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The Long Goodbye: A California Couple Self-Deports to Mexico
Enrique Castillejos and his wife stopped at a Winchell’s Donut House. It was part of their after-church routine on Friday nights.
That evening’s sermon had been about finding peace in God in turbulent times, and they felt it spoke directly to them. Enrique, 63, and his wife, Maria Elena Hernandez, 55, were undocumented immigrants. Like millions of others in Southern California, they had been looking over their shoulders as federal agents conducted immigration sweeps.
Freedom, they felt, had become impossible in the land of the free. They had made a decision: Leave America and move back to Mexico.
The process has the sterile, bureaucratic name of self-deportation. For Enrique and Maria Elena, it resembled a long, slow-motion goodbye. It took an emotional, spiritual and logistical toll on everyone around them, including their three children and two grandchildren. They had to decide what to do with their old, beloved dog and their trucking business. They had to suddenly cut ties with their church and their neighbors. Visitors bearing gifts dropped by unannounced.
Maria Elena had suggested to Enrique that he leave for Mexico first, while she waited for her broken foot to heal. “No,” she recalled Enrique telling her. “Together we came and together we go.”
Their decision to go came long before the Trump administration’s crackdown in Minneapolis, and long before federal operations intensified in their own San Bernardino County neighborhood. Returning to Mexico had always been in the cards. But they had wanted to go on their own terms, retiring there someday. The Trump administration’s crackdown had prompted them to make that “someday” now.
The couple’s departure hit the family hard. They watch the news now with conflicting emotions, as Enrique and Maria Elena start their lives over in Mexico and their adult children struggle to carry on without them. None of the couple’s friends or relatives tried to change their minds, and there were few heated debates over the decision. In their community, the federal immigration raids made such an extreme move seem entirely reasonable.
“It’s a mixture of all those feelings — being grateful for knowing that they’re safe, and at the same time, hating that this is the way it has to be,” said Lizbeth Castillejos, 29, the couple’s oldest daughter.
Back at the coffee shop, Maria Elena and Enrique could feel the clock tick. It was Aug. 8. They had just two weeks left. Their nearly 30 years in the United States were coming to an end.
“Ya casi,” Enrique told her: Almost time.
Maria Elena set down her coffee cup. “Ya casi,” she repeated.
Maria Elena had to squeeze her belongings into just a few suitcases. She insisted on taking a little piece of home with her: her curtains.
Some were thin and delicate, others thick to dampen sound. Gold, red, green — a color for every season. They had rented the house in Bloomington, an unincorporated community some 50 miles east of Los Angeles, for more than 10 years. It was semirural, with dirt sidewalks and residents on horseback. Outside, Enrique kept chickens in the backyard. Inside, Maria Elena had her curtains.
To make room in the luggage for them, Maria Elena took out all the socks. Her younger daughter, Helen, 23, a schoolteacher, told her not to worry because they could get new things in Mexico.
Eventually, Maria Elena gave up. Leaving America meant leaving her curtains, too.
It was lunchtime. Maria Elena and Enrique had just sat down at the kitchen table, plates of bistec, white rice, black beans and diced cactus spread out before them.
There was a sudden pounding at the door. For a moment, the conversation grew quiet.
For months, masked immigration agents had seemed to appear everywhere in Southern California, and fear gripped entire communities. Except for doctor’s appointments for her broken foot and strategically timed trips to the market, Maria Elena had stopped leaving the house.
One day, Enrique had called his daughter Lizbeth, who works for a local immigrant rights group. A white sedan was tailing him. He thought it might be ICE.
Nothing had come of it, but it was another sign that life as they knew it in the United States was over.
They were afraid of being picked up by agents, not so much because of the threat of deportation but because of the uncertainty of detention. One goal of the Trump administration’s mass deportation campaign is to effectively scare people into self-deporting while dangling financial incentives to leave. Enrique and Maria Elena had decided not to accept the administration’s offer of $1,000 and a flight home to migrants who deport themselves because they did not trust the government to honor the arrangement.
