MN Lawmakers Target Private Equity Nursing Home Ownership

ST. PAUL, MINNESOTA — State legislators are advancing legislation that would impose new disclosure and regulatory requirements on private equity firms seeking to acquire nursing homes and assisted living facilities, according to MinnPost. The bill, debated this week in both House and Senate human services committees, reflects mounting concern over the role of private-equity investment in eldercare — though neither chamber has yet voted on the measure.

Bipartisan Interest, Industry Pushback

The legislation, carried in the House by Rep. Liz Reyer, DFL-Eagan, and in the Senate by Sen. Alice Mann, DFL-Edina, would establish a comprehensive set of requirements for private equity buyers of eldercare facilities, as reported by MinnPost. A central aim of the bill is simply identifying which Minnesota nursing homes and assisted living facilities are already under private equity ownership — information the state does not currently track.

"Private equity's sole purpose is to squeeze every single cent out of the function of whatever business they've glommed onto to ruin," said Sen. Erin Maye Quade, DFL-Apple Valley, during a Senate Human Services Committee hearing, according to MinnPost.

Rep. Jeff Backer, the Republican co-chair of the House Human Services Finance and Policy Committee, indicated he shares the bill's transparency goals, as reported by MinnPost. However, nursing home industry representatives have raised concerns that additional regulatory burdens could increase costs for seniors, and some Republican lawmakers have questioned whether the legislation might discourage needed investment in the eldercare sector.

A National Movement

Minnesota's effort follows similar legislation enacted in California, Massachusetts, and Oregon over the past year, according to MinnPost. The push reflects growing national anxiety about private equity's footprint in healthcare, particularly in facilities serving vulnerable elderly populations.

Nationally, private equity firms are estimated to own up to 13 percent of nursing homes, according to the Private Equity Stakeholder Project, a nonprofit watchdog organization. However, that figure remains an estimate because ownership structures are often opaque.

Yashaswini Singh, a health care economist at Brown University, told MinnPost that private equity emerged as a significant force in health care investment around 2015. According to Singh, the distinguishing feature of private equity ownership is a fixed return timeline — typically ten years or less — which can drive aggressive cost-cutting measures such as reducing staff or executing sale-leaseback transactions on facility properties.

The Minnesota Department of Health currently licenses 339 skilled nursing facilities and more than 2,350 assisted living homes statewide, as reported by MinnPost. While the department requires owners to disclose whether a facility is privately held, nonprofit, or publicly owned, the underlying corporate structure is not revealed. Kelly Asche, a senior researcher at the Center for Rural Policy and Development in Mankato, confirmed to MinnPost that private equity ownership cannot be identified from standard licensing categories.

Research Raises Quality Concerns

The legislative debate is informed by a growing body of research linking private equity ownership to poorer outcomes in eldercare. In 2024, Consumer Voice, a Washington-based advocacy organization for long-term care residents, analyzed federal data and found that staff turnover rates tend to be higher at private equity-owned nursing homes, according to MinnPost. For instance, Tennessee nursing homes operated by the firm Portopiccolo reported staff turnover rates of 61 percent.

Atul Gupta, a professor at the Wharton School of Business at the University of Pennsylvania, has led research indicating that private equity-owned nursing homes tend to cut staffing levels, as reported by MinnPost. These findings are particularly relevant in Minnesota, where the state's Nursing Home Workforce Standards Board has established a minimum wage for nursing home workers that has not yet been implemented. The board has indicated it has not examined private equity's specific effect on staff retention, according to MinnPost.

CMS Inspection History

Federal inspection data illustrates the quality standards that transparency advocates are seeking to protect. Assumption Home, a 76-bed nonprofit, church-affiliated skilled nursing facility in Cold Spring, Minnesota, demonstrates what well-resourced, mission-driven ownership can achieve. The facility holds a five-out-of-five overall rating from the Centers for Medicare and Medicaid Services, with top marks in both staffing and quality measures, and a four-out-of-five health inspection rating.

According to CMS records, Assumption Home has accumulated 47 deficiency citations across 17 inspections. Its most recent inspection in August 2024 resulted in a citation for failure to maintain an environment free from accident hazards and provide adequate supervision to prevent accidents, classified at severity level G, indicating actual harm to a resident. An earlier inspection in February 2023 cited a similar deficiency at the same severity level. Other recent citations include a May 2024 finding related to timely reporting of suspected abuse or neglect, and November 2023 citations for notification requirements before resident transfers and for psychotropic medication management practices.

While even highly rated facilities receive deficiency citations, the contrast between nonprofit and for-profit ownership models is at the heart of the legislative debate. Advocates for the Minnesota bill argue that without transparency into private equity ownership structures, regulators and families cannot assess whether investor-driven cost-cutting is compromising care quality across the state's eldercare system.

Ownership & Operations

The proposed legislation would fundamentally change how Minnesota tracks nursing home ownership. Currently, the state's licensing framework does not distinguish between a locally owned for-profit facility and one controlled by a multi-layered private equity fund. The bill would require disclosure of the full corporate ownership chain, giving regulators, researchers, and families meaningful insight into who is ultimately responsible for care decisions.

Proponents argue this transparency is a prerequisite for any future policy response, whether that involves stricter oversight, investment standards, or simply public awareness. The legislation has ample time to advance during the current session, and its bipartisan support suggests the issue will remain a priority in upcoming committee deliberations.

Resources for Families

Families with loved ones in Minnesota nursing homes or assisted living facilities who have concerns about care quality, ownership changes, or potential neglect have several avenues for assistance. The Minnesota Long-Term Care Ombudsman program advocates for residents and can be reached at 1-800-657-3591. The National Long-Term Care Ombudsman Resource Center is available at 1-800-677-1116.

Residents and families can also file complaints directly with the Minnesota Department of Health. Federal regulations require that all nursing homes post information about how to contact the state ombudsman and file grievances. For additional resources on understanding nursing home ratings, inspection results, and resident rights, visit the Long-Term Care Ombudsman program website at ltcombudsman.org.