Category Archives: Nursing Home Industry

Which Politicians & Political Organizations Receive the Most Money From the Nursing Home Lobby?

Posted on by

By:

Dave Kingsley

The AHCA/NCAL has invested $millions in politicians and the Democratic and Republican Parties in the past few years. This is an investment that returns large financial rewards and weak regulation to its corporate funders. This appalling corruption is costing lives of patients in long-term and skilled nursing care.

Summary of Overall Spending of Nursing Home Lobby in 2017-2018 is shown below. Later years will be posted soon. I don’t want to overwhelm readers with data in one post. The expenditures below total $1,221,772.

SectorDescriptionTotal Expenditures
AdministrativeMiscellaneous administrative$4,398
ContributionsContributions to federal candidates$623,617
ContributionsContributions to committees$317,000
ContributionsContributions to joint fundraising committees$121,000
ContributionsContributions to national parties$115,000
ContributionsContributions to state & local candidates$12,600
ContributionsMiscellaneous contributions$10,000
FundraisingFundraising fees$17,533
UnclassifiableUnclassifiable$624
From OpenSecrets.org:https://www.opensecrets.org/political-action-committees-pacs/american-health-care-assn/C00006080/expenditures/2018.

Politicians & Political Entities Receiving the Largest Donation from the Nursing Home Lobby:

RankVendor/RecipientTotal Expenditures
1Team Ryan$45,000
2Democratic Congressional Campaign Cmte$35,000
3National Republican Senatorial Cmte$30,000
3Democratic Senatorial Campaign Cmte$30,000
5National Republican Congressional Cmte$20,000
6McCarthy Victory Fund$15,000
7Hoyer’s Majority Fund$10,000
7Montanans for Tester$10,000
7Young for Iowa$10,000
7Committee for Hispanic Causes-BOLD PAC$10,000
7Friends of Sherrod Brown$10,000
7Support to Ensure Victory Everywhere PAC$10,000
7Friends of Jim Clyburn$10,000
7Nancy Pelosi for Congress$10,000
7Bridge Pac$10,000
7Friends of Chris Murphy$10,000
7Ameripac: the Fund for A Greater America$10,000
7James E Clyburn Research & Scholarship Foundation$10,000
7Heidi for Senate$10,000
7Scalise Leadership Fund$10,000
7Stabenow for US Senate$10,000
7People for Ben$10,000
7Victory by Investing Building & Empowering PAC$10,000
7Stivers for Congress$10,000
7Pac To the Future$10,000
OpenSecrets.org

Lobbying inside the Washington, D.C. beltway and all 50 state capitols is responsible for continuation of low quality care in America’s nursing homes. It’s that simple. The highly profitable industry is providing low quality and deadly care because they can. We will keep the data flowing to the public as long as this blog exists. The 2019-2021 AHCA lobbying data will be posted within the next 24 hours.

The New York Times Slams CMS & The 5 Star Rating System for Nursing Homes

Posted on by

By:

Dave Kingsley

A Much Needed Expose of What Some of Us Already Know

In a prominently displayed, above the fold, article today entitled “How Nursing Homes Hide Their Most Serious Lapses,” New York Times writers laid out a case against the CMS process for inspecting and rating nursing homes on their 5-Star rating system (with 1 being the worst and 5 the best). Those of us dealing regularly through research or advocacy with nursing homes, state agencies, and CMS are not surprised by what these investigators uncovered and I, for one, am happy to see the public informed about the sham 5-Star system.

Essentially, the NYT investigative journalists concluded that serious infractions uncovered in inspections often do not appear in reports on the CMS website “Nursing Home Compare,” and frequently immediate jeopardy and actual harm findings are appealed by the operators in a secretive administrative hearing process from which families are excluded. So what you see on the CMS website is often not what you get. Even if serious infractions make it into the public inspection reports on NHC, they often don’t affect a facilities 5-Star rating.

The Most Important Take Away: Agencies of Government Are Under The Thumb of The Industry

The nature of the appeals process in which owners can hang up a finding for a year or more behind a veil of secrecy often keeps the public in the dark about some very serious negligence and abuse cases in facilities in which our loved ones reside or are about to be placed. A former CMS attorney quoted in the article said this: “Once I realized that people wouldn’t see cases that are on appeal, I thought, why would anyone ever look at this again.” Presumably, he is saying you might never know that an inspector found your frail elderly mother laying in a pool of blood in the parking lot, or that a the staff placed a patient with a positive test for COVID in the room with your grandfather.