Ultimately, there had been no dramatic incident that spurred their departure; they had simply grown weary, day after day, of watching their world shrink to fit only the bounds of their home.
“He said he would go after criminals, and we don’t consider ourselves criminals,” Maria Elena said of the president, adding, “We consider ourselves working people. It turns out, for him, we’re all criminals.”
Although they were living in America illegally, the couple saw no contradiction in that: Undocumented immigrants were part of the fabric of everyday life in Southern California. Over time, it didn’t seem especially risky.
Still, they expressed regret that they had never obtained legal status. In 2006, Maria Elena and her children had joined protests in Los Angeles demanding amnesty for undocumented immigrants. The family had also discussed another pathway: If one of their children joined the military, Maria Elena and Enrique could get the right to stay. Each of their three children had seriously considered signing up when they turned 18. But the couple never wanted their children to set aside their dreams and careers for their parents.
Were immigration agents now at the front door? Responding to the pounding, Enrique and Maria Elena’s son, Joaquin, 26, bolted to open it. It was their close friend, Kiké, dropping by to say hello.
Everyone was anxious about Rex, the family’s scruffy 14-year-old dog. Maria Elena and Enrique had decided to put Rex down before they left. He was ailing, could hardly walk and was in constant pain.
Rex had seen Joaquin and Helen grow from children to adults. One day, when Joaquin was away in college, he learned his parents were giving the dog to a family friend because Rex had been killing chickens in the backyard. Joaquin raced home. He took Rex in himself.
This time, Joaquin was not stepping in to save him. Everyone had agreed that Rex was suffering. Still, saying goodbye to the dog was like saying goodbye to a member of the family. Rex was a “constant,” as Helen put it, and those constants were ending as the family prepared for self-deportation.
“It needs to be done soon,” Helen told her dad over dinner as they discussed when to put down Rex. But she didn’t want it done this soon.
“Right now, there’s too much loss,” she added. “I can’t do both.”
A nervous Enrique stood at the front of the church and clutched the microphone. He was telling the congregation, with Maria Elena standing at his side, that they were leaving for Mexico.
To Enrique, it wasn’t so much the president’s will, but God’s.
He saw self-deportation as an opportunity to spread the word of God to his family back in his hometown of Mapastepec, near the plot of land in rural Chiapas where they had decided to move. He found comfort in Psalms 37, which says that God does not forsake those who believe.
Every Sunday, Enrique carried a composition book with notes on Scripture and a Bible with his name scrawled on the side. Maria Elena brought a tambourine for the hymns. And in the house, Enrique led prayers before meals.
For Maria Elena, leaving the United States was a way for her to come clean with God. For years, the couple said, Enrique had been using another person’s identity — a common but illegal way for undocumented immigrants to get the paperwork they need to work in the country. They said that not long after arriving in the United States, a friend had helped Enrique use the identity of a Honduran who had work authorization. Last year, the Trump administration moved to end that type of work authorization, making it harder for Enrique to keep using that identity.
Guilt weighed on Maria Elena. “We got tired of living in a lie,” she said, adding, “We have to be good before God. You can’t be a child of God and lie with two names.”
She already had a name for the plot of farmland awaiting them in their native Chiapas: Rancho La Promesa de Dios. God’s Promise Ranch.
At the church, a long line formed before them. For half an hour, one by one, congregants gave them tearful hugs.
Michael, 2, bounced around the living room, his brightly colored toys scattered all over the tiled floor. Olivia, 4, was fixated on a cartoon on the television.
Maria Elena was on grandmother duty.
Grandma and Grandpa’s house was where the little ones learned Spanish, and where Enrique cut up fruit to feed them one piece at a time. It was days like these that the grandparents cherished. It was days like these that made Maria Elena cry.
“It’s only when I look at my grandchildren and say to myself, ‘Who is going to take care of them?’”
