After Pennsylvania ManorCare Home Is Accused, Livonia Home Now Charged With Spending Its Funding To Illegally Fight Caregivers’ Union

DETROIT – Just weeks after the National Labor Relations Board issued a complaint against ManorCare for violating labor law in Pennsylvania, ManorCare again finds itself in the hot seat for breaking labor law, this time for its actions at Heartland Health Care Center – University in Livonia.  The trial addressed a complaint that charges ManorCare with 10 separate incidents of violating Federal labor law, including threatening employees for protected union activity and directing employees to file a petition against the union.  (Read the full complaint and notice of hearing.)

Caregivers at the Livonia nursing home point to this as an example of ManorCare’s misplaced priorities. While management spent time and resources fighting the union, the quality of care at Heartland Health Center-University is falling short of the state average in several measures. In just the last inspection cycle, three times as many long-stay residents at Heartland Health Center-University suffer from pressure sores, compared to the average Michigan nursing home, and twice as many short-stay residents suffer from moderate to severe pain. The home was also cited for 18 patient care deficiencies, including two deficiencies that caused “actual harm” to residents, one of which was failure to protect each resident from all abuse, physical punishment, and being separated from others.

“They should have spent that funding on caring for residents,” said Cora Pearson, a CNA at the Livonia home. “Instead, they spent it trying to take away our voice for quality care at our job. That’s just plain wrong.”

On one charge, the Union claims management directed employees to sign a petition in order to get rid of the union. Another count states that management threatened employees that their wage increases would be cancelled if the union returned. Together, the 10 counts show the efforts of management intent on pushing the union out.

Just weeks ago, the National Labor Relations Board issued a complaint to a Pennsylvania ManorCare home, accusing it of violating workers’ rights. Among other counts, the Labor Board's complaint charges that ManorCare unlawfully threatened an employee with job loss or reprisal because of the employee's support for the union, and unlawfully issued a disciplinary warning to an employee in order to discourage membership in the union.

The Union has asked for relief in the form of a Cease and Desist order against the illegal activities and an order for management to return to the table to bargain in good faith.

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New Laws Address Accountability, Transparency Problems Raised by Private Equity Buyouts

ANNAPOLIS – Seniors in Maryland’s nursing homes have reason to sleep better tonight. Governor Martin O’Malley signed two bills last Thursday that will do a better job of holding nursing homes accountable for the quality of care they provide.

Lawmakers introduced the legislation in response to concerns about nursing home transparency and accountability raised by advocates, caregivers, and family members. These concerns were highlighted last year when the Carlyle Group, one of the world’s largest private equity buyout firms, sought permission to operate ManorCare nursing homes in the state.

HB 1187 will require companies applying for nursing home licenses to demonstrate their ability to meet certain medical and financial standards that are necessary for quality resident care. The bill also requires applicants to clearly show who owns the nursing home and who is responsible for care at the home. This comes just after Carlyle, in its buyout of ManorCare, restructured the company with many layers of limited liability corporations separating each home’s operating entity from Carlyle, the actual owner, making it difficult for family members and regulators to hold the company accountable.

The second bill, HB 807, establishes a task force to study the impact that nursing home ownership has on quality of resident care. This study will determine whether the state should develop new restrictions or regulations on nursing home ownership in order to protect fragile residents.

The bills’ technical titles are “Person Who Operate Nursing Homes – Licensure” (HB 1187) and “ Task Force to Study Financial Matters Relating to Long–Term Care Facilities” (HB 807).

Advocates continue to raise concerns over the impact of profit-hungry private equity ownership on fragile nursing home residents. Though Carlyle had promised to provide quality care at ManorCare after the buyout, in some areas the firm is failing to keep its promises. In February 2008, ManorCare Rossville in Baltimore was placed on the Centers for Medicare and Medicaid Services’ “Special Focus Facility” list, commonly know as the list of the nation’s most troubled nursing homes. The designation comes after a series of poor inspections, the most recent of which took place in January 2008 on Carlyle’s watch.

WASHINGTON , DC -- In response to scrutiny from residents, lawmakers, and advocates, Carlyle in early May announced the formation of a three member "independent" committee to advise the company regarding quality of care. Carlyle-ManorCare's decision to refer the issue of quality to a committee falls far short of the real and immediate action needed to improve quality of care for its residents.

Although Carlyle describes its committee as "independent," committee members include Gail Wilensky, who served on the ManorCare Board of Directors as recently as last year and who received a one-day windfall of more than $1 million as a result of the transaction, according to ManorCare's SEC filings. A few months ago, Wilensky also appears to have served on both the ManorCare Board and as Vice-Chair of the Maryland Health Care Commission-- a state regulatory body that issued rulings Carlyle needed to complete its buyout of ManorCare. SEIU does not know whether Dr. Wilensky recused herself from Commission proceedings related to Manor Care.

The Carlyle-ManorCare press release lauding the "independence" of its new committee makes no mention of the connections between Wilensky, the company, and the Carlyle buyout.

