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St. Louis Judges Embrace Ankle Monitors Amid Calls to Reform Bail
In the heat of an argument last spring, Khyla Mason raised a handgun into the air on a neighbor’s porch. She was acting in self-defense, she said, and never fired, but the confrontation was captured on video, and some children were nearby. Ms. Mason wound up in a St. Louis jail charged with unlawful use of a weapon.
Just a few years ago, someone facing the same charge in St. Louis was likely to pay a small bond and resume life as usual until trial, local attorneys said. But Ms. Mason, who was then 21, was released from jail with a box the size of a deck of cards strapped to her right ankle. It tracked her every move.
For weeks, the device alerted officials each time she missed her court-imposed curfew or left her house without approval. Sometimes, she was buying food or diapers for her 2-year-old son, or taking him to the hospital, she said. After more than two dozen violations, she was sent back to jail.
She remained there for a month.
More and more defendants across the country are being placed on electronic monitors, part of an ambitious effort to prevent overcrowding in the nation’s jails and keep people from being imprisoned while awaiting trial for minor offenses.
Like courts in Baltimore, Dallas and Los Angeles, the St. Louis city circuit court is among those that have embraced electronic monitoring as a powerful reform of the cash bail system. The number of new monitors activated here more than doubled from the first half of 2021 to the first half of 2024, when it surpassed 550, a New York Times analysis found.
But in that time, St. Louis has had to grapple with some unforeseen complications — including technological mishaps, privacy concerns and high costs — that offer lessons to other courts. More significantly, the devices are now worn by hundreds of people who most likely would not have stayed in jail anyway.
The Times analysis found that about three-quarters of the people monitored in St. Louis in the first half of 2024, including a small number ordered to download monitoring apps, were charged with misdemeanors or lower-level felonies such as unlawful gun possession, driving while intoxicated and third-degree assault. In the past, people facing those kinds of charges would generally have been offered a cash bail, four local criminal attorneys said.
The devices have subjected some defendants to more scrutiny than those individuals would have otherwise faced. They have also made it more obvious that the defendants were accused of a crime, and several said that having a visible monitor cost them a job or made it hard to attend school or care for a child or an older relative.
In a statement, Joel Currier, a St. Louis city circuit court spokesman, acknowledged that monitoring was “an imperfect tool,” but said that the court’s program balanced “the rights of the accused as well as the safety of crime victims and the community.”
Michael K. Mullen, a retired St. Louis city circuit judge who supports monitors, said the devices were better for defendants than jail.
“That’s what they have to be reminded of when they come in front of me,” he said.
But Matthew Mahaffey, who runs the city’s public defender office, which represents people who cannot afford attorneys, said that monitoring was too often required of people who posed no flight risk or threat to public safety.
Making matters worse, he said, the devices have occasionally malfunctioned and provided inaccurate readings.
“Until it gets cleared, it looks like a violation, which can put the client in a tricky spot,” Mr. Mahaffey said, adding that defendants had been sent back to jail or issued harsher sentences as a result.
Research has also shown that electronic monitoring can lead to isolation and prejudice from landlords and employers, said Kate Weisburd, an expert on surveillance and technology who teaches at U.C. Law San Francisco. She raised further concerns about privacy.
“As there is a growing appetite to end incarceration, there’s this knee-jerk reaction to want to substitute incarceration with something,” she said. “We can’t just strip people of their privacy rights the moment they are arrested for a crime.”
Dead Batteries and Missed Curfews
Last year, The Times sat in on dozens of pretrial bond hearings, which are held to determine whether a person who has been arrested will be released or held in jail, and interviewed more than 20 people who wore ankle monitors. The charges against them ranged from harassment and property damage to domestic assault.
James Neal wore a monitor for about six months last year after he sped away from a traffic stop. He was later charged with fleeing, resisting arrest and drug and firearm possession, court records show.
Mr. Neal, 42, was not allowed to carry a weapon because of a past felony conviction. He said he kept one anyway because of the city’s high crime rates.
Once the monitor was installed, Mr. Neal had to charge the device by connecting it to an outlet and sitting tethered to the wall for hours at a time. That was especially difficult while he was looking after his young son, he said.
