- Sean Metcalf
On paper, Spring Village at Essex was a local endeavor. The developer of the planned eldercare home was South Burlington-based BlackRock Construction. Local business leaders vouched for the company's integrity when it sought a state license for the home in 2016.
But BlackRock had no say over the quality of care provided to the seniors who would live there. Its plan was to sell Spring Village to a Florida investment firm as soon as it was built. That firm would contract with yet another out-of-state company to operate it.
"This is an odd situation that this office has not seen," the state's eldercare home licensing chief, Pam Cota, wrote about the project.
A majority of the 133 residential care and assisted living homes in Vermont have fewer than 20 residents and are not owned and operated by out-of-state groups. The industry's continued connection to its rural "boarding house" roots is a point of pride for the Department of Disabilities, Aging and Independent Living, Commissioner Monica Hutt said.
"It's really Vermonters taking care of Vermonters," she said.
Increasingly, though, arrangements like BlackRock's have become common nationally as investors eye aging baby boomers as a potential profit center. Now corporate interests have turned their attention to the Green Mountain State. Out-of-state owners have built or bought at least 580 eldercare beds here since 2014, an investigation by Seven Days and Vermont Public Radio found. That's roughly 15 percent of Vermont's residential care and assisted living beds.
The rush to cash in has led to fierce competition; managers face immense pressure to fill facilities and control costs. When problems at large investment properties arise, they have affected dozens, even hundreds, of seniors.
Spring Village was built to house 56 residents with dementia, making it one of the largest residential care homes in the state.
BlackRock sold the property in November 2016 to an Orlando, Fla.-based real estate investment trust called Sentio Healthcare Properties. The sale was worth $11 million, according to U.S. Securities and Exchange Commission disclosures. Sentio contracted with WoodBine Senior Living, a Maryland eldercare management company, to operate the Essex facility and four others in its $500 million senior housing portfolio.
By early 2017, Spring Village wasn't even half full, but complaints began pouring in to DAIL, which regulates Vermont's residential care homes. Inspectors investigated the home four times between March and September of that year and issued 44 citations: for neglect, short staffing and admitting residents without assessing their medical condition. One new resident arrived with an infected bedsore and exposed bone, contrary to state rules that restrict who may be admitted to an eldercare home.
Related Vermont Eldercare Navigator
As violations went uncorrected, the state cited Spring Village's upper management in August 2017 for failing to ensure that local leadership followed DAIL regulations.
The very next day, Sentio sold Spring Village and the rest of its eldercare holdings to real estate private equity behemoth Kayne Anderson in a deal valued at $825 million.
DAIL took a rare step the following month: It barred Spring Village from admitting new residents and fined the facility for each day the problems went uncorrected. Fines eventually topped $70,000 — by far the largest the state has imposed in recent years.
The crackdown got the new owners' attention. Kayne Anderson, one of the largest senior housing owners in the country, dropped WoodBine in the spring of 2018 and brought in a Massachusetts-based group called HallKeen Management. The home rebranded as Maple Ridge Memory Care. Citations have waned since.
"We worked directly with the state to repair what concerns there were," HallKeen spokesperson Greg Anderson said.
The level of dysfunction at Spring Village was remarkable given that the home served seniors who could pay monthly prices exceeding $10,000. But to its far-off owners, Spring Village was one line on a balance sheet.
"Too often, the model of the corporate franchises is to return the investment of the investors and not to keep the funds within the local facilities," said attorney Emily Joselson, of Langrock, Wool & Sperry, who represents residents' families in civil cases against eldercare homes.
When facilities are owned by out-of-state corporations — and half of the state's 20 largest ones are — poor management can quickly become a major crisis. That's what happened in the dramatic near-collapse in 2018 of three South Burlington and St. Albans homes known as the Pillsbury communities.
East Lake Capital Management, a Texas private equity firm led by Andrew White, bought the facilities from their local owners in 2017. White's company didn't cash residents' rent checks. Nor did it pay bills. The situation got so bad that staff were driving to grocery stores to buy food for residents with their own money. State officials took a rare step and went to court in November 2018 to have the homes placed in the hands of a temporary outside manager called a receiver.
As the Pillsbury homes descended into disarray, White and his wife were evicted from a $6,300-a-month Dallas apartment in June 2018 because a delivery driver reported being assaulted by White. He also "became aggressive" with a building concierge and made harassing calls to the landlords, the company wrote in an eviction petition.
