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Trump Asserts a Muscular Vision of Presidential Power on First Day Back

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Trump Asserts a Muscular Vision of Presidential Power on First Day Back

After President Trump left the White House in 2021, critics of his norm-breaking use of executive power implored Congress to tighten legal limits on when presidents can unilaterally reshape American government with the stroke of a pen. But lawmakers largely did not act.

On Monday, as Mr. Trump took the oath of office to begin his second term, he asserted a muscular vision of presidential power. He not only revived some of the same expansive understandings of executive authority that were left unaddressed, but went even further with new claims of sweeping and inherent constitutional clout.

Among a blizzard of executive orders, Mr. Trump instructed prosecutors not to enforce a law that bans the popular social media app TikTok until its Chinese owner sells it. President Joseph R. Biden Jr. had signed the measure into law after it passed with broad bipartisan support, and the Supreme Court unanimously upheld it.

Whatever the law’s merits, the Constitution says presidents “shall take care that the laws be faithfully executed.” Mr. Trump offered no clear explanation for how he has any legitimate power to instead suspend the law, making only a vague gesture toward his “constitutional responsibility” for national security, foreign policy “and other vital executive functions.”

Unilateral actions like emergency declarations and executive orders cannot create new legal powers for a president. Instead, they are a vehicle by which presidents exercise legal authority they already have, either because the Constitution has bestowed it upon their office or because Congress passed a law creating it.

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That said, there are often disputes about the proper interpretation of the scope and limits of executive power. It is not uncommon for a president to use an executive order to take some action whose legal legitimacy is contested, leading to court fights that ultimately come before the Supreme Court.

It is not clear that anyone opposed to suspending the TikTok law would have standing to sue. But many of Mr. Trump’s moves concerned immigration law, making it very likely that legal challenges will follow and the legitimacy of his executive power claims will land before judges.

In several orders, Mr. Trump invoked his constitutional role as the military’s commander in chief, portraying migrants as invaders while blurring the line between immigration law enforcement and war powers.

“As commander in chief, I have no higher responsibility than to defend our country from threats and invasions, and that is exactly what I am going to do,” he said in his inaugural speech.

Among those orders, Mr. Trump declared that newly arriving migrants may not invoke a law allowing them to request asylum. As a basis, he said the Constitution gave him “inherent powers” to “prevent the physical entry of aliens involved in an invasion into the United States,” in addition to citing a few vague provisions of immigration laws.

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Another such order directed the U.S. Northern Command, which oversees military operations in continental North America, to swiftly draw up a plan for a “campaign” to seal the border “by repelling forms of invasion including unlawful mass migration, narcotics trafficking, human smuggling and trafficking, and other criminal activities.”

Mr. Trump and his advisers have talked about invoking the Insurrection Act to use troops as additional immigration agents at the border. But the order referred only to his constitutional power as commander in chief, raising the possibility that he is envisioning using troops for a military operation rather than to act as law enforcement.

Some of the orders were a return to fights over executive power that surfaced during Mr. Trump’s first term.

On Monday, Mr. Trump reprised a move from 2019 by declaring a national emergency at the border. He also invoked a statute that allows presidents, during an emergency, to redirect military funds for construction projects related to the exigency. His purpose, in 2019 and again now, was to spend more taxpayer money on a border wall project than lawmakers authorized.

Is there really an emergency that an extended border wall would address, and that would justify circumventing Congress’s role in deciding where to direct taxpayer money?

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A wall does not address the main border problem in recent years: the overwhelming number of migrants requesting asylum, flooding the system and leading to lengthy backlogs for hearings. And over the past seven months, illegal crossings have plunged to the lowest levels since the summer of 2020, during the early phase of the coronavirus pandemic.

But facts matter little to whether or when it is legal for presidents to invoke emergency power, declarations that are governed by the National Emergencies Act of 1976.

That law does not tightly define the circumstances under which presidents may determine that an emergency exists, leaving them with essentially unfettered discretion to unlock exigent powers for themselves. But previous presidents adhered to norms of self-restraint.

In his first term, critics challenged the legal legitimacy of Mr. Trump’s border wall spending, but the Supreme Court never resolved the dispute before Mr. Biden took office and canceled the projects. So any new legal challenge would have to start from scratch.

In the wake of Mr. Trump’s first term, House Democrats in 2021 passed a bill that would have tightened limits on presidential use of emergency powers, part of a package of reforms they called the “Protecting Our Democracy Act.” But Republicans opposed the measure as a partisan attack on a president who was no longer in office anyway, rendering it dead on arrival in the Senate.

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Mr. Trump’s absence from the presidency, however, turned out to be temporary.