Mr. Neal received violations because the battery died and because he left his house without the court’s permission, court records show. Once, he was cited for spending two nights at his mother’s house after a death in the family, the records confirm.
Mr. Neal pleaded guilty in July and was sentenced to probation.
Ms. Mason, who was sent back to jail last summer for the violations her monitor flagged, fell behind on her rent while she was incarcerated, she said. By the time she was released in August, she had been evicted from her north St. Louis apartment. She was in the second trimester of a new pregnancy.
Ms. Mason said the monitor affected her life in other ways. After wearing it to the hospital where she worked as a dietary worker, she lost her job. The hospital said she was let go because of poor attendance, but Ms. Mason said she had covered her absences with sick time.
In the months that followed, she said, potential employers zeroed in on her ankle at job interviews.
“I can’t really get a job or any good opportunities because people instantly judge me,” she said in October.
In December, a judge reduced Ms. Mason’s felony charges to a single misdemeanor. If she stays out of trouble for two years, the remaining charge will be expunged from her record.
She had the ankle monitor removed two weeks before giving birth in the new year.
‘Least Restrictive’ Conditions
The St. Louis city circuit court began using devices with GPS technology to monitor a small number of defendants about a decade ago. At first, the initiative drew criticism because of how it was funded: The private company running the program charged defendants installation and surveillance fees, and those who could not afford those fees could be sent back to jail.
The program remained small for years. But in 2019, amid a wave of bipartisan bail reform policies, the Missouri Supreme Court directed judges across the state to seek out alternatives to incarceration for defendants who could not afford bond.
In St. Louis, the number of people ordered to wear monitors spiked, data shows. The numbers held steady during the pandemic, when public health officials called for fewer people to be held in jails, and then surged when Gabe Gore — who cast himself as a law-and-order candidate — became circuit attorney and ramped up prosecutions.
In the cases The Times observed last year, prosecutors regularly recommended monitoring for people being considered for release. In a statement, Mr. Gore’s office said that monitors were not the default, and that prosecutors evaluated the facts of each individual case.
While defense lawyers can weigh in on the recommendation, judges ultimately decide whether a defendant will be detained or released, and whether monitoring is necessary. Judges are supposed to impose the “least restrictive” conditions to ensure public safety as well as the defendant’s return to court.
Mr. Currier declined to make Judge Christopher E. McGraugh, who became the court’s presiding judge in January, available for an interview.
In many ways, the St. Louis court has done more than most to make the monitors less disruptive to defendants’ lives. It now covers the costs of monitoring for those who cannot afford to pay, something many other courts across the country, including the neighboring St. Louis County circuit court, do not do. In recent months, the city’s circuit court has paid for almost 90 percent of people who were being monitored, data shows.
In addition, the court’s pretrial services office offers bus passes and mental health and shelter referrals to people with pending cases, Mr. Currier said.
Total Court Services, a company based in Michigan, is the court’s contractor for monitoring services. It rents a small office across the street from the courthouse; there, four or five employees keep tabs on more than 400 defendants at a time.
The vice president for sales and marketing, Jason Tizedes, said the company was trying to make monitoring less intrusive. It recently released a smartphone app that judges in the St. Louis city circuit court have started to use in a limited number of cases.
“If folks are lower risk, you don’t want to overmonitor them,” Mr. Tizedes said in an interview. “If you oversupervise, overmonitor people that don’t need it, it’s essentially setting them up for failure.”
As for the privacy concerns, Mr. Tizedes said, the company shares people’s location data only with court officials and law enforcement officers who have warrants. He blamed the job loss and the discrimination people with monitors sometimes face on unsympathetic employers.
David D. Hemphill, who works in home renovation, said he felt that discrimination while wearing a visible monitor last year. After landing fewer contracts than he expected, he fell into a depression.
Mr. Hemphill, 38, said that he had been arrested after failing to pull over for a traffic stop and leading the police on a 30-minute chase. He said that the officer who had initiated the stop was a neighbor, and that he did not trust the police.
Four months after the arrest, the charges against Mr. Hemphill were dropped, he said. But in that time, Mr. Hemphill became increasingly paranoid. His monitor beeped constantly and issued loud voice alerts. Sometimes he did not know whether the noises meant that the equipment was faulty or that he had unknowingly violated the terms of his release.
