By Robert Weisman Globe Staff

June 23, 2019

DARTMOUTH — When five Skyline nursing homes shut their doors last month, Frank Romano came to the rescue. He accepted more than three dozen old and frail residents at a pair of nursing homes he owns here and in neighboring New Bedford.

Now he’s scrambling to find nurses to care for them, along with more kitchen, laundry, and maintenance workers. As he looks for help, he’s struggling to operate the properties profitably in a Massachusetts long-term care sector that’s been losing money for years.

“They’re human beings, and I want to do the right thing,” said Romano, 76, chief executive of Essex Group Management, which owns six nursing homes and two assisted living residences. “But for every Skyline resident I took in, I’m losing $37 a day.”

Romano’s homes boast distinctive features — a Japanese koi pond and red British phone booth brighten the grounds of his Brandon Woods home here — but they face the same financial squeeze that’s weakened most of the state’s remaining 386 skilled nursing facilities.

Thirty nursing homes have shuttered in the past 18 months — and 214 since 2000 — a little noticed 35 percent shrinkage that has uprooted many of the state’s most vulnerable residents.

After a state court appointed a receiver to manage the shutdown of the five South Coast homes operated by Skyline Healthcare, residents were moved with little notice — or choice about their destination.

“They said, ‘We’re closing up shop and you’re going,’” recounted John Pine, 88, one of about 15 residents sent to Brandon Woods in Dartmouth. “Some went here, some went somewhere else. . . . They just put you where they want.”

In all, 245 residents were displaced from the five Skyline nursing homes in New Bedford, Fall River, and Dighton after their New Jersey-based operator surrendered its licenses earlier in the spring. Many of their residents are disabled or suffer from dementia, and most need help with daily activities such as getting out of bed, eating, and using the toilet.

The circumstances behind the Skyline closings are under investigation by the state attorney general. A pending lawsuit by the state of Florida accuses the company of deducting money from employee paychecks for insurance that wasn’t provided. Former employees and operators who took over Skyline homes in other states have said the company bounced checks.

Its unraveling was only the latest setback for the Massachusetts nursing home industry.

Romano, a gregarious businessman who greets many of the residents and employees of his homes by name, can tick off the pressures facing operators.

They’ve gotten only small payment adjustments from MassHealth, the state Medicaid program that covers two-thirds of nursing home residents. The adjustments don’t keep pace with rising labor costs and expenses such as utilities and real estate taxes.

At the same time, employers such as Amazon, which opened a massive warehouse in Fall River two years ago, woo nursing home workers with slightly higher wages.

Romano said he can’t find enough workers to staff his properties here or in Tewksbury, Milford, and Worcester. It’s especially tough to recruit certified nursing assistants. He offers base pay of $15 an hour — plus a differential for evening and overnight shifts, along with overtime and bonuses to cover weekend shifts — but still finds it hard to compete with Amazon, which a spokeswoman said pays warehouse workers as much as $18.25 an hour.

“They’re offering higher wages, he said. “That’s where people are going.”

New federal restrictions on immigrants, who make up about 40 percent of nursing home employees, further aggravate the crisis. Early next year, the US government is set to end temporary protected status granted to Haitians who came here to work after the country’s 2010 earthquake. That means Haitian nursing home workers, including those at Romano’s homes, will be forced to return to the island.

“These are the workers who never call in sick or come in late,” said Tara Gregorio, president of the Massachusetts Senior Care Association, a Waltham-based trade group for the state’s nursing home operators. “These are the workers we can least afford to lose.”

Romano said he has taken out advertisements seeking American citizens to work at some of the jobs being vacated. “None of them even want to apply,” he said.

In response, Romano sought and received permission from Puerto Rico, a US territory, to bring 150 workers to his Massachusetts properties over the next year. They include nurses, nurse assistants, personal care aides, housekeepers, and mechanics. But to make sure they can afford to live in a high-cost state, he’ll also have to provide housing for them.

He’s counting on the state government to boost MassHealth reimbursements for nursing home residents, which would in turn increase his revenue. State lawmakers have recommended modest payment increases for the coming fiscal year, but thus far the Baker administration has budgeted no new funding.

Without more government spending, Romano said, he’ll lose money on the new residents he’s taken in. Nonetheless, he feels a sense of responsibility to give them a home. He used his company’s buses to cart all their belongings, along with meds and medical records, to Brandon Woods last month.

Some of the Skyline residents who were transferred to other nursing homes were limited to two bags by the ambulance service that transported them. Kay Butler, a nurse, was hired by Brandon Woods after Skyline shuttered her previous employer, Rockdale Care in New Bedford. She said one elderly woman she cared for at Rockdale was crestfallen when movers wouldn’t take her teddy bear to her new nursing home in Fall River. They also accidentally left her walker behind.

“It was so sad,” said Butler, who ultimately retrieved the walker and the stuffed bear and drove them to the woman in Fall River. “When you move into a nursing home, your life has been reduced to half a room. And they still won’t let you take everything.”

Pine, one of the new Brandon Woods residents, said he felt lucky to land in a clean facility where the staff is friendly. It’s only 10 miles from his former home, Bedford Gardens in New Bedford. Best of all, his buddy Bob Jepson also moved here.

Not everyone was as fortunate. With a shortage of beds to accommodate them on the South Coast, some were moved as far away as Cape Cod or the Merrimack Valley, residents said. Katherine Lapre, 68, a former nurse who now uses a wheelchair, said that while she likes her new home, she misses friends from Bedford Gardens who were sent elsewhere.

“It will be hard to see them now,” said Lapre.

Jepson, 80, is glad that Brandon Woods is still within easy driving distance of Plymouth, home to his grown son and daughter.

“People are very good here. The only complaint I have,” he joked, “is they don’t have a bar.”

Romano hopes he can find a way to keep it going, and someday leave the business to his children.

But his Rowley-based senior care company lost money the past two years. Though its two assisted-living operations generated profits, as did its four adult day health centers and two businesses that provide home health aides, the profits were more than offset by nursing home losses.

“It’s just become a hard business,” Romano said.