Executive Compensation for CEO’S of Major Nursing Home Chains did not Decline Significantly During 2020: For Most, it Increased by a Significant Amount

    The nursing home lobby operating in Washington and state capitals is continuing its long running financial hardship campaign.  An article in the latest issue of Provider (the main propaganda organ for the industry) claims that COVID presented such a serious financial blow to providers that enhanced financial assistance from government would be the only way to implement needed substantive reform. The reform needed, according to the article, is due to increasing demand in long term care services (Patrick Connole, “COVID Challenges Bring Opportunity for Systemic Changes,” June 2020, 9-10).

    The article states that “With the majority of nursing homes already operating on razor-thin margins, the cost of making improvement will not be possible without financial assistance.”  Perhaps the razor thin margins to which the author is referring apply to the LLC listed as the owner and not to all the other LLCs such as the property LLC, the management LLC, the rehab LLC, the medical transport LLC, etc.  Certainly, holding companies and REITs have not fared badly at all during 2020 and the height of the COVID pandemic.[i]

    One would think that the entities at the top of the financial food chain would have taken a major hit and pared back their CEO pay considerably if the razor thin margins at some point in the flow of capital diminished shareholder value.  However, as the table below suggests, CEO pay for major nursing home operator/real estate chains listed on a public exchange were either enhanced by a large amount over 2019 and 2018 or remained steady.

    The above table does not display the proportion of total pay that is due to an “incentive bonus.”  Nevertheless, in cases where a major increase year over year appears for an executive, a large amount is for performance, which one must assume is financial performance.  The loss of life throughout the companies overseen by the executives in the table was a historical first for institutionalized U.S. populations.  An estimated 132,000 to 140,000 people in the care of these CEOs unnecessarily lost their lives.

    The government funded companies headed by CEOs at issue in this blog post are increasingly powerful players in taxpayer subsidized long-term and skilled nursing. In blog posts ahead, I will be discussing the growth of their power and influence.  For instance, the ManorCare property sold off by the private equity firm The Carlyle Group is now owned by Welltower and operated through a Welltower-Pro-Medica joint venture.

In the future, I will be blogging about the convoluted ownership structures in the nursing home industry and the complexification of that facet of the business due to the creativity of corporate lawyers and financial experts. Without exposing the financial trickery employed by providers, the public will be victimized by falsehoods of lobbying groups such as the AHCA/NCAL and others.

NOTE: The data in this post were derived from proxy statements filed with the Securities & Exchange Commission. In the future, I will be discussing compensation for board members and other officers/executives of major LTC/SKn corporations.


[i] Kingsley DE, Harrington C. COVID-19 had little financial impact on publicly traded nursing home companies. J Am Geriatr Soc. 2021;1–4. https://doi. org/10.1111/jgs.1728

The Impact of Voter Suppression on Elderly & Disabled Americans

The Reason Corporate America is Silent About Restrictions on Voting Rights

Blue Chip corporations such as Delta Airlines, Coca Cola, and UPS, have recently been strong proponents of civil rights for practically every class of citizen suffering from discrimination. They have sent their lobbyists to state legislatures to support anti-discrimination legislation and to pressure legislators for enhanced gay, ethnic, and gender rights. But when it comes to voting rights, corporate America is, for the most part, silent. Why?

It is understandable that more democracy is not in the best interests of corporations as they have evolved over the past few decades. Beginning with the Reagan Administration, the Milton Friedman philosophy of radical shareholder rights became a political movement. Throughout the past 40 years, deregulation has become de rigueur – even among some Democrats. Tax codes have been incessantly modified for increased transfer of wealth from the mass of Americans to ultra high net worth investors.

Corporations may jump aboard with some social responsibility movements, but more democracy is a bridge too far. Indeed, less democracy will be more protective of low corporate tax rates and tax subsidies. The Trump/Republican 2017 Tax Cuts and Jobs Act was an extreme move to subsidize corporations and wealthy individuals. They certainly won’t want to give that up and will fight to keep it.

Voters overwhelmingly favor reforms that would hit corporations in their bottom lines (or in their cash flows). Corporate executives, corporate boards, and major investors do not want to see voters have the power to set things right – to make the system more just and fair. This is not good news for all proponents of democracy, but it is especially threatening to institutionalized elderly and disabled Americans.

Deregulation & Government Capture Are Bad for Elderly & Disabled Americans

Republican voter restriction laws typically undermine the ease of absentee voting, which is of particular importance to people who have difficulty getting out to the polls. Missouri has the most restrictive voting laws in the nation. An absentee ballot must be notarized. It is likely that the draconian voting restrictions (e.g., no early voting) of Missouri will be copied by other states controlled by reactionary Republicans.