Once he began wearing his monitor, he noticed just how many of his co-workers on construction sites were wearing the same kind of device. He started talking to them about their experiences and realized that many felt the same as he did.
“Each violation plays on your mental,” he said. “You don’t know what the outcome is going to be. These people have your life in their hands.”
A Record Budget
Though many see it as a reform, electronic monitoring has drawn wide-ranging criticism both in St. Louis and across the country.
Blake Strode, the executive director of ArchCity Defenders, a St. Louis civil rights law firm that has challenged the use of cash bail and inhumane jail conditions, called the city circuit court’s monitoring program “an incarceration scheme” that set people up to be jailed for technical violations.
Mr. Strode acknowledged that judges used cash bail less frequently now, and that the jail population had shrunk. But electronic monitoring starts punishing people as soon as they are charged with a crime, he said, not after a finding of guilt.
“We should ask whether that trade-off is worth it,” Mr. Strode said.
The policy has also faced a different critique: that letting people accused of crimes await trial at home undermines public safety. Some critics have also said that court officials and prosecutors have not been aggressive enough in punishing people for violations.
In St. Louis, that argument gained traction in 2023, after a man awaiting trial on robbery charges ran a red light and seriously injured a teenage pedestrian. The defendant, Daniel Riley, had amassed dozens of GPS violations before the crash, but was never ordered to appear in court over the infractions. The city’s circuit attorney at the time, Kim Gardner, resigned amid the controversy.
National proponents of electronic monitoring like Carl Wicklund, a former executive director of the American Probation and Parole Association, continue to see the value in the system. But Mr. Wicklund said that people with the devices must be able to hold jobs, secure housing and be involved with their families, churches and communities.
Without those things, he said, defendants become “higher risk, because they have nothing to lose.”
According to the St. Louis circuit court’s 2023 annual report — the most recent it has published — nearly 87 percent of defendants who wore monitors completed their pretrial periods without a new arrest. The figure was nearly the same for defendants who awaited trial at home without monitors. (The court cautioned against using the statistics to draw conclusions about the effectiveness of monitoring, saying that the figures did not account for factors such as age, criminal history and substance abuse.)
Court officials’ investment in the program continues to grow. This fiscal year, the city budgeted more than $850,000 for the initiative, a record high for St. Louis. Budget documents show the court is on track to spend more than $1 million on the initiative.
In the spring, the court plans to solicit proposals from contractors interested in providing monitoring services after its current contract expires. Mr. Tizedes said Total Court Services was likely to submit a bid.
Justin Mayo contributed reporting. Susan C. Beachy contributed research.
This article was reported in partnership with Big Local News at Stanford University.
ABOUT THE ANALYSIS
To calculate the number of new ankle monitors activated in St. Louis, The Times analyzed hundreds of pages of monthly invoices that Total Court Services sent to the St. Louis City 22nd Circuit Court from October 2020 through June 2024. The invoices, obtained through a public records request, show how much Total Court Services billed for each defendant (identified by case number) who used 24/7 ankle monitoring services. The Times excluded defendants monitored only via the company’s smartphone app, CourtFact, which has a limited GPS component. The invoices specify start and end dates, as well as whether the court or the defendant was responsible for payment.
To calculate the share of monitored defendants who were charged with misdemeanors or class D or E felonies, The Times analyzed the court’s monthly pretrial data reports. The reports, which are available online, include monthly counts of defendants released from jail with GPS monitors broken down by class of charge.
Discrepancies between the invoices and the court’s reports are because the reports indicate the month judges ordered defendants to wear GPS monitors while the invoices indicate when the monitors were activated, and the two dates can be different. Additionally, pretrial data reports included defendants released with CourtFact smartphone monitoring in the totals. Beginning in June 2024, the reports included only defendants with GPS ankle monitoring.
Leslie Adams holds a photo of his mother, Shirley, who died after developing infected bedsores at a rehabilitation center, according to a lawsuit he filed. A court awarded the family $17 million, but they are still trying to collect it.
Taylor Glascock for KFF Health News
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Taylor Glascock for KFF Health News
By the time she was hospitalized in 2020, Pearlene Darby, a retired teacher, had suffered open sores on both legs, both hips, and both heels, as well as a five-inch-long gash on her tailbone. She died two weeks later at age 81 from infections and bedsores, according to her death certificate. Her daughter sued the nursing home, alleging it had left Darby sitting in her own feces and urine time and again.
