Families want answers and action after abrupt closing of Princeton Care Center

The abrupt closure Friday of the Princeton Care Center, the only long-term care facility in the municipality of Princeton, has raised questions about the legal obligations such facilities have to residents and their families when closing, and the role of the state in overseeing the orderly closure of such facilities. Families with loved ones at the facility and staff members are calling for a state investigation into the closure of Princeton nursing home.

Princeton Care Center closed permanently Friday and gave the families of residents less than 12 hours to find a new skilled nursing facility just before the long holiday weekend. Some families learned of the closure through a social worker that morning, while others received phone calls from distressed parents living at the facility. Residents who did not have a facility to go to were shipped out on buses to other facilities, including one long-term care facility in Morristown an hour away. The last resident was bussed out of Princeton Care Center at about 11:30 p.m. on Friday, according to one local official. Video footage provided by a family member of a resident showed a chaotic scene inside the facility, with people shouting and trying in vain to get answers about what was going on and what led to the closure.

“I was in disbelief. It was outrageous,” Princeton resident Lisa Ferguson said of the closure. Ferguson’s mother was living at the nursing home with 71 other residents the day it was closed down. She received a call from a social worker that morning telling her she had a few hours to pick a new place for her mom, or she would be sent to Morristown.

“Even the Princeton Department of Health didn’t believe it when I called there Friday to tell them what was happening. At first, the person on the phone said it wasn’t true. No one believed it because it seemed so crazy,” Ferguson said. “It was terrible. This was their home, their friends, their community. People were shipped off to places where they didn’t know anybody.”

Employees at the Princeton Care Center, who were owed two to three weeks pay and did not receive their regular checks Thursday, were also shocked. While some learned of the closing late Thursday afternoon, others didn’t know anything until they arrived for work Friday. After the state ordered a corrective action plan for the facility in August, staff members were hopeful someone else might take over the facility. On Aug. 31, staff members said they waited after their shifts to get paid, and were told the company that owns the facility could not promise it would meet payroll.

One Princeton Care Center employee told Planet Princeton staff members were distressed because many were unable to pay their rent and bills. She said the administrator of the facility told her there was nothing he could do. Yet staff members showed up to work Friday even though they had not been paid, she said.

“Staff walked into what felt like a sinking ship, finding out all patients were to be evacuated and relocated. It sounded like a joke,” the staff member said. “Various companies in the area showed up with their social workers and admissions staff to begin frantically taking the patients they could…I witnessed residents confused, anxious, fearful, worried, and shaken. Families were only beginning to find out about this evacuation. Some families showed up at the facility for a visit, only to discover it would be a day of moving. Families were distraught and feeling sadness, concern, pressure, and anger.”

The staff member said many residents at Princeton Care Center were in wheelchairs and some were bed-bound. Some residents had lived there for 15 years. “Imagine packing up all of your stuff within hours, leaving friends and relationships that were built over time,” the staff member told Planet Princeton. “These are not easy things for the average person, but incomprehensible for the patients…It was difficult to hold back tears as I packed patients’ belongings for the patients I didn’t want to leave. Some patients were alone and were transferred without family. Each time a patient left the building I sobbed for them, their family, and for the grief in my heart. I squeezed some of them tight, knowing I’d never see them again.”

Loved ones of the families who were living at the Princeton Care Center are now pressing local and state officials to develop a timeline for an investigation into how such an abrupt closure could be allowed. They also need help resolving outstanding issues. Ferguson told Planet Princeton families want to:

1. Ensure the continuity of care for the residents impacted, including support to relocate to another facility if necessary
2. Understand how residents and families will be compensated for lost items and find out where their spending accounts reside
3. Understand what kind of support employees will receive
4. Make sure there are policies in place to ensure other residents, family members, and employees at other facilities do not have a similar experience
5. Make sure all medical records are provided to the new facilities where their loved ones were moved to on Friday

“We need an investigation. We need to know why we weren’t informed about the financial situation and the closure in advance, who knew what and when, what will be done to compensate the residents for things they are missing, and who will take care of the things that are still outstanding,” Ferguson said. “We also need to see a change in policy in New Jersey to make sure this doesn’t happen again.”

Some families say their parents’ new facilities do not have their medical records yet, including their COVID-19 vaccine records. Others say resident spending accounts, sometimes worth thousands of dollars, can’t be accessed. Some families also say the abrupt relocation has caused distress and a decline in their loved one’s health.

Amita Mehta of Lambertville had to rush over to the Princeton Care Center Friday, comfort her father, pack up his belongings in trash bags, and prepare him for the move to a new facility. She said the administration at the facility tried to pressure her into signing a consent form to move him to the Morristown facility, but she refused. Her father is now in a facility in Middlesex County.

