Massachusetts Nursing Home Chain Settles Understaffing Claims for $4 Million

Next Step Healthcare LLC agrees to a $4 million settlement with the Massachusetts Attorney General for compromising patient care.

Empty nursing home room

ByAri Magill, MD, BS

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Published on July 9, 2024

Empty nursing home room

Next Step Healthcare LLC, a long-term care management firm, headquartered in Woburn, Massachusetts, and operating 16 nursing homes statewide, has agreed to a $4 million settlement with the office of Attorney General Andrea J. Campbell. This agreement addresses claims that the company intentionally understaffed its facilities, leading to instances of “harm and neglect” among its residents.

The long-term care management firm holds ownership and operational control over skilled nursing facilities located in the following Massachusetts municipalities: Attleboro, Fall River, Fitchburg, Lee, Malden, Melrose, Middleborough, Norwood, Plymouth, Taunton, Walpole, West Newton, Westborough, and Worcester.

On the morning of June 10, the attorney general's office announced the settlement agreement, the largest ever reached with a nursing home in the state’s history. Pursuant to the settlement agreement, Next Step Healthcare must maintain staffing levels at its facilities in compliance with state mandates, in addition to financial penalties.

The settlement directs Next Step Healthcare LLC to remit $750,000 to the Massachusetts Commonwealth. This sum will be divided amongst MassHealth (Medicaid) and a quality improvement fund for long-term care facilities administered by the Department of Public Health.

Additionally, the settlement mandates that Next Step Healthcare LLC allocate $3.25 million to increase staffing levels and improve employee retention across its facilities over the next three years. This measure is designed to ensure compliance with state regulations. The Attorney General's office has appointed a compliance monitor to oversee Next Step's adherence to these workforce requirements.

Under the terms of the settlement, the appointed monitor will evaluate the quality of care provided at eight of Next Step Healthcare's nursing facilities. Additionally, the monitor will conduct periodic on-site inspections of Next Step's operations and furnish biannual compliance reports to the Attorney General's office, detailing the company's adherence to mandated standards.

The parties reached this settlement agreement before the initiation of any formal court proceedings.

The multi-million dollar settlement resolves the Attorney General's investigation prompted by Department of Public Health complaints and referrals alleging substandard care and regulatory violations at Next Step Healthcare's facilities.

The Attorney General's investigation revealed persistent understaffing at Next Step facilities. Allegedly, the company reduced staff below already inadequate levels in April 2019 and continued these practices even after new state staffing regulations were implemented in April 2021. The AG contends that these staffing deficiencies led to resident neglect and harm, placing Next Step facilities in the bottom 10% for staffing among comparable facilities in their respective counties.

Moreover, the Attorney General's allegations stated that Next Step Healthcare violated the Massachusetts False Claims Act, the Massachusetts Consumer Protection Act, and a statute safeguarding elders from abuse and neglect in nursing homes by billing MassHealth, the state's Medicaid program, for the deficient level of care provided.

In an announcement, Attorney General Campbell stated that Next Step consistently prioritized profitability over resident care for years “by failing to adequately staff its nursing homes.” She also commended her team for securing this precedent-setting settlement and sending “a message that this conduct will not be tolerated.” Campbell further stated that by securing Next Step's future compliance with staffing mandates, the agreement ensures “that vulnerable elderly residents receive the proper care they need.”

This settlement exemplifies Attorney General Campbell's ongoing initiatives to champion the rights and welfare of elderly citizens across Massachusetts. Her office highlighted the establishment of a dedicated Elder Justice Unit during her inaugural year and her legislative proposals aimed at fortifying the Attorney General's civil enforcement capabilities to combat abuse and neglect of elderly and disabled individuals in care facilities.

Commenting on the settlement, Kate Walsh, the Secretary of Health and Human Services for the Commonwealth of Massachusetts, stated: “We have an obligation to create a safe and caring environment for some of our most vulnerable residents in Massachusetts.”

About the author

Ari Magill, MD, BS


Ari Magill, MD, BS, is a neurologist and medical communications expert who specializes in cognitive disorders, wellness, functional medicine, and positive psychology. With an M.D. from UT Southwestern Medical School and neurology residency training from the University of Arizona, followed by a Movement Disorders Fellowship at the University of Colorado, Dr. Magill is deeply committed to advancing neurologic and medical therapeutics. Board-certified in Neurology and holding an active Arizona medical license, his career is distinguished by roles such as a Clinical Research Investigator for CNS investigational therapies and a Neurologist at QTC Management Inc., where he assessed veterans suffering from traumatic brain injury. Dr. Magill's professional journey reflects a persistent drive to contribute to the prevention and reversal of cognitive decline through integrated approaches to wellness and functional medicine.

Currently thriving as a freelance medical writer, Dr. Magill leverages his specialized knowledge and passion for medical science to communicate complex concepts with clarity and precision. His work spans from consulting and writing on mild cognitive impairment for Alzheimer's Germ Quest to serving as a Medical Writer for the Expert Institute. Dr. Magill's approach emphasizes the importance of a nutrient-dense diet, regular exercise, novel cognitive stimulation, deep restorative sleep, meaningful social connections, and the supplementary support of neuronal network maintenance and neurogenesis.

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