The lawsuit, settled on confidential terms last year, blamed not only the managers of City Creek Post-Acute and Assisted Living but also the building’s owner, a real estate investment trust, or REIT. In the year Darby died, City Creek paid CareTrust REIT more than $1 million in rent, while the Sacramento, California, nursing home ran a deficit, court records show.
Federal tax rules ban REITs from running health care facilities, but CareTrust was not an absentee landlord either, according to internal records filed in the case. It chose the nursing home’s management company and required through the lease that the home keep at least 80% of beds occupied. CareTrust granularly tracked how well the home kept to its financial plan, down to the money spent monthly on nurses and food, the records said. And the documents showed that the real estate company kept tabs on government safety inspection findings and Medicare quality ratings.
Both CareTrust and the nursing home operator denied liability for Darby’s death. CareTrust officials said in court papers that it is not involved in day-to-day nursing home decisions or patient care, and that it monitors facilities to ensure nothing jeopardizes rent payments.
In a written statement, CareTrust Corporate Counsel Joseph Layne told KFF Health News: “We are the property owners, not the operators.”
Pearlene Darby, pictured here with her grandson Caleb Darby, was a resident of a Sacramento, California, nursing home. She died two weeks after being hospitalized for bedsores and an infection. The home denied liability and the case was settled out of court.
Shirlene Darby
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Shirlene Darby
Landlords with influence
Over the past decade, real estate investment trusts have bought thousands of buildings that house nursing homes, hospitals, assisted living facilities, and medical offices. A KFF Health News examination of court filings and corporate records shows that these landlords have more influence than the health care facilities publicly acknowledge.
The documents reveal REITs often select the management who oversee the operations and leave them in place even when they are aware of threadbare staffing, floundering governance, repeated safety violations, or other problems that hamper quality of care. A California jury in March awarded $92 million in punitive damages against a former REIT over the death of a 100-year-old resident with dementia who froze to death outside her assisted living facility.
“The REITs are in charge,” said Laraclay Parker, one of the lawyers who represent Darby’s daughter.
Absence of oversight
Despite their ubiquity, REITs remain invisible to state and federal health regulators. Hospitals and nursing homes are not required to disclose rent payments or landlord identities in the annual reports they submit to Medicare.
Under President Donald Trump, the Centers for Medicare & Medicaid Services indefinitely suspended a Biden-era requirement that nursing homes disclose REIT involvement. Catherine Howden, a CMS spokesperson, said in a statement that the agency does not regulate facilities based on their tax status or corporate form and instead focuses on the quality of the care they provide.
REITs now own a fifth of the nation’s senior housing, which includes assisted living, memory care, and independent living, according to an industry analysis. REITs also hold investments in 1 in 6 nursing homes. Publicly traded REITs that focus on health care are now worth nearly a quarter of a trillion dollars, according to Nareit, an industry association.
While one research study found REIT investments were associated with higher spending on nursing wages, another concluded that after being bought by REITs, nursing homes frequently replaced registered nurses with less skilled nurses and aides. A third analysis concluded that health inspection results were worse after REIT investment.
Researchers also found that investor-owned hospital chains that sold buildings to REITs were more likely to close or go bankrupt, as happened in 2024 with Steward Health Care. Often, private equity investors kept the sale proceeds as profits while the hospitals were burdened with new rent costs. “There were no improvements in clinical outcomes,” said Thomas Tsai, an associate professor at the Harvard T.H. Chan School of Public Health.
REITs are required to distribute most of their income and don’t have to pay the 21% federal corporate income tax on it. There is a catch: A REIT that “directly or indirectly operates or manages” a health care facility loses the tax break for five years. Typically, a REIT leases the property to another company that runs the nursing home or assisted living facility and maintains its tax break. Nareit said health care REITs distributed more than $7 billion in dividends in 2024.
Michael Stroyeck, head of health care analysis at Green Street, a real estate research company, said “there’s definitely a symbiotic relationship” between REITs and facility managers because they have the same goals. He said he has seen REITs replace operators that are having difficulties or go bankrupt.