Here is the dirty little secret about government agencies such as CMS and the various state agencies charged with regulating nursing homes and protecting patients and looking after the interests of the taxpaying public: they work for the industry. That is who they protect. I have spent years trying to pry needed – and what should be public – information out of the Kansas Department of Aging and Disability Services (KDADS), CMS, and other various and sundry regulatory agencies. They will stonewall like no agency of government that has gone before them has stonewalled. I swear, if you called KDADS and asked for their address, they would tell you to file a Kansas Open Records request. If you ask for anything more serious than that, even a KORA won’t get it for you.

I have heard staff members at KDADs claim that the industry isn’t reimbursed well enough and is struggling financially, which is absolutely false – that is why these agencies hide financial information from the public. But public information you can find tells a totally different story than what you hear from the industry and their shills in government.

Flaws in The Article: The Writers Didn’t Talk to The Right People And A Less Than Serious Research Claim

Only a couple of “experts” were quoted in the article: the former attorney for CMS mentioned above and Dr. David Gifford, the medical director for the industry and a corporate shill. The people I respect and the people with real knowledge of how the system works are experts like Professor Charlene Harrington (UCSF), Richard Malott with the Long-Term Care Community Coalition, Lori Smetanka with the National Consumer Voice, Lydia Nunez – an Ombudsman from Texas, Margaret Farley and Lenette Hamm with Kansas Advocates for Better Care and others who fight nursing home inspection/quality problems day in and day out.

The NYT writers claimed that “researchers have found a connection between better inspection results and greater profits.” That makes absolutely no sense to me. Given the solid financial data we have – which is only for publicly listed companies – that is not what I would conclude. Some very profitable operations are providing very poor care.

Furthermore, the article indicated that “The Times analyzed nursing homes’ financial statements from 2019 and found that four- and five-Star facilities were much more profitable than lower-rated facilities.” I would like to know where they found the needed financial information from closely held corporations to make that determination. Did they see an income statement, balance sheet, and cash flow statement? If they did, I would like to know where they found them. I’m very skeptical of this research. Using a qualitative, ranking measure as a predictor of profit – a measure with equal intervals – is sketchy to say the least. The ranking data from inspections give noisy data a whole new meaning.

Nevertheless, I was happy to see the article appear in the NYT. We need to debunk so much of what is purveyed by the industry and the government in regard to the safety and health of patients in nursing homes.

Does The Public Believe That Nursing Home Operators Are Underpaid? Have We Failed to Create a Narrative to Support a Political and Media Strategy to Debunk Industry Propaganda?

Posted on by

By:

Dave Kingsley

    My last post laid the groundwork for ongoing blogging about and discussing the privatized, publicly funded U.S. medical care system with colleagues and anyone interested in that discussion.  I understand that it was a long post.  However, it is presented in chunks.  There is no necessity to read through the whole piece to take away the point I’m making:  the system is rigged on behalf of corporations and high net worth individuals at the expense of ordinary wage and salary workers.

    One might think that everyone knows that.  But we have no good studies of public opinion to inform us about exactly what “most” people believe.  My focus in the past few years has been increasingly on the long-term care/skilled nursing sector, i.e., nursing homes.  In addition to many dimensions of this Medicare/Medicaid funded system I have worked on – mostly financial – I have interacted with journalists on a consistent basis and have discussed what I perceive as pervasive substandard care with medical professionals and lay persons.

    I believe that a negative view of nursing home care is widespread.  Let’s face it, no one wants to end up in one.  However, I would hypothesize that a large proportion of the public is confused or ambivalent about, or even in some cases sympathetic with, the owners of facilities.  Trade associations and their lobbyists repeatedly spread a hardship narrative, claiming that corporations are operating on a razor thin margin and on the edge of bankruptcy. Major media outlets report on specific scandals and a small number of scandalous chains and their scurrilous activities.

    This industry narrative, and the political and media strategies it supports has been effective – even though it is based on falsehoods and misinformation.  Although my colleague Charlene Harrington and I have conducted an analysis 2020 financial reports submitted to the SEC by publicly listed corporations and concluded that they did quite well during COVID (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.17288), there has been no call from any quarter for holding the industry accountable for the death of at least 140,000 patients.  Industry representatives have appeared on many major media outlets claiming that the government is at fault for not providing operators with sufficient resources.