Enrique grabbed his belongings from the old turquoise Toyota. His longtime friend who had dropped by to say hello that one day, Kiké, was there to pick it up. For Enrique, it meant the old clunker was one less thing he had to get rid of.
Kiké and Enrique had much in common, including their names. Kiké is short for Enrique. The two men are from the same town in Mexico, and they ended up here in the same place in America.
Kiké was sad to see them go, but he, too, was contemplating leaving because of the Trump administration’s immigration crackdown.
“A lot of fellow paisans are wanting to leave,” he said. “It doesn’t look like this thing is going to get resolved. It’s going from bad to worse.”
Each sibling took turns on the mic.
It was Enrique and Maria Elena’s farewell party, at a nearby property. Earlier that day, the family had said goodbye to Rex before putting him down. At the party, a mariachi belted out Christian ballads. Butterflies — a symbol of migration — decorated a towering fruit spread.
Joaquin said he would miss the little things, like stopping by on his lunch break for his mom’s beans.
Helen, the youngest, talked about how there was always mom and dad. When her older siblings had moved out, she had remained. Now, for the first time, the unit of three — Helen, Maria Elena and Enrique — would be apart.
Lizbeth tried to focus on the positive.
She said this was a fresh chapter. Their parents’ legacy in America would live on. Three college-educated children with dignified careers. And two grandchildren, one old enough to express her wish to spend every summer in Chiapas.
On the party invitation cards Lizbeth had sent out weeks earlier, there was nothing that suggested the gravity of self-deportation. The occasion was simply titled “New Beginnings.”
It was Aug. 24. Sixteen days had passed since that stop at the donut shop after church.
At the house in Bloomington, after instant coffee and pan dulce, the family huddled in the living room and bowed their heads. This was the day Maria Elena and Enrique were self-deporting.
“This morning, our father, we’re grateful to you because you have kept us here in this land, in this country for 29 years,” Enrique said. “And we thank you because you never abandoned us.”
Then they squeezed into the van and set course for the two-hour trip to the border crossing in San Diego.
In the blink of an eye, as they crossed into Mexico, 29 years reset to zero. This was the couple’s first time returning to Mexico together. It was their home country, but a sense of wonder seemed to overtake Maria Elena and Enrique. They had entered the United States nearly three decades ago, crossing that same border on foot. They had initially intended to stay for a few years, save up money and return to Mexico, but after they had children, their plans changed.
“Saliendo del sueño Americano y ahora entramos al sueño Mexicano,” Maria Elena told her family in the van: Leaving the American dream and now entering the Mexican dream.
A bright day greeted them in Tijuana as they strolled through downtown. Maria Elena ambled around on a scooter for her broken foot, feeling out of place. Joaquin put his arms around her, trying to cheer her up. They planned to stay at a relative’s house until their flight to Chiapas.
In the months to come, Maria Elena and Enrique would try to adjust to life in Mexico. They would stay with relatives, and make slow progress fixing up a small dwelling on their plot of land. They would find themselves at times overwhelmed and homesick.
But before all of that, on this first bright day in Tijuana, Enrique pulled out his Mexican I.D. and smiled. It might have felt like any other family trip. The political forces and fears that had forced them to leave went unspoken.
After the siblings had dropped off their parents in Mexico and headed back home in the van, they felt a sense of optimism as they waited in the long line at the port of entry. Vendors selling churros, chips and religious ornaments paced between cars.
Joaquin lamented that there was no time for a final Dodgers game with his dad or a family trip to the beach.
Lizbeth assured him there would plenty of memories for them to make in Chiapas.
Helen, the schoolteacher, was anxious to get home and prepare her lesson plan for the week. She read aloud a list her mom had given her. It had all of the things she had forgotten to pack but wanted from home the next time she saw them.
“No. 1,” Helen read aloud in the van, “look for my earrings.”
Hours had passed when a customs agent finally waved them into the United States. Soon, everyone except the driver slipped into a slumber, and the road home was quiet.