Voting restrictions designed to defeat candidates in favor of liberal democracy are particularly dangerous for elderly and disabled Americans, many of whom are institutionalized or could at some point be in need of long-term skilled nursing care. Reactionary conservatives will reward industry with less oversight and increased up-transfer of wealth through privatization and tax expenditures. Money that could be invested in care will be pocketed by investors at the expense of patients – even more so than now. Horrid conditions pervasive in publicly funded skilled nursing facilities will become worse.

The “Reagan Revolution” has not run its course. It has become increasingly fanatical and the politics of the Republican Party have become toxic and sick. Some of the nasty subtexts noticeable during the early phase of the revolution have become glaring and potent in the movement today. For instance, white supremacist, social Darwinist “survival of the fittest,” “winner take all,” “let nature take its course” attitudes can be seen in the treatment of refugees at the Southern border, refusal to increase the minimum wage, lack of safety for workers, and refusal to address debilitating, neglectful care for people in nursing homes – just to name a few manifestations of government for plutocrats rather than for everyone.

In the world of unfettered capitalism and autocracy, the elderly and disabled have little value except as products to be monetized and utilized to add value to revenue producing real estate or to justify excessive prices for privatized medicine. If the current anti-democratic moves on the part of right-wing reactionaries succeed, our lives will be shortened more than they currently are through isolation, segregation, and debilitating institutionalization. Unfortunately, American capitalism has become debauched and only liberal democracy can save us from a very dark future.

The Stock Market Is Going Up & Nursing Home Owners Are Doing Fine: Are You Perplexed?

Monetary Policy & The Rising Stock Market

    Most Americans are perplexed about rising stock markets during the current economic collapse.  As someone with an avid interest in the history of economics, I can say with a high degree of confidence, this is a first.  But when you consider the evolution of the U.S. economic system over the past 50 years, monetary and fiscal policy have been incrementally arranged to support investors and reduce protection for workers and consumers.

    Indeed, the history of the “nursing home” industry reflects these macroeconomic changes.  Advocates and activists should consider the trend toward financialization of corporations in all businesses and prepare a legislative agenda accordingly.  I will return to the nursing home industry later in this post.  First, I want to explain the phenomenon of a roaring stock market in an economic collapse.

    As I’ve been pointing out for months, the Federal Reserve can create an unlimited amount of money and make it available to lenders and corporations.  The Fed can do that in several ways.  One way is to buy debt from banks and corporations.  Where do they find the money to do that? They create it with keystrokes (that’s a metaphor for an accounting gimmick).  It can lower interest rates to practically zero and invite banks to borrow. It can lower bank reserve requirements and allow for increased lending at very favorable interest rates for borrowers.

    In a front page article yesterday (8/19/2020) entitled “The Market Is Nuts: Stocks Defy a Recession,” the New York Times finally decided to provide a partial explanation of the realities of contemporary government policy, which amounts to nurturing of concentrated wealth at the expense of most Americans.  If you read the article to the end, you will find this coming from Michael Hartnett, chief investment strategist at Bank of America Global Research:

“The performance of the market in the face of such dire expectations for growth, he wrote, is just the latest example of investors betting that low growth will prompt the Fed to continue to pushing (sic) money into the financial system, ultimately bolstering stocks.  In other words, stocks are going up not because of economic optimism, but the future looks fairly grim.  Mr. Hartnett titled his report, ‘I’m so bearish, I’m bullish.’”

https://www.nytimes.com/search?query=%22This+Market+is+nuts%3A+Stocks+Defy+a+Recession%22

Nursing Home Corporations Will Come Out Just Fine

    Publicly listed nursing home companies are enjoying the current bull market.  I checked The Ensign Group’s stock on the Nasdaq yesterday (ESNG). It closed at $56.50 per share – near its all-time high. In March, it was trading as low as $29. 

Furthermore, The Ensign Group second quarterly report indicates strong earnings:

“We are pleased to report that despite continued unique challenges presented during the current global pandemic, the operational momentum we experienced in the first quarter continued into the second quarter where we again achieved record-breaking results. While there were many things that contributed to our strong results, we announced today that we returned all of the CARES Act Provider Relief Funds, which are meant to cover lost revenue and increased expenses tied to the COVID-19 pandemic. Therefore, our results do not include any benefit related to those distributions,” said Ensign’s Chief Executive Officer Barry Port. The Company indicated that, like other well-capitalized healthcare providers, they returned these unneeded provider grant funds. He continued, “As we said last quarter, this pandemic arrived at our doorsteps at a time when our organization had never been stronger clinically and financially

https://finance.yahoo.com/quote/ENSG/history?p=ENSG

    Some of the big corporations in the business such as Genesis Health Care don’t appear to be faring so well, but that’s simply because they have been looted.  A number of years ago, for example, Genesis was the victim of takeover artist Arnold Whitman’s Formation Capital.  I’ll be writing much more about that in future blog posts.

