workers losing their jobs without severance pay, after the company went into bankruptcy as the result of a leveraged buyout in 2005.
  • In June 2015, Senator Warren was an original co-sponsor of the Carried Interest Fairness Act, legislation to close the carried interest loophole that allowed private equity fund managers to pay lower taxes. The legislation was re-introduced in March 2019 and is included in the Stop Wall Street Looting Act.