Out-of-State Chains Quietly Bought Up One-Fifth of Massachusetts Nursing Homes. Then the Star Ratings Started Falling.

Boston, Massachusetts — A handful of out-of-state nursing home chains have spent the last five years quietly buying up Massachusetts facilities, and a new investigation ties that buying spree to falling care quality across the state.

The numbers are stark. In 2019, chains based in New York and New Jersey owned 12 nursing homes in Massachusetts. Today they own 61 — roughly one in five facilities in the state. Nine different chains drove the expansion, according to an investigation by The Boston Globe’s Spotlight team, and eight of the nine saw their facilities’ average federal star ratings decline after taking over.

Five stars to one

The Globe tracked what happened inside individual buildings, and the pattern is hard to ignore. A nursing home in Taunton dropped from a five-star rating to a single star within three years of its acquisition. A Quincy facility fell the same distance.

At the Taunton home, operating spending fell 19% after the sale. Registered nurse hours dropped by more than half. Licensed practical nurse hours fell by more than a third.

Meanwhile, money flowed out the back door. Nursing services spending at the Taunton property fell by $530,000 between 2021 and 2025. Over that same stretch, rent paid to a separate company owned by the chain’s CEO climbed to $522,000. By 2025, the building was sending $1.6 million a year — about 16% of its operating expenses — to affiliated companies.

A license problem nobody caught

The man behind the largest of these chains, RegalCare CEO Eli Mirlis, had his nursing home administrator license permanently revoked in New Jersey in 2018 after regulators there found he committed fraud involving continuing education requirements. That revocation never appeared on his Massachusetts applications.

RegalCare acquired 12 homes in Massachusetts and at least 29 across five states, several of them highly rated at the time of purchase. Last week, the company and two of its executives agreed to pay $1 million to resolve allegations that they billed Medicare and Medicaid for rehabilitation therapy residents didn’t need. A related therapy company had earlier settled for $315,000.

Why regulators didn’t stop it

Here’s the part that should worry other states. The Massachusetts Department of Health oversees about 340 nursing homes and has the authority to reject buyers it deems irresponsible. It hasn’t denied a single acquisition application — or revoked a license — in seven years.

Health Commissioner Robbie Goldstein told the Globe that state law historically didn’t let regulators weigh an operator’s out-of-state track record. A law passed two years ago changed that. Whether enforcement follows is now the question, because the buyers aren’t slowing down.