    This is a falsehood.  But have we – advocates and scholars – failed to frame issues and develop a narrative and political/media strategy based on objective, evidence-based, information?  I think we have failed to do that.  Therefore, the public and the media are responding to a well-funded media and legislative presence of nursing home industry lobbyists such as Mark Parkinson, former governor of Kansas, and others who have been well received in legislatures and by major news sources.  The time has come for us to go on offense with our own knowledge-based narrative and legislative-media strategy.

Capitalism, Electric Vehicles, and Nursing Homes

Posted on by

By:

Dave Kingsley

Why would any capitalist believe that government funded medical care is amenable to capitalist fundamentals.  It’s nonsensical, even crazy, to think that “free markets,” “competition,” “buyer-seller negotiation” (bargaining over price), and so forth are relevant to medical care.  The results of this delusion – that Medicare and Medicaid can be administered through a “free market” – are: (1) bizarre, costly, and insulting advertising blitzes during Medicare open enrollment, (2) excessive costs due to payouts to shareholders and executives, (3) corrupt politics, which is also driving up costs, (4) dearth of R&D and innovation, and (5) lack of access for many citizens and residents who pay taxes that help fund the system.  I’m amazed that the public tolerates this corrupt, inefficient, unfair, and costly system.

    For a comparison to what is happening in the medical-industrial complex, consider the merging electric vehicle industry – about which I’m thrilled – as an example of real capitalism.  The traditional auto industry failed to move quickly enough toward vehicles that reduce the kind of emissions posing a threat to the future of the human species.  Hence, companies like Tesla have disrupted the staid auto manufacturing business.  Either Ford and GM will move much faster or will shrink into oblivion.  It is exciting to see upstart companies like Rivian (recent IPO & a contract to build delivery vehicles for Amazon), Lucid, and Archimoto challenge big auto and other gas vehicle manufacturers. We have a whole new exciting industry that is designing and building electric vehicles, inducing battery technology, spawning charging station manufacturers (e.g., ChargePoint), and creating well-paying jobs.

    Compare the Medicare-Medicaid funded, tax advantaged, nursing home industry to the rapidly emerging electric vehicle industry. The primordial roots of the industry can be dated to 1950 when the Social Security Act was amended to authorize federal funds for medical care (almshouses were state and local eleemosynary institutions and did not receive federal funds). It wasn’t long before federal lending began to boost a private, for profit, real estate industry – justified by a façade of medical care.  Medical delivery was based on the total institutional, industrial, model because efficiency and economy trumped professional medical standards. In 1965, massive amounts of federal and state dollars began to flow into the industry, which grew into a major sector of the commercial real estate industry and the medical industrial complex.

    There has been no innovation to speak of in the design of facilities and delivery of care in the nursing home industry since 1950.  The same substandard, disgraceful, care delivered in 2021 is essentially the same standard of care that has been delivered for the past 70 years. Conversely, financial innovation since the 1980s has been breathtakingly swift.  The “shareholder as supreme” theory of management and financialization throughout the economic system overtook a publicly funded nursing home system.

    What we now have is trillions of dollars funneled into the medical industrial complex – including the nursing home sector – without a correlative expectation that providers deliver a standard of care that is comparable to the money they are paid.  The nursing home industry operates in collaboration with government in a cartel like arrangement in which prices are guaranteed but labor floats in the low-wage service market.  Entry into the market is restricted and those providers privileged with a license are guaranteed an excessive return.  Owners, executives and their families are becoming fabulously rich in this system while patients suffer from low grade care without concern for professional medical standards. 

There is no disruption and innovation in a system like this.  Hence, it is not a capitalistic system at all.  It is government funded privilege accorded to select groups of shareholders. The tax codes are not incentivizing them to invest in capital and operational improvements. Rather, they have been able to arbitrage tax provisions into enhanced revenue streams without any other purpose than increasing shareholder returns.

Watch For Future Posts:

“The General Welfare Clause in the U.S. Constitution: What Should be Public and What Should be Private in a Democratic Republic with a Capitalist Economic System.”

“Taxpayers & Tax Codes: What Should Residents of the United States Expect for the Money They Spend on Medical Care?”

“Conservative Industrialists Have A Narrative and a Political Strategy. Advocates, Liberals, and Progressive Legislators Do Not.”

“Framing & Narratives Do Not Have to Be Based On Deceits, Falsehoods, and Propaganda. The Truth and Scientific, Objective Data & Information Work Well.”

WARNING! The Mainstream Media is Writing COVID-related Deaths in U.S. Nursing Homes Out of History.