    In addition to government largess, companies like the Ensign Group can enhance free cash flow through low interest loans from their lending facilities.  Available liquidity, plus the CARES Act, and Paycheck Protection Program will ensure that the skilled nursing business will land on its feet coming out of the pandemic.

No Better Place to Invest Your Money

    An article by Alex Spanko in Skilled Nursing News yesterday (8/19/2020) with the headline “Skilled Nursing M&A Remains Active: Investors Don’t ‘Have a Better Place to Put Their Money’” indicates that the infusion of cash from Federal and state governments plus ongoing price supports makes it difficult to value real estate.  This simply means that unlike the rest of the commercial real estate market, nursing home real estate is maintaining value due to factors unrelated to market forces (e.g. such as retail and office space).

    Although bed occupancy has dropped during the COVID pandemic, unlike other commercial real estate, lessee revenue remains steady. Operators will be able to meet most or all of their lease payments.  In most cases, real estate corporations are owned by the same holding company as the operator.  Leases are favorable to lessors; hence, a partial modification of lease arrangements combined with the amount of cash infused into the business by governments will hardly lower overall revenue.  As stated in Spanko’s article:

The question of valuations has become complicated by the vast influx of federal stimulus cash for skilled nursing operators. The Department of Health and Human Services (HHS) so far has earmarked nearly $10 billion exclusively for nursing home operators, on top of billions in Medicare- and Medicaid-based CARES Act relief tranches that providers can also access. Providers have also seen state-level bumps in Medicaid rates, and have been able to take advantage of the Paycheck Protection Program (PPP) and advance Medicare payment programs.

https://skillednursingnews.com/2020/08/skilled-nursing-ma-remains-active-investors-don’t-a-better-place-to-put-their-money/

Summary

    The American economy has evolved increasingly toward financialization, which means that finance has morphed from a supportive ancillary function to a dominant business.  No doubt, the primary business of the nursing home industry is finance rather than real estate and skilled nursing as has been the case historically.  The difference between the thousands of corporations involved in skilled nursing and other financialized corporations is the maintenance of a price floor and generous supplemental payments without any relationship to quality of care or competitive performance in a market.

    Due to a powerful, well-funded, and well-organized lobby, the industry has been able to capture government – both elected officials and agencies with an original mission of oversight.  Agencies such the Center for Medicare & Medicaid Services and correlative state agencies protect the industry from public scrutiny while providing a veneer of oversight.  State legislatures have propped up corporations in the skilled nursing business in spite of their low quality and neglectful care for patients.

My Thoughts About President Obama

Even though I disagree with some of President Obama’s decisions, and although I find myself disappointed at times with lack of progress toward cherished, progressive goals, I believe he is the best thing that has happened to the Democratic Party since the administrations of John Kennedy and Lyndon Johnson.  He has inherited an ungodly mess from the worst administration in U.S. history.  Furthermore, the Republican Party, backed by right-wing billionaires, now has a single-minded purpose, which is to make this president fail.

President Obama has an almost impossible mission.  Never in the history of this country has one political party, after leaving messes of crisis proportion,  mobilized so totally, thoroughly, and energetically for no other purpose than to make the presidential administration of the other party fail.  The right wing in this country has no interest in supporting any programs of President Obama – even if those programs are in the best interests of the American people and are badly needed to stop deterioration in our quality of life.

I do not want to hear my progressive brothers and sisters talk of a Henry Wallace-Eugene McCarthy-Bobbie Kennedy type of primary challenge in 2012.  That would be self-destructive and self-defeating.  Jean and I expect to be holding our annual celebration of President Obama’s election through 2016.

Fight Privatization of Kansas Government!

Beware of Privatization of Government Services

In response to today’s editorial, “Privatization caution,” I submitted the following letter to the Lawrence Journal World:

A move is under way to privatize government services and jobs in Kansas.  The so-called Reason Foundation (heavily funded by the Koch Billionaires of Wichita) is pushing this irrational idea.  In pushing their wacky form of right-wing libertarianism, the Koch oil magnates and other far-right billionaires will claim that their purpose is economy and efficiency in government.  Don’t fall for this.

Privatization has historically cost taxpayers more than services provided by government employees and has essentially lined the pockets of executives and investors.  If you don’t believe this, just consider the costs of outsourced defense/war functions.  Logistics and food services provided by KBR are far more expensive than when these services are provided by the military.  One small example:  The Army Times reported on their website on Nov. 1, 2009, that Pentagon auditors are attempting to deal with KBR’s “disjointed processes” and “weak accounting practices.” 