A judge in a separate case in Delaware took the extraordinary step in June of dissolving the East Lake entity that owned the Vermont homes and two others in Oklahoma. White narrowly avoided arrest over his lack of cooperation in the case. When he did testify, his comments were "rambling," "distorted," and at times "incomprehensible," the judge wrote.
White did not respond to requests for comment. He has denied claims of mismanagement.
The Delaware suit was brought by an international investment firm, GMF Capital, that had acquired a minority stake in East Lake in 2017. Now, GMF is poised to assume ownership of the Pillsbury homes, previously unreported court records show. Last month Vermont Superior Court Judge Mary Miles Teachout approved their sale from the court-appointed receiver to a subsidiary of GMF in a deal worth around $31 million.
The receiver, Mark Stickney, selected GMF over the only other bidder, the Burlington housing nonprofit Cathedral Square, which had managed the Pillsbury homes for a period during the receivership. The decision came down to dollars and cents. Though the local nonprofit offered to match GMF's purchase price, Stickney wrote in court filings that Cathedral Square's bid did not qualify because it did not agree to cover certain costs related to a sale and was contingent upon securing financing.
"We tried to work with Cathedral Square on the financing end," Stickney told Seven Days. "They couldn't get there."
Stickney said he thinks GMF will provide a "long-term solution" for the troubled homes and noted that DAIL did not object to the sale. GMF's contracted operator, Maryland-based Meridian Senior Living, is currently managing the facilities.
But the approved sale could prove a missed opportunity to expand the affordable options that Cathedral Square provides, communications and outreach director Deb Bouton said last week. The nonprofit put forward its best offer but was "dismayed that the court approved a bid process that made it virtually impossible for a nonprofit to qualify," she said.
More than 400 mostly Medicaid-reliant seniors are on Cathedral Square's waiting list for its 51 assisted living and memory care beds in the Burlington area, Bouton said. The nonprofit also manages around 1,000 units of senior housing.
Yet many of the state's expensive, private-pay facilities have vacant apartments that marketers work aggressively to fill. Vermont does not require that developers of new residential care and assisted living facilities prove their services are needed, though it does require it of nursing homes. Nor does Vermont require that homes accept residents who pay through Medicaid.
Lynn Vera's late partner, Pam Gale, spent six months at the University of Vermont Medical Center while waiting to find a long-term care facility that would take in a dementia patient who relied on Medicaid. The 69-year-old woman deteriorated dramatically during her prolonged hospital stay, Vera said. Gale was finally able to secure an apartment at Memory Care at Allen Brook, an all-Medicaid facility in Williston run by Cathedral Square. Vera said Allen Brook's high-quality care and therapeutic environment gave Gale "some of her dignity back" before she died eight months later.
Vera criticized policymakers for not doing more to address the shortage of beds.
"These private-pay, out-of-state-owned, corporate beds — why do we not require these facilities to set aside a percentage of beds for Medicaid, the way we require housing to be set aside as affordable?" she asked.
The Village at White River Junction, a cutting edge, amenity-rich assisted living and dementia home in the Upper Valley, has rented half of its 80 units after nearly a year of operation, local codeveloper Brooke Ciardelli said.
The facility's owners are local, though it contracts with national operator Life Care Services to manage the care.
The Village has already won national awards for its architecture and design, part of its strategy to appeal to discerning baby boomers. But leasing started slowly as Life Care Services searched for ways to sell it to Vermonters, whose "sniff test for authenticity is very high," Ciardelli said.
Hundreds more eldercare units are planned for the coming years — though there's no guarantee they'll put a dent in waiting lists for affordable care. Developer Heidi Eichenberger plans to break ground next year on a retirement community in Newport that will include more than 67 assisted living apartments. A senior housing project planned inside the Berlin Mall will reportedly include assisted living and memory care units. Kayne Anderson, owners of the rebranded Maple Ridge Memory Care, will soon construct an adjacent assisted living building.
Then there's the Florida family that owns the historic Cortina Inn near Killington. The Bhaktas bought the defunct motel out of bankruptcy a decade ago and reopened it. The refreshed business was still "barely breaking even," so they are now converting it to what Ravi Bhakta believes will prove to be a more lucrative use: 65 units of assisted living and memory care.
The hotel-to-eldercare formula has worked for Bhakta in Texas and Massachusetts. Vermont, he expects, will be no different.