The Nursing Home Law That Waits Until 2028

Introduction

2028 is the year Connecticut's new nursing home law actually starts stopping private equity firms from controlling how a resident gets cared for, even though it was signed back on June 4, 2026 and called potentially the toughest law of its kind in the country by Stateline and CT Mirror. The chain whose two Connecticut closures forced the bill, Genesis HealthCare, spent the front half of that wait watching its owner, private equity financier Joel Landau, try to buy the bankrupt company back from himself with the injured residents' lawsuits wiped clean. Landau had paid $100 million in 2021 for 93% of Genesis and control of its board, and a federal bankruptcy judge rejected that buyback in December 2025 for "too many irregularities." If a parent or grandparent of yours is in a nursing home today, you can't find out whether a fund like his controls their care, because the ownership this law forces into the open isn't due to be disclosed until February 2027.

Nineteen Months of Runway

Connecticut didn't write this law in the abstract. It wrote it after the exact ownership structure it targets had already produced two shuttered Connecticut homes and a bankrupt national chain, then handed that structure more than a year and a half of runway before the binding part switches on. To see why the delay matters, follow how Landau ended up on top of Genesis. The company was buried in debt long before he arrived: private equity firms JER Partners and Formation Capital bought it in a $1.5 billion leveraged buyout in 2007, and in 2011 Genesis sold essentially all of its real estate to the real estate investment trust Welltower for $2.4 billion, then rented the same buildings back. By 2021 that arrangement had pushed the company toward insolvency, and Landau's firm ReGen Healthcare stepped in with $100 million for 93% of the equity and two board seats, according to a Senate oversight letter from Elizabeth Warren, Richard Blumenthal, Peter Welch and Rep. Maggie Goodlander.

The two Connecticut homes are why the bill exists at all. In 2022, state regulators shut down Quinnipiac Valley Center in Wallingford after two resident deaths and multiple violations, emergency-transferring 94 people. In August 2025, Genesis closed the 269-bed St. Joseph's Center in Trumbull after residents were evacuated twice over safety concerns. The strain is statewide, too: Connecticut logged 14 "immediate jeopardy" citations in the first quarter of federal fiscal 2026, up from 8 a year earlier, CT Insider reported from Department of Public Health data.

What Connecticut actually passed is narrower than the headlines suggest. Public Act 26-103 is a disclosure-and-attestation regime, not an outright ban on private equity owning nursing homes. Stateline and CT Mirror called it potentially "the strongest law in the country," not the first; California, Indiana, Massachusetts, Maine, New Mexico, Oregon and Washington had already passed related measures. And it arrives in stages. Ownership-disclosure rules take effect October 1, 2026, with the first filings due February 15, 2027. The provision everyone is calling the ban, Section 1(e), which orders every license holder to "maintain full governance control" over clinical, operational, financial and staffing decisions, doesn't take effect until February 1, 2028. The same date brings an annual attestation that "no investment entity has control over nursing home resident health, safety or care," a category the law defines to include both private equity funds and REITs like Welltower. A surety-bond requirement waits until that July.

The 11% and the Missing $41 Million

The research on what happens when private equity takes over a nursing home is unusually direct. Economists Atul Gupta, Sabrina Howell, Constantine Yannelis and Abhinav Gupta studied roughly 12,400 for-profit homes from 2000 to 2017, isolated 1,674 that private equity acquired across 128 deals, and followed 4.2 million Medicare patients through them. Their working paper, later published in the Review of Financial Studies, found that PE ownership caused an 11% increase in short-term patient mortality, an effect that showed up as early as 15 days after discharge and held steady out to a year. The mechanism isn't a mystery: frontline nursing-assistant hours per patient fell about 3% after a buyout, the amount billed to Medicare per stay rose 8%, and interest payments to lenders more than tripled.

Genesis's own litigation record shows how that lands on families. When it filed for Chapter 11 in July 2025, the company estimated $259 million in liability across nearly 1,000 settled and pending lawsuits. Reporters at KFF Health News (republished by the Alabama Reflector) read the terms of 155 of those settlements and found Genesis had paid nothing at all in 85 of them, made only partial payments in the other 70, and still owed $41 million of the $58 million it had agreed to across the cases reviewed. Eighty-five of those families had already signed a settlement and still walked away with nothing. On the government's own five-star scale, 58% of Genesis-affiliated homes rated below or much below average, and CMS had fined the chain $10 million for health-standard violations over three years.