In the show of force upon his return to office, he also declared a national energy emergency so that, as he said in his inaugural speech, “we will drill, baby, drill.” No president has declared that type of emergency before, and it empowers him to suspend legal protections for the environment and to speed up permits for new oil and gas projects.

The nation’s energy situation hardly seems like an emergency: The United States is producing more oil than any country ever has, in no small part because of the fracking boom and because of thousands of new permits to drill on federal lands issued by the Biden administration — outpacing Mr. Trump’s first-term record. Prices for gasoline, natural gas and electricity are relatively low compared with their historical levels.

But the order said Mr. Trump had determined that Biden administration policies had “driven our nation into a national emergency, where a precariously inadequate and intermittent energy supply, and an increasingly unreliable grid, require swift and decisive action.” He also cited a growing need for electricity to run computer servers for artificial intelligence projects.

Elizabeth Goitein, a director of the Brennan Center for Justice’s Liberty and National Security Program who has written extensively on presidential emergency power, predicted that many of Mr. Trump’s planned actions would be challenged in court.

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“Emergency powers should never be used to address longstanding problems like unlawful migration that can and should be addressed through legislation,” said Ms. Goitein, who was among those calling on Congress to curb presidential power. “The bad news is that Congress failed to enact reforms to the National Emergencies Act that would have helped prevent such abuses.”

There is no dispute that Mr. Trump had legitimate authority to take other unilateral actions. The Constitution clearly gives presidents unfettered authority to grant pardons to people for federal criminal offenses or to commute their sentences, for example, so there is little doubt Mr. Trump had the power to grant clemency to all of the nearly 1,600 people charged or convicted of crimes in connection with the Capitol riot.

But Mr. Trump appeared to put forward novel or expansive interpretations of legal authorities in other ways.

He ordered his administration to make recommendations about whether to designate certain transnational gangs and drug cartels as “foreign terrorist organizations,” stretching a law that is intended for groups that use violence for geopolitical and ideological purposes to criminal groups that, while also violent, are motivated by profit.

He also set in motion the possibility of invoking the Alien Enemies Act of 1798 to summarily expel immigrants suspected of being members of drug cartels and transnational criminal gangs without full due process hearings. That law’s text seems to require a link to the actions of a foreign government, so it is not clear whether the courts will allow Mr. Trump to invoke it to deny deportation hearings to people.

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Mr. Trump is also seeking to change the basic understanding of a provision of the Constitution’s 14th Amendment that grants citizenship to most babies born on American soil and “subject to the jurisdiction” of the U.S. government. That provision has long been understood to include infants born to undocumented parents.

In an order, Mr. Trump invoked a theory developed by conservatives who want to curtail so-called birthright citizenship because they see it as a magnet for illegal immigration. By that rationale, the provision could be interpreted to not apply to babies whose parents are not American citizens or lawful permanent residents, even though visitors or undocumented people are subject to the jurisdiction of government prosecutors if they break the law.

Mr. Trump instructed agencies to refrain from issuing citizenship-affirming documents — like passports and Social Security cards — to infants born to undocumented immigrants or to parents lawfully but temporarily visiting the United States, starting with births 30 days from now.

Hours later, critics, including a coalition of Democratic-controlled states, brought multiple court challenges against it. Mr. Trump, the coalition asserted, sought to breach “this well-established and longstanding constitutional principle by executive fiat.”

It was yet another legal claim that seemed destined to come before the Supreme Court.

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Video: 8 Children Killed in Louisiana Shooting, Police Say

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Video: 8 Children Killed in Louisiana Shooting, Police Say

new video loaded: 8 Children Killed in Louisiana Shooting, Police Say

A gunman shot 10 people, killing eight children, in a domestic violence shooting at multiple locations in Shreveport, La., the police said. The victims ranged in age from 1 to 14. The gunman was later fatally shot by officers.

By Christina Kelso

April 19, 2026

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Communities launch cleanup after severe weather and tornadoes churn across Midwest

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Communities launch cleanup after severe weather and tornadoes churn across Midwest

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.

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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 tornado on April 18, 2026 in Lena, Illinois.

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.

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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.

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Real estate investors are buying up long-term care facilities. Residents can suffer

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Real estate investors are buying up long-term care facilities. Residents can suffer

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.

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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.

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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 is shown in a family photo with her grandson Caleb Darby. She has a big smile and they are both doing a dance move, with an outstretched arm.

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.

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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.

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“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.

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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.”

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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 is shown sitting on a staircase outside a brick building.

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)

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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.

A multistory brick building on a city street is show. Two bare trees are visible. The word "Lakeview" appears on an awning, and a large sign says, "Thank you, Staff."

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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“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.”

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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.

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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 is pictured in a midrange photograph. She is smiling broadly and has curly gray hair.

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.

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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.

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“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.

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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.

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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.

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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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