Posted on by

By:

Dave Kingsley

If you visit your local Barnes & Noble store, you will find three new arrivals chronicling the COVID-19 scourge:

Washington Post journalists Yasmeen Abutaleb & Damian Paletta: Nightmare Scenario:  Inside the Trump Administration’s Response to the Pandemic that Changed History (New York:  HarperCollins).

Freelance writer John Sternfeld (Introduction by New York Times Columnist Timothy Egan): Unprepared: America in the Time of Cornovirus (New York: Bloomsbury Publishing).

New Yorker staff writer Lawrence Wright: Plague Year: America: America in the Time of COVID (New York:  Alfred Knopf).

This post is not a full-fledged review of these books.  I have read them and find them disturbing because of what they don’t say.  I’m warning the “less physically abled” people of America needing skilled nursing and long-term care that they are being disappeared from history.  That puts those people we dehumanize as “frail” and “disabled” out of sight and out of mind, which puts them at great risk.

Authors of these books have ignored the estimated 140 to 200 thousand mostly unnecessary deaths and suffering of patients and their families due to dereliction of the nursing home industry and government regulatory agencies.  Their focus is on Washington, D.C., inside the beltway politics and the Trump Administration’s handling of the pandemic (sans nursing home related issues). 

It is not surprising that Timothy Egan’s introduction to Sternfeld’s book ignores the “nursing home tragedy” altogether.  He has, in the past, demonstrated hostility toward the “elderly.” In an NYT column he claimed that “pill popping seniors” were robbing younger generations.  He was referring to the cost of Medicare, which he failed to recognize is paid for by the beneficiaries through a payroll tax and out of pocket expenses. I remember this column so well because I was in Washington circa 2012 on many occasions lobbying to stop cuts in Medicare and Social Security.  NYT columnists like David Brooks and Timothy Egan were accusing the aging population of selfishness merely because of their audacity to fight for the benefits they had worked hard to earn.

The Silence of Professional and Advocacy Groups is Deafening

COVID-19 resulted in a horrendous failure of care and protection for the institutionalized less abled among us, i.e., those individuals institutionalized in the so-called “nursing home system.”  Not only were government agencies and corporations charged with the care of millions of patients in skilled nursing and long-term care facilities derelict, but professional organizations comprised of physicians, gerontologists, and advocacy groups such as the AARP were reticent and vacuous in speaking out about the preventable mass fatalities occurring in these government-funded and regulated institutions during 2020 – and remain so to this very day.

How elites and paid professionals and the organizations in which they are employed react to the massive loss of life in SKN/LTC facilities will greatly impact the public attitude toward the value of Americans with physical barriers preventing their full independence and participation in society.  Ignoring the unnecessary loss of life in the institutions ostensibly designed for humane care will send a strong signal about what we can expect in the years ahead.

Lobbyists for the Nursing Home Industry are Pleading Financial Hardship on Behalf of the Corporations they Represent: Advocates & Activists Need to Debunk that False Narrative

Posted on by

By

Dave Kingsley

A Government Funded Service that Requires Heart & Soul has been Turned over to Businesses that have no Heart and no Soul

Corporations in the nursing home industry do what corporations do – they make as much money as they can for their shareholders.  Advocates and activists do what caring people do – they fight for patients with heart and soul against corporations that have no heart and no soul. Profit is profit and care is care, and “ne’re the twain shall meet.” 

In this age of little integrity, corporate behavior has little to nothing to do with social responsibility and everything to do with executives’ perceived obligations to their investors/shareholders and themselves.  In that endeavor, they have no qualms about deceiving the public with misinformation about their finances. A number of times I have attended legislative hearings and listened to lobbyists convince legislators that providers’ net income is so low they can barely stay in business.

Providing low quality care and excusing it with a claim of “running on a thin profit margin” is a typical maneuver of long-term care providers. This is a lie and deserves some intense and strong pushback. It is not hard to find evidence to rebut this falsehood.  For instance, it is my opinion that The Ensign Group is the biggest owner and operator of nursing homes in the United States. I’m claiming it is the biggest because unlike the other large operators it owns the 270 properties (at latest count) it operates, whereas companies like Brookdale have sold their facilities to Welltower and other REITs (they manage them on a contract basis).

The Ensign Group is doing quite well – even during the COVID pandemic. The table below displays the company’s income statement, which includes revenue and net income through the 3rd quarter of 2020 compared to the same period of 2019. Revenue has increased from $1.5 billion during the same period in 2019 to $1.8 billion in 2020. The company’s net income (profit) in the third quarter was $43.3 million compared to $27.8 million in the 3rd quarter of 2019. The 2020 year-to-date net income in the 3rd quarter was $125.2 million compared to $84.4 million in 2019.