“I would equate Friday to the day when my family was displaced from Uganda 51 years ago with just the clothes on our backs,” Mehta said. “But at least we had 90 days to evacuate then, versus only hours with trash bags.”

Cathy Rowe, executive director of New Jersey Advocates for Aging Well, said her organization sees the sudden closure of the Princeton Care Center as a completely inexcusable and unnecessary event.

“There can be no excuse for the suddenness of this collapse and the way residents were treated,” Rowe said. “We need to stop viewing long-term care as a business to make money and focus on the care and dignity of our older residents and their families.”

Rowe said she was glad to see that the New Jersey Long-term Care Ombudsman’s office had three staff members on-site Friday at the Princeton Care Center after the closure of the facility was announced. “Laurie Facciarossa Brewer and her staff have been great champions for New Jersey’s oldest and most vulnerable residents, and I’m sure will prevent this from happening to anyone else,” Rowe said.

The ombudsman is an independent advocate for individuals receiving long-term care. The office is also charged with advocating for policy and legislative initiatives to advance the rights, dignity, and self-determination of people in long-term care. In an interview last Friday, Facciarossa Brewer called what happened at the Princeton Care Center the worst possible outcome for residents of a long-term care facility.

Princeton Care Center is owned by Gail Bogner. Her son, Ezra Bogner, was the administrator. The family owns or has a stake in at least two other nursing homes in the state, the 123-bed FountainView Care Center in Lakewood and the 180-bed Tallwood Care Center in Bayville. So far the family has declined to comment on the closure of Princeton Care Center. Planet Princeton was thrown off of the property on Friday.

Health department oversight

In addition to not being able to make payroll, the Princeton Care Center defaulted in a court case in July related to $272,000 in unpaid bills for medical supplies. Staff members said sometimes the facility bought food from McCaffrey’s to get by and that waste management was often neglected. There is also a pending lawsuit in Mercer County Superior Court regarding a resident who died from sepsis after getting bed sores at the facility.

The New Jersey Department of Health is the state agency that is responsible for the licensing and oversight of nursing homes. Asked about the closure of the Princeton Care Center, a spokesperson for the department told Planet Princeton the state was made aware that Princeton Care Center was experiencing financial difficulties and that the owner of the facility was in the process of negotiating terms of a sale to a long-term care system in the state.

“Throughout August, the department continuously deployed survey staff and a mission-critical team to Princeton Care Center to ensure that the nursing home residents were safe and provided with appropriate care during sale negotiations,” said Dalya Ewais, director of communications for the New Jersey Department of Health, in an email to Planet Princeton.

“A letter of intent had been signed earlier in August, and the purchasing system was already working with the facility closely. The agreement was abruptly terminated on Thursday, triggering this emergency situation, as the facility was unable to pay its staff, despite repeated assurances to the department that payroll would be made, and could no longer provide care to its residents. Because of this, the facility initiated its emergency evacuation plan,” Ewais said. “An emergency evacuation plan is required of all long-term care facilities in New Jersey. When the plan is initiated by a facility, the main goal is to relocate residents to temporary facilities to ensure continuity of care. Once relocated, residents can choose to permanently stay where they were moved or they can choose to move to a different facility.”

Ewais said when the Princeton Care Center initiated its evacuation plan, the department immediately sent its survey and mission-critical staff to Princeton Care Center and remained onsite during the residents’ transfers until the last resident left the building to ensure their health and well-being.

“The department will continue to monitor the residents who were relocated to make sure they are afforded a choice of their permanent homes and will continue to review the safety and quality of those facilities,” Ewais said.

Asked if the owner of the Princeton Care Center would be penalized in any way by the state, Ewais declined to comment. “The department declines to comment on potential enforcement actions or fines against health care facilities,” Ewais said.

Eldercare lawyers have pointed to statutes regarding the closure of the facility or the involuntary transfer of a resident that are meant to protect residents.

“The abrupt closing of Princeton Care Center is shocking, as people who are unable to live independently lost their homes with mere hours of notice for what appears to be financial mismanagement,” said eldercare lawyer Denise Mariani of Stark & Stark. “First, let’s put this in context.  These people are fellow citizens who have contributed to our society for decades in various ways.  They have retired from employment or military service, raised families, and have reached an age or developed medical issues that require assistance with their medication, nutrition, and activities of daily living. To force these people out of their homes with little to no time for preparation is unconscionable. They are vulnerable and their vulnerabilities should not be used against them.”  

