PHILADELPHIA, PA — Genesis HealthCare, once the largest nursing home chain in the United States, is leveraging bankruptcy proceedings to avoid paying tens of millions of dollars in settlements stemming from lawsuits alleging resident injuries and deaths, according to a KFF Health News investigation published in March 2026.
The company, which filed for bankruptcy in a Dallas court in July, reported approximately $259 million in total liability from nearly 1,000 settled and pending lawsuits, according to court filings. A review of 155 settlement agreements and corporate financial documents by KFF Health News reveals that Genesis structured many of its settlement deals with built-in payment delays — often deferring the first installment by a year or more — despite company officials being aware that insolvency was a real possibility.
Of those 155 reviewed settlements, Genesis failed to pay anything in 85 cases and made only partial payments in the remaining 70, according to civil court records and bankruptcy claims reviewed by KFF Health News. The company still owes an estimated $41 million of the $58 million it had agreed to pay across those cases, the records indicate.
Among the most disturbing allegations is the case of Nancy Hunt, a Pennsylvania resident who arrived at an emergency room from a Genesis facility in such severe condition — including a gangrenous foot infested with maggots — that hospital staff contacted both an elder abuse hotline and law enforcement, according to a lawsuit filed by her son. Hunt died five days after her hospitalization, and her death certificate listed the foot injury as a "significant" contributing factor, as reported by KFF Health News. Genesis denied any wrongdoing but agreed to a $3.5 million settlement in August 2024. Court records show that most of that debt remains unpaid.
In another case detailed in the investigation, Nellie Betancourt, a retired nurse, fractured her hip while staying at a Genesis rehabilitation facility in Albuquerque, New Mexico. The medical examiner's report indicated the injury contributed to her death. Genesis agreed to pay $650,000 to the Betancourt family in April but structured the settlement so that the first of seven installments would not come due for another year, according to the settlement document reviewed by KFF Health News.
"It just feels like they killed my mom and got away with it," said Vanessa Betancourt, Nellie's daughter, as quoted by KFF Health News.
Additional lawsuits paint a pattern of alleged neglect across the chain's facilities. One case, settled for nearly $1 million, accused Genesis managers of ignoring repeated warnings about a male resident's threatening behavior before he sexually assaulted a female patient with Alzheimer's disease, according to court records. In a separate case resolved for $500,000, a Genesis facility allegedly delayed hospitalizing a resident who had been vomiting brown mucus; the resident died of a bowel obstruction. Genesis has paid nothing on either settlement, according to bankruptcy claims reviewed by KFF Health News.
John Anthony, a bankruptcy attorney representing 340 personal injury claims against the company, told KFF Health News: "They never had any intention to honor these deals."
Genesis issued a written statement saying the company remained "focused on delivering high-quality, compassionate care to our patients and residents without disruption" during the bankruptcy process, according to KFF Health News. The company did not respond to questions about individual personal injury cases.
CMS Inspection History
Federal inspection records add important context to the Genesis story and the broader challenges facing large nursing home chains. According to Centers for Medicare & Medicaid Services data, 58 percent of homes affiliated with Genesis received below-average or much-below-average ratings under the agency's five-star quality system. CMS has imposed approximately $10 million in fines against Genesis facilities for violating federal health standards over a three-year period, as reported by KFF Health News.
To illustrate the kinds of deficiencies found at large institutional nursing homes, NursingHomeNews.org reviewed the CMS inspection record for Philadelphia Nursing Home, a 402-bed county-operated facility in Philadelphia, Pennsylvania. While not a Genesis property, the facility's record highlights the systemic challenges that plague nursing homes across the country.
Philadelphia Nursing Home currently holds an overall CMS rating of 3 out of 5 stars, with a health inspection rating of just 2 out of 5 stars and a quality measure rating of 2 out of 5 stars. The facility's staffing rating stands at 4 out of 5, suggesting adequate personnel levels, though inspection outcomes tell a different story about care delivery.
According to CMS records, the facility has accumulated 41 deficiencies across 10 inspections. During its most recent inspection on January 10, 2022, surveyors cited the facility for five separate deficiencies, all classified at severity level D. These included failures to maintain a safe and homelike environment, develop comprehensive care plans with measurable goals and timetables, provide adequate assistance with activities of daily living, deliver appropriate care to maintain or improve residents' range of motion and mobility, and ensure residents received necessary behavioral health services.
These types of deficiencies — particularly around care planning and daily living assistance — mirror the kinds of systemic failures alleged in lawsuits against Genesis facilities nationwide. Federal regulations require nursing homes to develop individualized care plans and provide the staffing necessary to carry them out, yet inspection records routinely document gaps between regulatory requirements and the care residents actually receive.
Ownership & Operations
Genesis HealthCare's bankruptcy filing is one of 11 large senior care bankruptcies filed in 2025 alone, according to KFF Health News, reflecting a broader financial crisis in the nursing home industry. The company reported spending approximately $8 million per month defending and settling lawsuits related to resident injuries and deaths in recent years.
As of December, the company's owners were seeking approval from the U.S. Bankruptcy Court for the Northern District of Texas to sell Genesis facilities and other assets to its largest investor, a private equity firm. Attorneys representing residents and other creditors have argued in court filings that the proposed sale structure would effectively prevent them from pursuing claims against the new ownership or other entities they hold responsible for the company's financial collapse, as reported by KFF Health News.
Families of deceased and injured residents who reached settlement agreements with Genesis are now expected to recover only a fraction of what they were promised — if they receive anything at all. The case raises fundamental questions about whether the bankruptcy system provides adequate protections for the most vulnerable creditors: the families of nursing home residents who suffered harm.
In 2022, Connecticut health regulators took the extraordinary step of shutting down a Genesis facility following two resident deaths, according to KFF Health News, underscoring the severity of care failures documented across the chain's operations.
Resources for Families
Families concerned about the care of a loved one in a Pennsylvania nursing home can contact the Pennsylvania Long-Term Care Ombudsman at 1-800-254-5164. The ombudsman program advocates for residents of nursing homes and other long-term care facilities and can investigate complaints about care quality, abuse, or neglect.
The National Long-Term Care Ombudsman Resource Center can be reached at 1-800-677-1116 or online at [ltcombudsman.org](https://ltcombudsman.org).
If you suspect abuse or neglect, contact your state's ombudsman program immediately. Families should also request copies of a facility's most recent CMS inspection reports, which are available through Medicare's Care Compare tool, and document any concerns in writing. In cases of immediate danger, contact local law enforcement or call 911.
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