While troop levels are dropping off in Iraq, KBR’s level of employment has remained at the January 2008 level (17,000 employees).  During my service in the Marine Corps in the 1960s, I paid the same dues as every other Marine had paid up to that time.  I served on mess duty.  Cooking and other food services were provided by sergeants, corporals, and privates.  You can bet that this was done far cheaper than it would have been done by KBR.

Consider Medicare Part C (Medicare Advantage Plans).  According to the Center for Medicare Services, the federal government pays private insurance companies on average 14 percent more for providing coverage to Medicare Advantage beneficiaries than it pays for the same services to beneficiaries in the traditional Medicare program (20 percent more in some parts of the country).

Examples of these types of rip-offs of taxpayers abound.  The right-wing, anti-government libertarianism promoted by the Kochs has, as its primary objective, the destruction of government programs.  Furthermore, the main result of privatization is transfer of wealth from the bulk of U.S. taxpayers to the top 5 percent of wealth and income classes.

Legislators are being irresponsible when they hand your government, and in effect your taxes, over to the likes of Halliburton, Cigna Insurance, and the Correction Corporation of America.  One Republican legislator was quoted in the Journal World on Nov. 30 as telling the Reason Foundation representative, “You had me at hello.”  This is a mindless bending to the will of a powerful private interest with selfish motives that are contrary to the best interests of the people of Kansas.

Beware of the Kochtopus!

If you read the Lawrence Journal World this morning (Nov. 30, 2009), you may have noticed on page 3A that some outfit called the Reason Foundation is pushing Kansas state legislators to “privatize” more public services and, consequently, to privatize more public jobs.  What the article by Scott Rothschild (“Push to privatize is on the table“) failed to mention is that the Koch family billionaires of Wichita (and Park Avenue in New York City) are putting up the money for this nasty little piece of  anti-human libertarianism.

The “Kochtopus” (a term I borrowed from Thomas Frank’s What’s the Matter with Kansas) wants to wrap its blood-sucking, dollar-soaked tentacles even more tightly than they are already wrapped around the Kansas legislature, and, in essence, kill government.  What the Kochs are really all about is enriching themselves at everyone else’s expense.  For instance, the Kochtopus–through its front group, Americans for Prosperity–was a financial force behind the tea bagger movement to kill health care reform.  Americans for Prosperity is one of  many Koch front groups put in motion to transform the United States into a two-tier society…with the Kochs and a few of the other super rich on top, and the rest of us on the bottom, serving them.

A primary objective of this blog is to watch the Kochtopus and to reveal its stealthy goings-on.  If you think that the Koch blob has not been effective, you would be wrong.  One Republican, State Representative Kasha Kelley, was quoted as saying to the Koch apparatchik, “You had me at hello.”  That would probably be correct for practically all of the Republicans in the Kansas State Legislature.

The DNC, President Obama, and Change We Can’t Believe In

During the past week, I have received three phone calls from the DNC.  Rather, I have received three phone calls from DNC-hired fundraisers.  They wanted money.  I thought my crankiness during the first call would have been warning enough about me as a difficult customer to give pause to any subsequent caller.  But naively, I failed to realize that I am just a name in a database through which a dialing machine churns– nothing more, nothing less.

Why would I give these people money?  I have already blogged about the “Obama/DNC Listening Tour” that I attended (during which no one was listening).  Now I see that President Obama will be sinking us deeper into the quagmire of Afghanistan.  Did he forget that he is president by virtue of Hillary Clinton’s vote on the Iraq War?  Had it not been for her militarism, she would be president instead of Barack Obama.  He was the anti-war candidate.

President Obama’s tepid support for real health care reform has indeed been puzzling.  Is he willing to make more deals with Blanche Lincoln, Joe Lieberman, Mary Landrieu and Ben Nelson?  Will the DNC be giving these obstructionists to decency and social justice money to run their next campaigns?  I want to know that.  I would rather support  primary candidates against these destructive, pro-Republican turncoats.  Rahm Emanual can tell us that we are f…ing stupid for criticizing another Democrat, which he has said.  Since he is a big part of the problem these days, I would say,  f… him.

Apparently, Emanual has been successful in purging Greg Craig from the Obama Administration.  This is a bad sign.  Craig was one of the members of the president’s inner circle who was pushing for adherence to the spirit of the Obama campaign.  That was a campaign that inspired many of us to give money, walk neighborhoods in Missouri, and heartily celebrate Barack Obama’s election

I think we need a very quick and serious course correction by President Obama at this juncture in his administration.