51黑料

ST. LOUIS 鈥� The north 51黑料 nursing home that closed abruptly last weekend, setting off a chaotic relocation of residents and layoffs of workers without warning, had been in decline for several years.

Its resident population slipped by nearly a third in five years. And as revenue fell, its profits turned into sizeable losses.

While the Dec. 15 shutdown of Northview Village Nursing Home 鈥� the largest such facility in the city and a key safety net provider in north 51黑料 鈥� came as a shock to many people, industry insiders say it was an extreme example of problems the industry has long faced. Other area nursing homes face similar financial pressures and lingering damage from the COVID-19 pandemic.

In Missouri, 21 nursing homes have shut down since 2021, including the 130-bed Riverview Care Center in south 51黑料 that closed in February, said , a lawyer who for decades has represented the Missouri Healthcare Association, a group for long-term health care organizations.

鈥淚 think we鈥檙e going to see a lot of nursing homes close, that鈥檚 my prediction 鈥� I mean a lot of nursing homes,鈥� Tettlebaum said. 鈥淚 think it鈥檚 going to escalate next year.鈥�

Among the most vulnerable are providers that primarily serve residents who rely on Medicaid, the government鈥檚 health insurance program for the poor. Because Medicaid pays less than private insurance and other programs, those operators have always faced the most pressure.

But the pandemic added new stress. People who had the option to move out of nursing homes left, and declining resident counts drove revenues down. Nursing home employees quit in droves, industry experts say, leaving many facilities struggling, especially those serving lower-income people.

The company that owned Northview still operates six other homes; five are in the 51黑料 region, including the Metro East. All are ranked poorly by the federal Centers for Medicare and Medicaid Services (CMS).

Addressing what she called 鈥渞umors鈥� about the closure of the other homes in Missouri, a spokeswoman for the state Department of Health and Senior Services said last week there are no imminent operational issues at the facilities.

鈥楾he furthest thing from normal鈥�

Northview鈥檚 closure came without warning. State staffers and patient advocates scrambled to locate residents who had been transferred to other facilities throughout the night of the closure. In some cases, family members were not notified. It took nearly a week to sort out the patient transfers and make contact with the former Northview residents.

Northview faced a patient mix that was overwhelmingly, if not entirely, covered by Medicaid. It cared for difficult residents, some with dementia or mental health issues, others left disabled by injury. Many had state-appointed guardians rather than family members. It also operated in a 93-year-old facility 鈥� the old DePaul Hospital on North Kingshighway 鈥� that was built before more modern nursing home staffing and equipment regulations. And it was prone to the same maintenance issues as all large, old buildings.

In a brief interview Thursday, Northview鈥檚 owner, Mahklouf 鈥淢ark鈥� Suissa, blamed the government for Northview鈥檚 demise.

鈥淭he state of Missouri is not paying enough money,鈥� he said. 鈥淲hat they were paying was not enough to keep up with the expenses in that building.鈥�

Records show the financial strain Northview faced. While labor, food and material costs rose in recent years, the number of residents had been steadily falling.

Of 320 licensed beds in Northview Village, only about 170 residents remained when it closed, down from just under 240 in late 2018, according to data from the .

According to Medicare cost reports, Northview鈥檚 patient revenues fell each year from 2019 to 2021, the most recent data available. The facility posted a $1.5 million profit in 2019, a $800,000 profit in 2020, and a $2.7 million loss in 2021. The Post-Dispatch reported Tuesday that Northview had also lost a roughly $1 million annual payment given to the state鈥檚 largest provider of Medicaid nursing home care after it fell out of the top spot in recent years.

Cost reports for Suissa鈥檚 other nursing homes show that four of six posted net losses in 2021.

Lisa Cox, a spokeswoman for the Missouri Department of Health and Senior Services, last week confirmed that Northview voluntarily surrendered its operating license and would give up its Medicare and Medicaid agreements. She said the state does have procedures to place nursing homes into receivership if it becomes aware of imminent closure or insolvency. But she said the state only became aware Northview was closing at 4 p.m. Dec. 15.

Northview did not file layoff notices or give the required 60-day notice before shutting down.

鈥淭his was the furthest thing from normal,鈥� said Marjorie Moore, executive director of VOYCE, the regional nursing home ombudsman program. 鈥淚 hope that everyone learns from what happened here.鈥�

Lenny Jones, state director for SEIU Healthcare, a labor union that represents nursing home workers, acknowledged the industry鈥檚 funding challenges but said companies need to be more transparent with their finances. He took issue with Suissa鈥檚 allegation that some workers walked off the job, forcing the closure.

