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Out-of-state nursing home chains expanded their Massachusetts holdings from 12 facilities in 2019 to 61 by 2025, according to a Boston Globe investigation. Eight of nine chains examined saw average federal star ratings decline after acquisitions; the report also documented staffing and spending changes at RegalCare-owned facilities. The state has new legal authority to weigh operators’ records outside Massachusetts, but its effect on acquisitions is not yet clear.
Out-of-state nursing home chains increased their Massachusetts holdings from 12 facilities in 2019 to 61 by 2025, while eight of nine chains examined saw average federal star ratings decline after buying facilities, according to a Boston Globe Spotlight investigation. The findings raise questions about ownership oversight and care quality in a state where the Department of Public Health oversees about 340 nursing homes.
The investigation identified chains from New York and New Jersey that bought at least five Massachusetts nursing homes each between 2020 and 2025. Together, the out-of-state operators came to own about one-fifth of the state’s nursing homes. The Globe reviewed federal ratings, public records, financial reports, lawsuits and inspections, and interviewed workers, residents and their families. Its findings describe a pattern across multiple owners, while the reported staffing and financial details at individual facilities are not evidence by themselves that every acquisition led to the same changes.
RegalCare and its chief executive, Eli Mirlis, acquired 12 nursing homes in Massachusetts and at least 29 across five states, the report said. Some facilities had high federal star ratings before the acquisitions. A Taunton nursing home’s rating fell from five stars to one within three years; a Quincy facility also fell from five stars to one. The Globe reported that overall operating spending at the Taunton facility dropped 19%, registered nurse hours fell by more than half, and licensed practical nurse hours fell by more than a third.
The Globe also traced changes in the Taunton facility’s spending. Nursing services spending fell by $530,000 between 2021 and 2025, while rent paid to a separate company owned by Mirlis rose to $522,000. In 2025, the facility paid $1.6 million to related companies, about 16% of its operating expenses, the investigation found. Separately, RegalCare and two executives agreed to pay $1 million to resolve allegations that the company submitted false Medicare and Medicaid claims for medically unnecessary rehabilitation therapy, according to Skilled Nursing News. The settlement resolves allegations; it is not described in the supplied report as a finding of liability.
Ownership Growth Meets Quality Declines
The reported expansion matters because nursing home ownership can shape staffing, spending and the resources available for resident care. The Globe’s findings connect a broad change in who owns facilities with declining average star ratings at most of the chains it examined, and document sharp staffing reductions at the Taunton facility. These trends warrant attention from residents, families and regulators, though the reported correlation does not establish that acquisitions alone caused rating changes or poorer care.
Massachusetts regulators have authority to reject buyers they consider unsuitable. Yet, the Globe found that the Department of Public Health had not denied an acquisition application or revoked a nursing home license in seven years. That history puts the focus on how the state applies its screening powers as ownership continues to change.
A New Rule for Buyer Reviews
The state’s post-pandemic nursing home market provided an opening for new owners to acquire facilities, the investigation reported. Massachusetts law historically did not allow regulators to consider an operator’s record in other states, according to Health Commissioner Robbie Goldstein. A law enacted two years before the report expanded that authority, Goldstein told the Globe. The source material does not specify how often the expanded authority has been used.
The investigation also reported that New Jersey permanently revoked Mirlis’ nursing home administrator license in 2018 after finding fraud related to continuing education requirements. The Globe found that the revoked license was not mentioned on applications for Massachusetts nursing homes. This detail concerns the applications described in the investigation; the supplied material does not say what state officials knew at the time they reviewed them.
“State law historically didn’t authorize regulators to consider an operator’s out-of-state record.”
— Robbie Goldstein, Massachusetts health commissioner, speaking to the Boston Globe
How State Screening Will Change
The investigation documents falling ratings and changes in staffing and spending, but the supplied material does not establish the cause of every rating decline or show how care quality changed at each acquired facility. It also does not identify which specific decisions or practices produced the reported outcomes across the chains.
It remains unclear how Massachusetts will use its expanded authority to review buyers’ records in other states, whether the department will reject future applications, or whether it will take licensing action against current operators. The material does not provide the companies’ responses to the investigation’s findings or their explanations for the cited staffing and financial changes.
The next significant development will be how the Department of Public Health applies the expanded law when reviewing nursing home acquisition applications. The supplied reporting does not identify a pending acquisition decision or a scheduled regulatory milestone. Residents, families and workers will also be watching for changes in staffing, federal star ratings and state inspection findings at facilities acquired by the chains.
The reported Medicare and Medicaid claims settlement is a separate development from the state’s buyer reviews. Further reporting or public records may clarify what regulators knew about operators’ out-of-state histories, how related-company payments are reviewed, and whether the state takes action in response to the investigation.
Key Questions
How many Massachusetts nursing homes did the out-of-state chains own by 2025?
The chains identified by the Globe collectively owned 61 facilities in 2025, up from 12 in 2019. That represented about one-fifth of the state’s nursing homes.
Did ratings fall at every chain’s facilities?
No. The investigation found that eight of the nine chains saw their facilities’ average federal star ratings decline after acquisition. The supplied material does not give the rating trend for the remaining chain.
What did the Globe report about RegalCare’s Taunton facility?
The facility’s rating fell from five stars to one within three years. The Globe also reported reduced operating spending and nursing hours, alongside increased rent and payments to companies connected to Mirlis.
Can Massachusetts consider a buyer’s record in other states?
According to Health Commissioner Robbie Goldstein, a law enacted two years before the report expanded the state’s authority to consider an operator’s out-of-state record. How the department has used that authority is not clear from the supplied material.
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