John Kane, a senior vice president at the American Health Care Association and the National Center for Assisted Living, an industry group that represents nursing homes, said in a statement: “Given government funding often falls short, REITs have been valuable partners in helping to invest in long term care without influencing daily operations.”
Low staffing at a chain
Strawberry Fields REIT, which like CareTrust trades on the New York Stock Exchange, owns or controls the buildings of 131 nursing home facilities. The nursing home operations inside 66 of those facilities are owned by Moishe Gubin, Strawberry Fields’ chief executive, and Michael Blisko, one of its directors, according to Strawberry Fields’ annual report for last year.
Gubin and Blisko also jointly own Infinity Healthcare Management, which manages their nursing homes; Blisko is Infinity’s CEO. On average, Infinity-affiliated nursing homes provided an hour and a quarter less nursing care per resident per day than the national average of four hours, a KFF Health News analysis of federal records found.
Infinity and several of its nursing homes have recently settled 30 death and injury lawsuits in Cook County, Illinois, totaling more than $4 million, said Margaret Battersby Black, a Chicago lawyer. A jury last year awarded $12 million in a lawsuit brought against Infinity and one of its Chicago nursing homes over the 2023 death of Shirley Adams. A retired candy factory worker, Adams died after developing infected bedsores at Lakeview Rehabilitation and Nursing Center, according to the lawsuit.
“She had wounds that no one could explain,” one of her adult children, Leslie Adams, testified at trial. Medicare gives Lakeview its lowest quality rating, one star out of five.
Leslie Adams lost his mother, Shirley, who died after developing infected bedsores at Lakeview Rehabilitation and Nursing Center, according to a lawsuit he filed. “She had wounds that no one could explain,” he testified. (Taylor Glascock for KFF Health News)
Taylor Glascock for KFF Health News
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Taylor Glascock for KFF Health News
Paul Connery, a lawyer for Adams’ family, said they are still trying to collect on the judgment against the nursing home and management company, which now totals $17 million with interest and attorney fees.
“If I get caught speeding and I went to court, they issue me a ticket and I’ve got a fine to pay,” Adams said in an interview. “How are they able to still continue to move on with business like nothing has happened?”
In a phone interview and an email, Gubin said Strawberry Fields, Infinity, and the nursing homes are all legally distinct and that he has not played an active role in Infinity in more than a decade. He said nursing homes get sued all the time but that the verdict against Lakeview is so large that it will force the home to declare bankruptcy or shut down.
The owners and operators of Lakeview Rehabilitation and Nursing Center in Chicago also are directors of the real estate investment trust that owns the building, a securities filing shows.
Taylor Glascock for KFF Health News
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Taylor Glascock for KFF Health News
“The whole thing is unfortunate,” Gubin said by phone. “For 15 years they were a perfectly good guardian” and “a well-run building,” he said. “You wouldn’t think it was fair to be judged on your worst day.”
Blisko and an Infinity lawyer did not respond to requests for comment.
Strawberry Fields, which owns 10 assisted living facilities and two long-term care hospitals in addition to the nursing homes, earned net income last year of $33 million from $155 million in rent, a 21% profit margin, securities filings show. Gubin said those weren’t excessive returns.
A $110 million verdict
Traditionally, REIT leases make the operating companies responsible for paying property taxes, insurance premiums, and maintenance costs. In 2008, Congress gave health care REITs a new option to make money: On top of collecting rents, they could set up subsidiaries and take profits directly from health care businesses. They still must have independent management overseeing care decisions. Many REITs have embraced the role even though the subsidiaries must pay corporate taxes and risk losing money if the businesses do poorly.
Colony Capital was a REIT that through layers of shell corporations owned both the building and the operation of Greenhaven Estates, a Sacramento assisted living and memory care facility. In 2018 Greenhaven paid Colony $1.4 million in rent, nearly a third of its $4.5 million in revenue that year, according to financial records filed in court.
Greenhaven also was on the verge of losing its license, according to a revocation notice filed in November 2018 by the California Department of Social Services. Greenhaven had racked up years of health violations, including from letting untrained workers administer medications, lacking enough employees to care for people with dementia, and neglecting a resident who smeared feces over his body, bed, floor, and bathroom, the notice said.