It is important to note that net income on the income statement is after depreciation, amortization, taxes, and interest. Calculating earnings after these expenses isn’t the current accepted standard for evaluating corporate performance. Earnings before interest, taxes, depreciation and amortization (EBITA), would be much higher than net income and is a better reflection of the company’s financial strength. There is no point in getting into the weeds on this particular point – it is an important point however. Suffice it to say that the financial data we are able to obtain from publicly listed companies suggest that long-term care is an attractive investment.

Senior Housing will be a Vibrant and Appealing Investment Opportunity for at Least the Next Ten Years

The Baby Boom generation began entering retirement age in 2011 and will swell the 65+ population until 2029, when the last year of the 1946 through 1964 birth cohort enters the magic retirement age of 65. Demographers are predicting that the 65+ demographic will reach 80 million. Real estate and finance sectors of the economy have been granted generous tax advantages. Those are the main undertakings of senior housing/long-term care. Furthermore, guaranteed revenue from Medicare and Medicaid and a powerful lobby for keeping regulators at bay or under control will attract investors to this industry.

Don’t take my Word For it, Look at the Trade Publications

Although the movement for community and home based care will continue to intensify, demand for skilled nursing will remain high due to an increasing 80+ population and advancing medical technology. In a recent article in Skilled Nursing News (Skilled Nursing Continues to Outpace Senior Living in Near-Term Investment Outlook, January 21, 2020), Alex Spanko wrote the following:

With a combination of strong federal relief and a seemingly safe place in the wider health care continuum, skilled nursing facilities have repeatedly emerged as bright spots in an otherwise hazy financial outlook for players in the senior housing and care sector.

Fitch Ratings on Tuesday added to that trend in awarding a BBB- rating and stable outlook to unsecured notes issued by National Health Investors (NYSE: NHI), a major publicly traded landlord in the space (https://skillednursingnews.com/2021/01/skilled-nursing-continues-to-outpace-senior-living-in-near-term-investment-outlook/).

Publicly listed corporations in the long-term care business will be reporting their 4th quarter and 2020 annual reports in the next few weeks. We will be compiling essential information for all them and posting it on this blog. Combined, these companies own a significant share of the long-term care industry. If their financial statements don’t support the “hardship pleas” of their lobbyists, then advocates need to ask for evidence of their claims.

DON’T WORRY ABOUT NURSING HOME CORPORATIONS: THEY ARE DOING FINE

Posted on by

   By Dave Kingsley

Don’t worry about the financial impact of COVID-19 on the nursing home industry.  Corporations paid to provide long-term care appear to be doing well financially.  In this post, I want to begin a discussion of the industry’s and regulators’ failure to protect patients from a scourge they should have known was coming.  Unfortunately, nursing home owners are not being held accountable.  Quite to the contrary, they are being financially rewarded as victims of the pandemic.

    My purpose in this post is to highlight the subsidization of the industry through immediate cash infusions while nursing home personnel have been forced to work in the same low paid jobs without adequate personal protective equipment.  This is an initial post in a series of posts in which I will provide information gleaned from the 2nd quarterly reports of three different types of publicly listed nursing home corporations – privately held corporations’ financial information isn’t available because they are not required to file reports with the SEC.

    If the public thinks providers of nursing home corporations are financially strapped due to the COVID pandemic, they will be dissuaded from that perspective by the 2nd quarterly 10-Q reports filed by a sample of publicly listed corporations. Consider the financial reports of the following representative corporations:

The Ensign Group

    The Ensign Group, a holding company, owns the fifth largest nursing home chain in the United States.  The company was formed in 1999 and, based on SEC filings, has demonstrated a robust growth and strong financial performance.  According to its 2020 2nd Quarter report (10-Q)[1], its earnings of $.78 per share was a 100% increase over the prior year quarter.  Revenues for the quarter were $584.7 million and increase of 18.6% over the prior year quarter.  Net income for the quarter was $43.1 million, an increase of 99% over the prior year quarter.

   Apparently TEG was doing so well, the corporation decided to return $110 million it received from the federal government under the CARES Act[2], which was basically a handout to America’s corporations for keeping them solvent even though nursing home companies had a guaranteed price and ongoing revenue.  Furthermore, they benefitted from the Payroll Protection Program and the HEROES’ Act intended to help companies keep employees paid and enough capital to maintain solvency.  Although, the TEG balance sheet indicates that the company has $210 million in cash and $302 million in accounts receivables, it still took perhaps a 100 million dollars of PPP money and a host of other CMS supplemental payments.

