Massachusetts adopts regulations strengthening nursing home oversight

The Massachusetts Public Health Council on Wednesday approved regulations designed to strengthen oversight of long-term care facilities and stop irresponsible nursing home owners from putting residents at risk.

The new rules expand the Department of Public Health’s authority to review the track records of the companies seeking licenses to run nursing homes, and to take action when nursing homes break the rules. They also introduce new standards, including staff training requirements.

The regulations had been pending since February and were written to finalize changes the Legislature passed in 2024 in a landmark long-term care law . The two-year delay between the law and final regulations had puzzled and frustrated elder advocates.

The elder advocacy group Massachusetts Dignity Alliance had supported the long-term care law and the proposed regulations that followed it.

“Better late than never, right?” said Jim Lomastro, an elder advocate with alliance who has experience leading and inspecting healthcare facilities.

The council came together on Wednesday for the first time since the Boston Globe published a Spotlight investigation into nursing home acquisitions on Sept. 28. The Globe found that public health officials had approved new, out-of-state nursing home owners with track records of poor care.

The Light has also reported on proposed nursing home sales in recent weeks, including transfers of local nursing homes to new owners with no track record or a history of regulatory scrutiny in other states.

Public Health Commissioner Robbie Goldstein referenced the Spotlight investigation in his opening remarks at Wednesday’s meeting, saying it “raised serious questions” about the department’s oversight of long-term care facilities.

“We must be accountable to the public,” Goldstein said. “We can do better, and we must do better.”

The commissioner said the department is moving to revoke the licenses of Eli Mirlis, a nursing home owner highlighted in the Globe report for buying up facilities and rerouting money away from resident care, while misrepresenting his credentials on license applications. Mirlis’ nursing homes are now under “enhanced” monitoring, Goldstein said.

He added residents and their families should be able to trust that nursing homes will care for them responsibly. He said the department is working to provide better oversight of the industry, including with the new regulations.

“The regulations are not the beginning or the end of our work,” Goldstein said. “They strengthen the tools available to a team that is doing this work every day.”

The rules allow health officials to conduct broader reviews to determine the “suitability” of potential and current nursing home owners as part of the licensure process. The management companies and real estate holding companies associated with those owners will now be part of that review.

The department now has the authority to appoint temporary managers for a nursing home when state inspectors find serious problems, and it can levy higher penalties on nursing homes that don’t follow state regulations.

Nurse aides, who provide most of the hands-on care to nursing home residents, face a new requirement to be certified in CPR and administering naloxone, the opioid overdose reversal medication. But the department pushed back the date when those requirements will go into effect, because the nursing home industry shared concerns about the cost and logistics, said Marita Callahan, director of policy and health communications for the department’s Bureau of Health Care Safety and Quality.

The original proposed regulations required nurse aides hired after Nov. 1, 2026, to have the training, and for nurse aides employed before that date to get trained by May 1, 2027. The final regulations require training for new nurse aides by Jan. 1, 2027, and for nurse aides hired before that date by Oct. 1, 2027.

The new regulations also set out rules for so-called small-house nursing homes, which are smaller facilities designed to provide care in a more home-like setting.

During the hearing, council members generally shared positive feedback on the regulations.

“It is reassuring to see that the department has put a focus on suitability of ownership,” said council member Kahoney Anderson. “That is very important in long-term care.”

A few council members asked about the new enforcement actions against Mirlis’ nursing homes and how the department can avoid similar situations in the future.

A license revocation can be subject to an extended legal appeal, said Jaclyn Gagne, a lawyer for the state health department. Health officials can appoint temporary managers or send inspectors to more closely monitor the facility in the meantime if necessary, she added.

In response to a question about how the department can prevent future nursing home buyers from cutting staffing levels, Goldstein said the suitability review process allows officials to consider staffing and indicators for quality care at other facilities a buyer already owns. Nursing home operators can expect a different process in future license applications and renewals, he said.

“We are now explicitly telling the industry that we are looking at staffing,” he said.

The council voted to approve the regulations unanimously.

This story was originally published by The New Bedford Light and distributed through a partnership with The Associated Press.