In February 2019, a few weeks after celebrating her 100th birthday, Mildred Hernandez, a resident with Alzheimer’s, wandered out of Greenhaven in the middle of the night. Her assisted living wing had no exit door alarms even though it housed several residents with dementia, court records showed. Berta Lepe, one of Greenhaven’s caregivers, found Hernandez under a bush, wearing only a shirt and underwear. The temperature was in the 30s.
Mildred Hernandez was 100 when she died of hypothermia after wandering out of her assisted living facility in the middle of the night. A jury awarded $92 million in punitive damages against the owner of the home.
Ric Tapia
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Ric Tapia
“She was talking, but I couldn’t understand what she was saying,” Lepe testified at trial over a lawsuit from Hernandez’s family. Hernandez died of hypothermia a few hours later, according to her death certificate.
Frontier Management, the company that Colony had hired to manage Greenhaven, denied liability and settled the lawsuit on undisclosed terms.
Since the lawsuit, Colony has changed its name to DigitalBridge, which no longer owns Greenhaven and gave up its REIT status. At trial earlier this year, DigitalBridge said resident care was the responsibility of Frontier and that Colony “encouraged” Frontier to address problems. Richard Welch, a former Colony executive, testified that replacing management is disruptive. “I viewed it as a last resort,” he said.
In March, a jury awarded Hernandez’s family a total of $110 million: $10 million in compensatory damages, $92 million in punitive damages against DigitalBridge, and $8 million in punitive damages against Formation Capital, an asset management company.
“REIT money is very detached from knowing about or caring about patient or resident outcomes, because it’s not in their business model,” Ed Dudensing, a lawyer for the family, said in an interview. “Their allegiance is to their investors.”
DigitalBridge has asked the judge to delay finalizing the judgment while its legal challenges to the lawsuit and the verdict are evaluated. A DigitalBridge attorney and a corporate spokesperson did not respond to requests for comment, a Formation attorney declined comment, and a Frontier attorney and a spokesman did not respond to a request for comment.
‘Wet from head to toe’
When CareTrust bought City Creek Post-Acute and Assisted Living in 2019, the Sacramento nursing home where Pearlene Darby lived had a one-star Medicare rating and was losing money. CareTrust leased the building to a management company called Kalesta Healthcare Group based on the business plan Kalesta submitted.
While CareTrust was not the operator, it held periodic phone calls with Kalesta, which provided “a full update of what’s happening at the facility,” including changes in leadership, financial progress, and health inspection survey results, according to deposition testimony by Ryan Williams, a Kalesta co-founder.
According to a state inspection report, in 2020, the year Darby died, City Creek left a resident in soiled linens “wet from head to toe lying in bed” for more than eight hours. During a different visit, a health inspector cited the home after watching a nurse put a dirty diaper back onto a resident after caring for a wound. “It was just a small stool and it is far from where the wound is,” the nurse told the inspector, according to the report.
James Callister, CareTrust’s chief investment officer, said in his deposition that CareTrust officials “review results of regulatory surveys provided to us by the tenant. We review the five-star rating.” He said, “We evaluate results of care, but we do not evaluate types of care given or how or when, no.”
Darby had been living in City Creek since 2011 after a stroke left her in a wheelchair. She needed help getting in and out of bed. From September through November 2020, Darby lost 30 pounds, her family’s lawsuit alleged. During those months, employees dropped her three times as one worker rather than the required two operated the mechanical lift, the lawsuit said.
The suit alleged City Creek failed to reposition her every two hours in bed or her wheelchair, which is the clinical standard for people at risk of bedsores, and to promptly order devices to protect her skin.
In November, the nursing home sent Darby to the hospital. A blood test found bacteria had entered her bloodstream from her feces’ touching open skin wounds, according to the lawsuit. The hospital diagnosed her with sepsis. A surgeon said she needed an operation to redirect fecal waste from her intestines but concluded she wasn’t medically stable enough for surgery, the suit said.
Darby began receiving comfort care measures and was sent back to City Creek. She died two weeks later. In court filings, CareTrust and Kalesta denied the allegations.
In a phone interview, Williams, the Kalesta co-founder, said Darby’s death occurred during the most challenging point of the covid pandemic, when California rules required any nurses testing positive for the virus to be sent home and nurses were quitting out of fear for their health. “It was the most herculean of professional efforts to secure enough staff,” he said.
