A new owner of the former Conestoga View nursing home in Lancaster Township pleaded no contest — meaning he accepts punishment without admitting guilt — to three counts of reckless endangerment of residents at the St. Francis Center for Rehabilitation & Healthcare in Darby, Delaware County, according to an announcement by Pennsylvania Attorney General Josh Shapiro last Wednesday. As LNP | LancasterOnline’s Tom Lisi reported, “Chaim ‘Charlie’ Steg of Lakewood, New Jersey, will be sentenced to six to 23 months of house arrest followed by three years of probation. Under his probation conditions, Steg ‘cannot staff, manage, own, or operate the nursing, clinical, or medical services of any skilled nursing facility for five years,’ according to the attorney general’s office. That includes serving as a majority owner of any nursing home.” The former Conestoga View now is called Lancaster Nursing and Rehabilitation Center.
Those who opposed Lancaster County’s sale of Conestoga View to a private company 16 years ago were right to be concerned.
We’re concerned now, too.
As former Lancaster city Mayor Arthur Morris recounted in a May 26 letter to the editor, he and other city residents decried the 2005 sale of Conestoga View because they saw it as the county “turning our backs on the most vulnerable.”
They feared that once the facility was out of the county’s control, its standards of care would decline, imperiling its low-income residents.
“Conestoga View will disappear off the horizon — until it becomes a real problem years from now,” Morris said in 2007.
The Lancaster City & County Medical Society filed a lawsuit aimed at overturning the nursing home’s sale in 2005. That lawsuit was settled in 2007 when Conestoga View buyer Complete Healthcare Resources promised to permanently maintain its staffing levels, to guarantee admission to all indigent seniors in need of care, and to continue to accept Medicare and Medicaid insurance as reimbursement for services.
Once known to locals as simply “the county home,” Conestoga View traced its history to 1799, when The Almshouse opened on East King Street to serve the area’s poor, sick and mentally ill.
To this day, most of the residents of the 446-bed facility rely on Medicare to pay toward their housing.
Rebranding and reality
Even if the terms of the 2007 settlement still applied, it didn’t save Conestoga View’s residents from what unfolded during this pandemic.
Lancaster Nursing and Rehabilitation Center may have a new name, but its rebranding doesn’t obscure the reality that the center had more COVID-19 deaths than any other long-term care facility in Lancaster County.
Despite the heroic efforts of nurses who were caring for patients living three or four to a room, according to previous LNP | LancasterOnline reporting, only five other such facilities in Pennsylvania saw more COVID-19 deaths.
According to data reported to the Pennsylvania Department of Health, 81 residents of the former Conestoga View had died of COVID-19 as of Tuesday. There were 233 resident cases and 189 cases among staff.
Last month, the facility was sold by Complete Healthcare Resources-Eastern to Imperial Healthcare Group — a New Jersey company registered under Steg’s name — for $29.8 million.
As Lisi reported, a crisis management firm emailed a statement to LNP|LancasterOnline last Thursday on behalf of Imperial Healthcare Group that said that company’s vice president of operations, Leon Tarlow, will become Imperial’s interim president and CEO. Steg has stepped aside from his “leadership positions to focus on an ongoing legal matter,” the statement read.
The statement said the investigation of Steg didn’t involve Imperial. “Mr. Steg was working as an employee in a regional support role with a different company” at St. Francis, and he joined Imperial later, the statement asserted.
But, again, Imperial is registered under Steg’s name.
We agree with Diane Menio, executive director at CARIE, a Philadelphia-based advocacy group for the elderly, who described nursing home ownership to LNP | LancasterOnline’s Lisi as “a tangled web” that needs the clarifying rectification of revived nursing home regulations in Pennsylvania.
This much we know for sure: What happened to three residents at the St. Francis Center for Rehabilitation & Healthcare in Darby was horrific.
Hard to bear
According to a March criminal complaint from investigators, the three residents died in 2017 from preventable pressure wounds, sepsis, dehydration and bowel obstructions as a result of Steg’s failure to address inadequate staffing levels.
It’s hard to bear even imagining the discomfort and pain those nursing home residents experienced.
Lisi reported that since 2018, “Steg has taken an ownership stake in 12 nursing homes, according to data from the Centers for Medicare & Medicaid Services.”
A review of that data “found that under Steg’s ownership, five of those 12 nursing homes fell from a three- or two-star rating to the lowest possible one-star rating. Six of Steg’s facilities saw no ultimate change in their star rating and one, Rose View Nursing and Rehabilitation Center in Williamsport, improved from one star to two stars after he took an ownership stake,” Lisi reported.
Lancaster Nursing and Rehabilitation Center’s one-star rating preceded Imperial’s takeover.
As Lisi reported, current and recently departed staff members told LNP|LancasterOnline that they are worried for the safety of residents due to staff cuts and departures. “Four current and former employees whose departures coincided with Imperial’s takeover said administrators have laid off dozens of non-nursing personnel,” Lisi wrote. Other staff members have left “to take better paying jobs elsewhere, they said.”
“We are the Titanic,” one told Lisi. “We're going down and I don’t think anything can stop it."
Imperial’s crisis communications spokesman told LNP | LancasterOnline in an email that “there have been no mass layoffs among caregivers prompted at this facility by budget cuts or other financial steps taken by Imperial. No direct caregivers were terminated or furloughed by Imperial upon transition. We did not reduce or change the ratios of caregivers to patients and on most days in the short time that Imperial has owned this facility, to our knowledge, we have met the Pennsylvania standard of providing at least 2.7 hours of hands-on care per patient.”
We are not comforted by the "most days" reference or by “to our knowledge” clause in that statement.
And as we pointed out in a January editorial, that Pennsylvania standard is weak. Federal research states that average direct-care staffing of 4.1 hours per resident per day is needed at nursing homes, given the age and morbidity of residents.
Given that county government long ago ceded control of the former Conestoga View to others, we don’t see what the Lancaster County commissioners might do to ensure that standards of care are upheld at Lancaster Nursing and Rehabilitation Center. They only can learn, we hope, from the sale of the former Conestoga View that private enterprise isn’t always the solution.
We do implore state officials, however, to ensure that the residents of the Lancaster center consistently get the proper care they deserve. And we need to keep a close watch, too. Turning our backs on the most vulnerable is not an option.