Advocates point to those connections – and the failure to mention them -- as further evidence that Carlyle does not intend to live up to the full spirit of promises it made during the Manor Care buyout. Carlyle had promised regulators as part of the buyout approval process that it would appoint an independent committee, but Wilensky’s inclusion makes this committee fall short of the mark.

Carlyle has already failed to live up to a promise from an October 27, 2007 “Quality Patient Care Pledge” to continue providing quality care. Since the buyout, at least two homes have had increases in the number of patient care deficiencies during their most recent regular survey inspections, and one home, Heartland Health Care of Jackson, MI, had a 260% increase in deficiencies compared to before the buyout. Furthermore, when workers at a Towson, MD home asked for a fully funded training program to improve their skills, Carlyle-Manor Care fought back against the workers’ request .

The buyout raised concerns of transparency, accountability, and quality that lawmakers are now moving to address. The Nursing Home Transparency and Improvement Act (S2641) in the Senate and forthcoming legislation in the U.S. House seek to address problems with accountability and disclosure that private equity buyouts have caused. The legislation has the support of a wide range of quality care advocates including AARP, the Alzheimer’s Association and the Leadership Conference of Aging Organizations .

Families visiting their loved ones at more than one hundred ManorCare nursing homes in sixteen states across the nation this Mother’s Day will receive a carnation and a call to action from quality care advocates. The effort, the latest in a long-running campaign to improve care at Carlyle-ManorCare facilities, asks family members to call Carlyle co-founder and Managing Director David Rubenstein to demand better care. In addition, families will be urged to call their Senators to request Congress step take action to protect all nursing home residents.

“Mothers’ Day is when we’re all doing something special for our mothers,” said Erica McDuffie, a quality care advocate with SEIU. “Many of these family members coming to visit don’t know that their mom’s nursing home was bought out, and that they can make a difference to make mom’s home better.”

Carlyle, one of the nation’s largest private equity funds, purchased ManorCare nursing homes last December amidst promises of quality care, training for caregivers, and sufficient staffing, but since the buyout, it seems they may not be keeping all of those promises. Some homes have had sharp increases in the number of care deficiencies since being acquired, one home is now on a provisional operating license after a resident’s death, and caregivers working for better benefits and a fully-funded training program are fighting sharp company opposition.

The campaign led by the caregivers of SEIU Healthcare, the nation’s largest nursing home workers’ union, is asking Carlyle’s billionaire co-founder to make patient care a first priority at ManorCare by investing in front-line staff. Because Rubenstein is still resisting efforts, advocates are taking their case to Capitol Hill.

In an effort to address outdated nursing home regulations advocates are supporting U.S. Senate Bill 2641, the Nursing Home Transparency and Improvement Act. The bill would prevent companies like Carlyle from setting up multi-layered entities that make it difficult to determine who is really responsible for care and would prohibit the separation of real estate holdings from nursing home operations, which companies do to shield key property assets from liability for care problems. The Nursing Home Transparency and Improvement Act would take steps toward closing these loopholes, requiring companies to show who is ultimately responsible for care. Advocates expect similar legislation will be introduced in the House shortly.

Caregivers will be at nursing homes in twelve states during brunch hour this Sunday, May 11.

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BALTIMORE, MD — The sixty nursing home caregivers from across the nation who assembled in Baltimore this week have one thing in common: they’re sick of nursing homes letting workers and seniors down, and they’re ready to take the case for better staffing, training, and better care to the public. The group, SEIU Healthcare’s “Nursing Home Accountability Team,” chanted and handed out flyers during a Rubenstein speech at the SABEW Conference in Baltimore.

Rubenstein’s firm, the Carlyle Group, bought out ManorCare nursing homes last December. Carlyle had issued a “Patients First Pledge” that included providing training for caregivers, maintaining adequate staffing levels, and ensuring quality care.

Residents and caregivers point to recent care problems and problems at the bargaining table as evidence that Carlyle is not truly committed to its promises. One home in Davenport, IA was cited for more than 30 violations of regulatory standards in a recent inspection. Meanwhile, when caregivers in ManorCare’s Towson, MD facility fought for a fully-funded training program, the company fought back, offering a plan that would require caregivers, already struggling to make ends meet at their low hourly wages, to pay back some of the cost.

SEIU members at the Towson, MD facility have been working without a contract for months, struggling to negotiate for better wages, a training fund, affordable family health care, and a better pension plan. Their fight underlines Carlyle-ManorCare’s reluctance to invest real money in improving front-line conditions, so that Manor Care homes can attract and retain the stable, high-quality staff needed to provide the highest quality care.

Today’s action was part of a three-day focus on ManorCare’s broken promises. After two days of on-the-street actions to draw attention to Carlyle-ManorCare’s broken promises, the caregivers will take their case to Capitol Hill as they meet with their Senators and lobby for the passage of the Nursing Home Transparency and Improvement Act (S2641). The bill would update nursing home regulations to take account of the increasing number of large buyouts. It requires more disclosure of who owns each nursing home, who is ultimately responsible for the care at the home, and how taxpayer funding is being spent.

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