Then came the part a federal judge balked at. In December 2025, Genesis's bankruptcy auction produced a winning bid from Landau's own affiliated entity, a deal that would have erased as much as $100 million in potential legal claims against Genesis insiders while leaving Landau in charge. The Official Committee of Unsecured Creditors accused Landau and Welltower of running "a covert plan" that let the landlord keep collecting rent while Landau could "siphon value to himself." Bankruptcy Judge Stacey Jernigan rejected the insider sale for "too many irregularities" and ordered a fresh auction. A previously uninvolved bidder, NewGen Health, won it, and the court approved a roughly $1 billion sale in late January 2026, Reuters reported, with junior creditors set to recover up to 30% instead of the 17% under Landau's version. The new deal deliberately kept alive the right to keep suing Genesis insiders.

How common is any of this? Nobody can say precisely, and that opacity is half the problem. The GAO estimated in 2023 that about 5% of Medicare-enrolled nursing homes were private-equity-owned as of 2022, then explained why the figure is probably low: CMS's ownership data often omits owners and can't reliably flag a PE firm. The Private Equity Stakeholder Project puts the real range at 5% to 13%. The Portopiccolo Group alone picked up more than 130 nursing homes across nine states between 2016 and 2022 without ever surfacing in federal ownership data, per Public Citizen. In Connecticut, only about 5.4% of homes are directly PE-owned, which is exactly why state Sen. Jan Hochadel, who co-chairs the Aging Committee, told the Hartford Courant that lawmakers don't actually know the true number, and that pinning it down is the entire point of the disclosure regime.

Who Benefits

Follow the money and it settles in two places. Joel Landau took control of a 175-facility, 15,000-resident chain for $100 million while the operating company absorbed the debt and the lawsuits that had piled up over decades. That split is the design. In a leveraged buyout the target borrows the money used to buy it, so the debt lands on the nursing homes rather than on the investor. The 2011 sale-leaseback ran the same play on the buildings: Welltower got a rent stream funded largely by Medicare and Medicaid, and Genesis traded an owned asset for a permanent bill. When the structure finally collapsed, the buyback attempt was just the last move in the sequence, an effort to reclaim the wreck cheap with the lawsuits shed and control intact. A judge blocked that particular version, though the incentive that produced it is still standing.

The Same Playbook, Minus the Fund

None of this is unique to Genesis, or even to institutional private equity. In November 2024, New York Attorney General Letitia James secured a $45 million settlement from the management company Centers for Care and its owners, Kenneth Rozenberg and Daryl Hagler, over four chronically understaffed homes. The mechanics were the same self-dealing you see in the fund deals, minus the fund: after one ownership change, the Buffalo Center's annual rent jumped from $600,000 to $2 million, paid to entities the owners controlled, alongside what the AG called "phony fees" routed to related companies. Thirty-five million dollars of the settlement was earmarked for a "Resident Care Fund," a quiet admission of where the money had not been going. It's the same property-owner-versus-operator split UnfilteredLedger traced through hospitals with Steward, one tier down the healthcare system.

Not every troubled home is PE-owned: Connecticut's most recent fatal case, a 93-year-old Alzheimer's resident who wandered out a propped-open door and was found in a snowbank this past February, happened at Bickford Health Care Center, a nonprofit. The academic findings are narrower than the headline figure, too. The mortality increase concentrated among lower-risk patients, and the authors caution that clamping down on acquisitions could, over time, discourage building the nursing capacity an aging country will need. Connecticut's own lawmakers revised the bill from a hard restriction into disclosure and attestation because, as Hochadel put it, "not every actor is a bad actor when it comes to private equity."

The compromise itself is defensible. The two-year wait before any of it binds is the part I keep snagging on. Connecticut watched two Genesis homes close and a national chain collapse into a $2.3 billion bankruptcy, then wrote a rule that lets the ownership structure it describes keep operating untouched until 2028. Disclosure in 2027 and a care-control mandate in 2028 are real steps. They are also slow enough that the exact owner the law has in mind had time to try buying his bankrupt company back from himself before the first form even comes due.

The Part No Law Answers Yet

The law will matter in 2028. The open question is what happens in the meantime, in the states that don't even require disclosure, to the families who still can't find out who controls the home they trusted. Connecticut at least decided the ownership is worth knowing, which is more than most states have managed.

This one is also still moving. The $1 billion NewGen sale drew objections from a joint-venture partner into late May, and on May 4, 2026 a federal district court threw out the bankruptcy court's order shielding Landau-affiliated entities from lawsuits, citing "several errors." The families Genesis never paid can still pursue the people who ran it. Whether they ever collect is the part no law on the books yet answers.