Mariani said that unfortunately, the nursing home industry is inundated with corporations seeking to maximize profits at the expense of the residents.  She said this is often done by cutting staffing budgets or diverting funds to “related entities,” i.e., companies owned by the same owner. “Even those residents with the most persistent advocates and frequent visitors are likely to suffer abuse and neglect in a mismanaged facility,” she said.

There are mechanisms in place to monitor the financial health of a facility. “Upon application to own and operate a nursing home in New Jersey, the financial health of the owners is and should be assessed,” Mariani said. “The license to operate a nursing home must be renewed annually.  The  financial health of the facility and its operations must be reviewed to ensure abrupt closures do not occur.”

Nursing homes that participate in Medicare and Medicaid funding must submit financial reports to Medicare and Medicaid, which are available to the public for a fee, Mariani said. These reports show the expenses of a facility such as rent, vendors, and fees. The state has the ability to appoint a receiver to take control of a facility when there is medical or financial mismanagement.  This was the case with Woodland Behavioral and Nursing Center, formerly Andover Subacute, in 2022.  “While the details of  Princeton Care Center’s financial issues are unclear, these problems did not occur overnight,” Mariani said. “It will be interesting to know whether receivership was considered.”

Laws in New Jersey recognize the problematic consequences of a nursing home’s closure and the importance of notice, Mariani said.  N.J.S.A. 26:2H-126 provides that “at least 60 days prior to the proposed date of the closing . . . the nursing home … shall notify, in writing, a resident of the facility, the resident’s legal representative, if applicable, and the Department of Health of the closing or relocation of the facility.” There is a waiver provision that allows the Commissioner of Health to waive this notice requirement for an emergent situation such as “the suspension or revocation of the facility license.” The law also recognizes the importance of medical records being available. When a facility closes, N.J.A.C 8:39-35.1 requires that the facility notify the New Jersey Department of Health, in writing, of the location and method of retrieval of medical records at least 14 days before a facility plans to cease operations.

Mariani said that N.J.S.A. 30:13-6 provides that when a transfer or discharge on a nonemergency basis of a resident is requested by a nursing home, the resident or guardian must be given at least 30 days’ advance notice of the transfer or discharge.

Another statute, N.J.S.A. 30:13-5(j), comes to mind when hearing about a nursing home resident sitting unchanged in urine and feces for extended hours or being put on a bus late at night, Mariani said.  “It is part of the NJ Nursing Home Act Residents’ Rights. That particular section provides that every resident has the ‘right to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident.’  Residents who receive poor care or treatment or undignified care may have a claim pursuant to this section.  Residents whose rights have been violated do not have to wait for the Department of Health to complete its investigation and should consult with an attorney.”

Could legislation prevent a similar scenario in the future?

State Sen. Andrew Zwicker said he was at the Princeton Care Center Friday for about three and a half hours. He described the scene as hectic, with family members becoming more tense as time went on. “It was far from clear who was in charge and in control,” Zwicker said, adding that local officials and police worked to diffuse the highly emotional situation.

“It was an utterly, completely unacceptable and outrageous situation that should have never happened,” Zwicker said.

Zwicker said the New Jersey Department of Health reached out to him, the mayor of Princeton, and other stakeholders in August, He said Sen. Joe Vitale, the chair of the New Jersey Senate’s Health, Human Services and Senior Citizens Committee, and Assemblyman Herb Conway, the chair of the Assembly’s equivalent committee, were also receiving briefings. There were two conference calls with state officials, one before former health commissioner Judy Persichilli retired, and one after she retired. Officials also received regular email updates.

“On the one hand, it looked like things were going smoothly until Thursday from the reports we were getting. On the other hand, Mayor Freda in particular pointed out his deep concern for a lack of transportation if the facility closed. They solved it, but it was not easy to do,” Zwicker said. “Mayor Freda pointed out the variety of different issues he had deep concerns about. The one nobody could have anticipated was that something would fall apart on Thursday. No one could have predicted that certainly. It was unclear how much money was needed to cover staff and where the money was coming from to cover the skilled nursing and support staff in the building. The time constraint that led to the emergency plan being invoked was driven by not having enough money to pay staff.”

Zwicker said he will be meeting with municipal officials to debrief, seek more information, and then figure out what needs to happen so such a situation never occurs again.

“There is no doubt that the emergency evacuation plan was inadequate. At this point it is not possible to point fingers at the why,” Zwicker said. He noted that there are plenty of staffing companies that provide daily and short-term nursing care, though ideally existing staff would be kept in an emergency situation where the state had to step in.

“We need to look at state rules and regulations and figure out what went wrong,” Zwicker said. “We need to figure out what the root cause was and solve it. If it happened in Princeton, it could happen somewhere else.”