They slowly woke up as the car rolled up to the house in Bloomington.
Olivia, 4, realized she was at Grandma and Grandpa’s house. Then, it dawned on her. Grandma and Grandpa were not there. She cried out for them.
The siblings embraced in the middle of the driveway. Their parents had once described what it felt like to leave life behind in America. They said it felt like a kind of death.
Lizbeth, surrounded that night with her loved ones on the driveway of her parents’ empty house, felt the same way, too. She called it grief.
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By Christina Kelso
April 19, 2026
An aerial view shows damage from a tornado, on Saturday in Lena, Ill.
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Communities across the Upper Midwest are cleaning up after tornadoes and severe weather impacted the region over the weekend, damaging and destroying dozens of homes and knocking out power for tens of thousands.
“Numerous” severe storms were tracked across parts of Iowa, Illinois and Missouri on Friday, according to the National Weather Service. At least 66 tornado reports were submitted in multiple states including Oklahoma, Illinois, Missouri, Wisconsin and Iowa, the NWS Quad Cities IA/IL office said Sunday.
No deaths have been reported from the severe weather and tornado outbreak.
In Marion Township in Minnesota, about 30 homes were damaged and a dozen have significant damage because of a tornado, according to the Olmsted County Sheriff’s Office. The tornado also damaged at least 20 homes in Stewartville and there is a temporary shelter in Rochester for people displaced by the storms, according to MPR News.
“Tornado disaster recovery continues to occur at full speed,” the Olmsted County Sheriff’s Office said on Saturday.
In Illinois, McClean County officials declared a disaster emergency because of severe storms in Bloomington. “At this time, no injuries have been reported, and emergency response agencies remain actively engaged to ensure public safety and continuity of essential services,” officials said in a statement.
But further north in the village of Lena, an EF-2 tornado caused the “most significant damage” where “many homes and outbuildings were damaged, trees uprooted, and power lines downed,” the NWS said. Numerous roads have also been blocked by debris, the Stephenson County Sheriff’s Office also said.
People continue to clean up following a tornado, on Saturday in Lena, Ill.
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There have been no fatalities and no reports of serious injuries associated with the storm, Chief Deputy Andy Schroeder from the Stephenson County Sheriff’s Office told NPR on Sunday.
More than 43,000 customers lost power in Illinois but power was restored to almost all of them by Saturday night, according to electric utility ComEd.
Several tornadoes also occurred across Wisconsin, according to the NWS office in La Crosse. Twenty-six tornado warnings were issued by the office on Friday, the most in one day since the weather service office was built in 1995.
In one Marathon County town, 75 homes were destroyed by a tornado, according to Ringle Fire Chief Chris Kielman.
“It took out a whole residential area,” Kielman said, according to Wisconsin Public Radio.
The American Red Cross of Wisconsin said volunteers are helping those impacted by the storm with meals, shelter and support.
Parts of the state are still dealing with multiple rounds of severe weather and tornadoes from earlier in the week that brought flooding to some communities.
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.
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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.
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South-Carolina45 seconds agoSouth Carolina Lottery Pick 3, Pick 4 results for April 19, 2026
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South Dakota7 minutes agoFCS Football Recruiting Roundup: South Dakota, Montana State Target 2027 Defensive Standouts
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Tennessee13 minutes agoNashville Sounds and Autism Tennessee partner to host inclusive Beyond the Label Day for local children
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Texas19 minutes agoTexas A&M Forward Transfer Seemingly on Visit to See Lady Vols Basketball | Rocky Top Insider
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Utah25 minutes agoGolden Knights vs. Mammoth Game 1 prediction: NHL odds, picks, best bets for Stanley Cup Playoffs
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Vermont31 minutes agoVermont lawmakers reject digital lottery initiative – Valley News
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Virginia37 minutes agoVirginia’s special election redistricting battle is next week and has national impacts
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Washington43 minutes agoThe Church of Jesus Christ has announced its 384th temple