Many nursing homes feed residents on less than $10 a day: ‘That’s appallingly low.
NJ Advance Media/NJ.com, May 22, 2025 (updated)
By Ted Sherman, NJ Advance Media for NJ.com, Susan K. Livio, NJ Advance Media for NJ.com, and Matthew Miller | mmiller@mlive.com
This article reveals a widespread issue of inadequate food spending and poor food quality in U.S. nursing homes, often driven by cost-cutting measures, particularly in facilities owned by private equity firms. An investigation, aided by Rutgers University and data experts reviewing federal cost reports, found that nationwide, more than a quarter of all nursing home operators spent under $10 a day per resident for food in 2023—less than the cost of a fast-food meal. Some owners even budgeted as low as $6 per day.
This minimal spending leads to numerous problems:
- Poor Quality & Insufficiency: Residents report receiving shockingly small portions (like a single ravioli for a meal), unappetizing, or even inedible food (“soup and a sammie” with one slice of bologna and cheese). Complaints include rancid meat, spoiled produce, and meals prepared in filthy conditions. Many residents, even when meals meet basic nutritional quantity, find nothing appetizing. Some reported going a day without food.
- Health Consequences: Malnutrition and dehydration are rampant, with studies showing rates between 30% and 85% in residents. Inadequate nutrition contributes to poor health outcomes and even early death. Lack of specific dietary needs, like potassium-rich bananas for a stroke patient, was also noted.
- Rising Issues: From 2021 through 2024, food-related deficiency citations nearly tripled. Dietary complaints to ombudsman offices increased by over 50% between 2020 and 2023, and outbreaks of foodborne illnesses tied to nursing home kitchens are also on the rise.
- Lack of Regulation: There are no federal or state regulations mandating minimum spending on food, making it an easy target for cuts. Experts note that when facilities are forced to increase spending in one regulated area (like staffing), they often cut costs in unscrutinized areas like food.
The article contrasts these low food budgets with the high cost of nursing home care (median annual cost of $104,000 for a semi-private room). While industry officials state their commitment to quality care and blame underfunding and inflation, advocates and experts like Sam Brooks, David C. Grabowski (Harvard), and Charlene Harrington (UCSF) describe food as a major source of complaints and a significant, under-addressed problem. Cases like the collapse of Skyline Healthcare, whose owner Joseph Schwartz was convicted of tax fraud after allegedly skimming profits while facilities cut corners on essentials like food, highlight how financial motives can severely impact resident care.
Ultimately, the piece underscores that food is crucial not just for physical health but also for the mental well-being and dignity of residents, for whom meals can be a “bright spot” in their day. However, it often becomes an “easy place for a company to cut corners.”
Inside the ‘multibillion-dollar game’ to funnel cash from nursing homes to sister companies
NJ Advance Media/NJ.com, May 1, 2025 (updated)
By Ted Sherman, NJ Advance Media for NJ.com, Susan K. Livio, NJ Advance Media for NJ.com, and Matthew Miller | mmiller@mlive.com
This article details how many U.S. nursing homes utilize complex financial structures, particularly related-party transactions, to allegedly siphon funds intended for resident care, thereby boosting owner profits while facilities often remain understaffed and under-resourced.
A key example highlighted is South Jersey Extended Care, dubbed one of New Jersey’s worst. Acting State Comptroller Kevin Walsh moved to bar it from Medicaid, accusing its operators of a “massive scam” by siphoning millions through side businesses controlled by the same individuals. Money that should have gone to resident care was allegedly diverted to owner distributions and inflated “consulting” fees.
The practice, sometimes called “skimming” or “tunneling,” involves nursing homes paying related companies (often owned by the same people) for services like rent, management, or supplies, frequently at inflated prices. While industry representatives from organizations like the American Health Care Association argue these arrangements are legal, common across industries, and sometimes necessary due to inadequate Medicare/Medicaid reimbursements, critics and studies suggest they obscure true profits and harm care.
Key findings and concerns raised in the article include:
- Prevalence: About 78% of U.S. nursing homes operate multiple entities with related owners.
- Hidden Profits & Inflated Costs: Economists estimate 63% of nursing home profits in 2019 were hidden via inflated transfer prices to related parties. These transactions can increase a facility’s stated costs for services like real estate and management by 20-25%. In 2023, nursing homes reported paying related businesses $2.76 billion over and above what was listed as “allowable costs” for those services.
- Impact on Care: Facilities engaging in these practices tend to have fewer staff, higher rates of patient injuries, and more complaints. The tragic case of Ronald Wysong, who choked to death in an Ohio facility, is cited in a lawsuit alleging the parent company extracted money through management fees while under-resourcing the home.
- Lack of Transparency & Oversight: It’s difficult to track where money truly goes. While disclosed in federal cost reports, these are hard for the public to access and parse. The HHS Inspector General found facilities failing to report related parties or properly adjust costs, and criticized CMS for insufficient guidance. Routine inspections are also lagging, with over 20% of homes behind on annual inspections, partly due to underfunding and understaffing at state and federal levels.
The article concludes by outlining potential solutions, such as federal standards for spending on food and administration, limits on profits, random audits by CMS, and improved inspections. However, advocates like NJ Comptroller Kevin Walsh describe the effort to prevent financial diversions as a “multibillion-dollar game of Whac-a-Mole,” with greed at the problem’s core.