While expressing sympathy for Darby and her family, he said it was “unconscionable” that personal injury lawyers sued nursing homes over care failures during “the worst of times.”
In court, CareTrust petitioned Judge Richard Miadich to dismiss it from the lawsuit before trial. “This case does not concern a property condition,” CareTrust’s lawyers wrote. “CareTrust is simply a landlord.” But the judge ruled last year a jury should decide whether CareTrust “exercised actual control over City Creek.”
The case was settled out of court a few months later. All parties declined to reveal the settlement terms.
A 67% Profit
As recently as November 2023 — four years after its acquisition — City Creek earned one star from Medicare. It was cited for failing to have the minimum nursing home staffing required by California law during five of 24 randomly selected days in 2022, according to an inspection report. Williams said in the interview that Kalesta had increased spending on nursing over the course of its ownership, including boosting wages, but that it takes a year or two to turn around a troubled nursing home. He said the home’s star rating in 2023 was dragged down by its poor inspection history from before Kalesta took over.
City Creek’s rating has climbed in the past two years, and it now has the top overall rating of five, according to Medicare. Medicare rates City Creek’s current staffing levels as average. That’s better than most nursing homes in more than 200 buildings CareTrust bought before 2025, according to a KFF Health News analysis of federal data. On average, CareTrust nursing homes provided a half hour less nursing care per resident per day than the national average of four hours.
In its statement to KFF Health News, CareTrust’s counsel Layne said the REIT worked to “identify quality operators as tenants,” and that the homes the REIT rents out have more nurses and aides than the minimum required for nursing homes by their state governments. “The operators are licensed by state regulators and retain sole responsibility for operations,” the statement said.
CareTrust, which now owns more than 500 senior housing and nursing home buildings, reported net income last year of $320 million from $476 million in rents and other revenue — a 67% profit margin. As one point of comparison, HCA Healthcare, one of the nation’s largest for-profit hospital and health care chains, reported a 10% profit margin for last year.
Lesley Ann Clement, one of Darby’s lawyers, said cases like hers show the nursing home industry is wrong to complain it lacks financial resources for more staffing.
“There’s plenty of money,” Clement said. “They’re just not spending it on patient care.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
The US is planning to board and seize Iran-linked oil tankers and commercial ships in the coming days, according to a Saturday report by The Wall Street Journal.
The report noted that these actions would take place in international waters, potentially outside of the Middle East.
The US “will actively pursue any Iranian-flagged vessel or any vessel attempting to provide material support to Iran,” US Chairman of the Joint Chiefs of Staff Gen. Dan Caine said. “This includes dark fleet vessels carrying Iranian oil.”
“As most of you know, dark fleet vessels are those illicit or illegal ships evading international regulations, sanctions, or insurance requirements,” Caine continued.
Caine was further quoted as saying that the new campaign, which would be operated in part by the US Indo-Pacific Command, would be part of a broader US President Donald Trump-led campaign against Iran, known as “Economic Fury.”
White House spokeswoman Anna Kelly told the WSJ that Trump was “optimistic” that the new measures would lead to a peace deal.
The potential US military action comes as Iran tightens its grip on the Strait of Hormuz, including attacking several ships earlier on Saturday, the WSJ reported.
The report cited CENTCOM as saying that the US has already turned back 23 ships trying to leave Iranian ports since the start of its blockade on the Strait.
The expansion of naval action beyond the Middle East will provide the US with further leverage against Iran by allowing it to take control of a greater number of ships loaded with oil or weapons bound for Iran, the report noted.
“It’s a maximalist approach,” said associate professor of law at Emory University Law School Mark Nevitt. “If you want to put the screws down on Iran, you want to use every single legal authority you have to do that.”
Iran claimed earlier on Saturday that it had regained military control over the Strait, intending to hold it until the US guarantees full freedom of movement for ships traveling to and from Iran.
“As long as the United States does not ensure full freedom of navigation for vessels traveling to and from Iran, the situation in the Strait of Hormuz will remain tightly controlled,” the Iranian military stated.
In addition, Iranian Supreme Leader Mojtaba Khamenei declared on Saturday in an apparent message on his Telegram channel that the Iranian navy is prepared to inflict “new bitter defeats” on its enemies.
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