Ventas Real Estate Investment Trust

    Ventas Real Estate Investment Trust (REIT) is illustrative of one of various types of corporations dependent on revenue from skilled nursing facilities.  REIT’s in the nursing home business are a special type of commercial real estate, but they are also a special type of skilled nursing home corporation.  Although they buy and lease facilities, they actually lease to contractors such as Brookdale from whom they often buy facilities and lease them back while also maintaining an interest in and control over operations. Furthermore, REITs have an operational interest in skilled nursing facilities.  Ventas describes its business this way: “We primarily invest in senior housing, research and innovation, and healthcare properties through acquisitions and lease our properties to unaffiliated tenants or operate them through independent third-party managers.”

    According to Ventas’s 10-Q[3], the COVID pandemic has not been financially disastrous due to the injection of funds from the CARES, PPP, and HERO’S acts.

    “In our healthcare triple-net leased properties portfolio, we collected substantially all rent due in the first and second quarters. This cohort of tenants has benefitted from significant government financial support to partially offset the direct financial impact of the COVID-19 pandemic on healthcare providers. Nationally, hospital inpatient admissions and surgeries have rebounded, although still below pre-COVID-19 levels, depending on the particular market.”

Brookdale Senior Living

Brookdale Senior living is the largest operator of senior living properties.  The company has sold most of its real estate. 

During months ended June 30, accepted $33.5 million of cash from CARES Act.  During July 2020 company applied for additional grants Emergency Funds based on 2% of portion of 2018 gross revenue from patient care

Under the CARES Act, the Company has elected to defer payment of the employer portion of social security payroll taxes incurred from March 27, 2020 to December 31, 2020. One-half of such deferral amount will become due on each of December 31, 2021 and December 31, 2022. As of June 30, 2020, the Company has deferred payment of $26.5 million of payroll taxes and presented such amount within other liabilities within the Company’s condensed consolidated balance sheet.[4]

As of June 30, 2020, total liquidity was $600.2 million, consisting of $452.4 million of unrestricted cash and cash equivalents, $109.9 million of marketable securities, and $37.9 million of additional availability on revolving credit facility.

Eric Carlson of Justice in Agency statement

    Eric Carlson, of Justice in Aging served on the so-called “Independent Nursing Home COVID-19 Commission,” and was the only member who refused to endorse the commission report resulting from a series of secret meetings between July and September.  I say good for him!  I say shame on those other members who either fully or partially endorsed a report that allowed the Trump Administration and nursing home corporations escape responsibility for dereliction of their duty to protect nursing home patients during the COVID-19 pandemic.

    Mr. Carlson gave the following reason for his refusal to endorse the report: “With limited exceptions, these recommendations … do not address accountability of nursing homes and their operators.” Having spent a considerable amount of time analyzing the report thus far, I would say that he is correct.

    Not only did CMS use the report to excuse its own inept and failed response to the COVID-19 pandemic, it also ignored failure of the industry and expectations from nursing home corporations in the future.  The Trump Administration failed to hold corporations accountable.  Furthermore, they have been providing generous subsidies through the CARES, PPP, and HEROES Acts passed by congress in March to keep employees paid and businesses from bankruptcy.

[1] https://investor.ensigngroup.net/sec-filings/sec-filing/10-q/0001125376-20-000134

[2] Two major pieces of legislation, the CARES Act, and the HEROES Act, which include cash grants, support for employees, and deferred payroll taxes are responsible for injecting hundreds of millions of dollars into the three corporations featured in this post alone.  The text of the acts can be found at:  https://www.congress.gov/bill/116th-congress/senate-bill/3548/text?q=product+actualizaci%C3%B3n; https://www.congress.gov/bill/116th-congress/house-bill/6800/text.  Detailed information from the income, balance sheet, and cash flow statements of major publicly listed nursing home corporations’ cash and equivalents, earnings, and liquidity indicate a rather strong financial position after several months of a nationwide pandemic.

[3] https://ventasreit.gcs-web.com/static-files/5ea1570e-14fd-45f6-8e31-15237eb49016

[4] https://brookdaleseniorlivinginc.gcs-web.com/static-files/0213cc1d-9228-4f8c-a7d4-273a1943197c