The Carlyle Group, one of the wealthiest private equity firms worldwide, was the owner of the ManorCare nursing home chain, which filed for bankruptcy in March of this year. During the five years preceding the bankruptcy filing, the second-largest nursing home chain in the United States exposed its roughly 25,000 patients to increasing health risks, an investigation discovered.“It was horrible — my mom would call us every day crying when she was in there,” said Debbie Bojo, whose mother was treated at ManorCare’s Pottsville facility. “It was dirty — like a run-down motel.  Roaches and ants all over the place.”The number of health-code violations found at the chain increased 26 percent in the four-year span between 2013 and 2017.  The citations included not preventing nor treating bed sores; medication errors; not providing proper care for people who need special services such as injections, colostomies, and prostheses; and not assisting patients with eating and personal hygiene.

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Michelle Maldonado’s father, a former factory worker, was at the Pottsville home for several months in 2017. “One time we came in to visit him and he was sitting there in a wheelchair naked, with just a blanket on him — no pants, no underpants.  He got bedsores, infections, and he had a couple of falls.  It was like they would never check on him.”Other signs of severe patient neglect included a disabled man with poor hygiene telling investigators he was tended to “once in a blue moon.”  Some residents regularly soiled themselves while waiting for help and a woman dying of uterine cancer was left on a bedpan for so long she had bruises.  Other effects included one man being dosed with so many opioids that he had to be rushed to a hospital, and during bus trip to church, a client flipped backward on a wheelchair ramp and suffered a brain hemorrhage.  Counting only the more serious violations, those with “potential for more than minimal harm,” “immediate jeopardy” and “actual harm,” the number of HCR ManorCare violations rose 29 percent just prior to filing.It all began after Carlyle and investors completed a 2011 financial deal that took out $1.3 billion from the company for investors but unloaded financial obligations that simply couldn’t be reconciled.  Shortly after, the company announced hundreds of layoffs, and just over a year later, many of the homes were not making enough to pay rent.  Then, eventually, the bankruptcy filing followed.“Carlyle was a very interesting group to deal with,” said Andrew Porch, a consultant on quality statistics. “They’re all bankers and investment people.  We had some very tough conversations where they did not know a thing about this business at all.”HCR ManorCare officials themselves said their nursing homes maintained high ratings issued by Medicare.  ManorCare homes averaged 3.2 stars in the years before bankruptcy, which was slightly below the U.S. average.  As for the rise in health-code violations, HCR ManorCare officials noted the number of violations increased at other nursing homes as inspection methods changed.“In the first four years [after the acquisition] we felt very good about the progress” at HCR ManorCare, said Chris Ullman, a Carlyle spokesperson. “They had improved some of the quality metrics.  We were looking to expand, then things changed drastically due to the massive Medicare rate cut.”Asked about the rise in legal complaints at Pottsville, the company offered a vague response without admitting to any wrongdoing.  Officials said Pennsylvania has been “increasingly targeted by out of state trial attorneys.”

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Overdoses, bedsores, broken bones: What happened when a private-equity firm sought to care for society’s most vulnerableHCR ManorCare files for bankruptcy with $7.1 billion in debt