鈥淭he closure of Northview Village Nursing Home and subsequent upending of workers鈥� and residents鈥� lives was a failure by Suissa and other Northview owners, not the Missouri Department of Health and Senior Services or federal agencies,鈥� Jones said. 鈥淕reed and the ineptitude of management led to the chaotic situation at Northview.鈥�

Suissa also has minority partners in the ownership of the building and in Northview Village. He alluded to issues with them in the closure.

鈥淥f course, I would have done it a different way,鈥� he said Thursday. 鈥淚 have other partners also involved, but unfortunately that鈥檚 the way it happened.鈥�

While he and his wife hold a majority stake, according to CMS documents, his minority partner includes members of the Rothner family, who own and operate nursing homes in multiple states.

William 鈥淎vi鈥� Rothner, a son of Eric Rothner who runs and is listed on Northview ownership documents, could not be reached for comment.

Suissa鈥檚 company, Healthcare Accounting Services LLC, operates another home in 51黑料, Grand Manor, and Cori Manor in Festus. It also operates three nursing homes in the Metro East and one in suburban Chicago.

鈥楾hey can鈥檛 survive on it鈥�

All six of Suissa鈥檚 remaining nursing homes have low ratings from CMS. Out of a five-star scale, three have one-star ratings 鈥� as Northview did 鈥� and three have two-star ratings. The ratings, at Medicare鈥檚 website, are based on factors that affect the quality of care, such as staffing levels and infection control.

Those scores aren鈥檛 uncommon for the area. In the city of 51黑料, nursing homes average just under two stars, but low-scoring facilities 鈥� ones that received the 鈥渕uch below average鈥� single star rating 鈥� are scattered all over the region, including Eureka, Florissant, St. Charles and Wildwood.

On Thursday, Suissa said his other facilities are 鈥渟ecure and beautiful, doing well. Nobody has any complaints. Everybody gets paid.鈥�

Diana Middendorf, of Fayetteville, Illinois, said her mother had a positive experience at one of Suissa鈥檚 properties, Edwardsville Nursing and Rehab Center.

鈥淪he seems quite happy, and we haven鈥檛 heard of any problems here,鈥� she said. 鈥淲e hope there aren鈥檛 any.鈥�

Sue Henderson, a retired teacher from Belleville, said her aunt spent four years in another Suissa property, Elmwood Nursing and Rehab Center in Maryville, Illinois, before she died in December. The staff was kind and wanted to be helpful, she said. But there weren鈥檛 enough of them.

鈥淭hey need a lot more care than they can give them here,鈥� she said.

Staffing has been among the industry鈥檚 biggest problems in recent years and grew only more challenging during the pandemic. Wage inflation and more leverage for workers have been difficult adjustments for an industry not known for high pay.

In September, CMS released a proposed rule that would create new minimum staffing requirements for long-term care facilities. According to a briefing released by KFF, , few nursing homes would meet the proposed standards. About 80%, the researchers found, would have to hire more registered nurses and nurse aides.

鈥淪taffing ratios are the biggest indicator of what kind of care residents get,鈥� Jones, with the SEIU, said. 鈥淭here have to be penalties for employers.鈥�

But the industry says it is barely hanging on, especially at nursing homes reliant on Medicaid payments like Northview.

Missouri finally readjusted how it reimburses nursing homes through Medicaid last year after 15 years of leaving the rates unchanged. That readjustment then took another year to receive federal approval, so nursing home operators just began seeing the money from the new rates.

The Medicaid reimbursement rates are finally higher for many operators. But they鈥檙e based on old data that hasn鈥檛 kept up with inflation.

鈥淭hey can鈥檛 survive on it,鈥� said Nancy Stevens, a nursing home dietician and management consultant who has worked with many long-term care operators, including Suissa. 鈥淲hen you look at what they increased those to, it鈥檚 pathetic.鈥�

The change also tied rates to quality measures, penalizing some facilities if they couldn鈥檛 demonstrate improved outcomes. One of the facilities that saw its Medicaid reimbursement rate lowered in January from last year鈥檚 new rate was Northview, according to Missouri data.

Earlier this month, several Missouri legislators met with about two dozen representatives and owners of Missouri鈥檚 nursing homes to discuss the problems the industry is facing. One of the lawmakers in attendance, Rep. Dale Wright, R-Farmington, said from the data he鈥檚 seen, Missouri lags 鈥渨oefully鈥� behind its neighbors in terms of its Medicaid payments to nursing homes. He suspects it will be an issue the Legislature looks at when it reconvenes next month.

鈥淲e鈥檝e got to do something about that or we鈥檙e going to see a lot more nursing homes close and we鈥檙e going to have a real problem,鈥� Wright said.

Austin Huguelet and Kelsey Landis of the Post-Dispatch contributed to this report.