State Spotlight: Pennsylvania - The SNF Operator's Nightmare 🔥
Pennsylvania has earned its reputation as the absolute worst state for nursing home operators, and with 661 facilities spread across the Keystone State, there's a lot of pain to go around. Here's why Pennsylvania combines the worst of all worlds: terrible Medicaid rates, aggressive plaintiff attorneys, hostile regulators, punitive oversight, and a legislature that actively tries to block private investment. It's basically designed to bankrupt nursing home operators while generating maximum legal fees for trial lawyers.
Before we get into the hell that PA is for most SNF operators, let's take a look at the players in this great State:
PENNSYLVANIA'S POWER PLAYERS
SABER HEALTHCARE GROUP - 40 Facilities
The Dynamic Duo Who Built an Empire
George Repchick and Bill Weisberg started Saber Healthcare in 2001 with a single inner-city nursing home in Cleveland (turned a $240,000 monthly loss into an average annual profit of $3 million), and grew it to 117 assisted and skilled nursing facilities generating just under $1 billion in revenue annually.
George started as a Resident Assistant, became a licensed nursing home administrator, worked his way up through Beverly Enterprises (then the largest long-term care company in the nation). Nice going George.
The guy gives back too. His donation to Pitt-Bradford was "one of the largest ever made by a Pitt-Bradford alumnus," funding athletic fields and nursing program scholarships. Kol Hakavod.
The Pennsylvania Chapter: In 2018, Saber took over 10 Pennsylvania facilities from the failed Oak Health chain after it went into receivership owing $10.5 million in rent.
Like every large operator, Saber has its share of citations - that's inevitable when you're operating 140+ facilities. But building a billion-dollar company from one struggling Cleveland nursing home? That's the American dream chevreh.
Ok that's enough goyim for now.
MARQUIS HEALTH SERVICES - 23 Facilities
Next we have one of the top yiddish SNF companies: Marquis.
Owned by Norman Rokeach who started in healthcare in 1999 as a Facility Administrator, worked his way through Beverly Enterprises as Regional Director and then realized he could do this on his own.
75% of Marquis facilities have four- or five-star CMS ratings. That's legitimately impressive - most large operators struggle to maintain quality during rapid expansion. Marquis has a very good reputation overall and they seem to run things very professionally.
Norman Rokeach credits success to "working hand-in-hand with health systems, understanding their metrics and aligning ourselves with their goals". Ok sure Norman. It could not possibly be hard work ethic, huge balls and many blessings from Hashem. Anyway they definitely work smarter at Marquis. For example, apparently they created a Hispanic Community Program at a SNF with bilingual staff and authentic cuisine to serve the local community. Smart yiddin.
PRIORITY HEALTHCARE GROUP - 19 Facilities
Ok next we have 2 pillars of the 5 towns community.
Founded in 2015 by David Gamzeh and Akiva Glatzer. Priority specializes in - to put it as boringly as possible - "improving under-performing long-term healthcare facilities." Why do I feel like these guys have actual college degrees?
The Golden Living Gamble: In February 2017, Priority purchased licenses for 11 Golden Living homes after the chain was sued by Pennsylvania's Attorney General for failing to provide proper care. Golden Living had become toxic - sued, investigated, and hemorrhaging facilities.
Priority walked into a nightmare scenario: Golden Living still owned all the real estate while Priority operated the facilities as tenants. Try running a nursing home when your landlord is a disgraced operator and you're inheriting their reputation.
In 2021, a large union in PA was going to strike against David and Akiva but then they reached agreement last minute. Who blinked first? Either way a huge bracha to these two yidden who have to deal with unions on top of one of the worst states for SNFs this country has ever seen.
Things were rough at first though. One of the SNFs they took over from golden living had been issued 37 care-related citations in 2016. In 2017 (after Gamzeh and Glatzer (can we just call them GandG) the home was cited 68 times, the fourth-highest among the nation's 15,000 nursing homes. Ok we all get a year to 18 month grace period when taking over a home while we try to right the ship. I think that's fair. So more power to you David and Akiva.
GENESIS HEALTHCARE - 18 Facilities
Pa. nursing home operator Genesis enters bankruptcy with $58 million tax debt to state. Enough said. Good luck getting your money PA!
EMBASSY HEALTHCARE - 17 Facilities
George Repchick's Second Act
Remember George Repchick from Saber? After stepping down from Saber in 2019, he joined Embassy Healthcare in January 2020 as CEO, partnering with Aaron Handler and his wife Darla.
KADIMA HEALTHCARE GROUP - 15 Facilities
Kadima Healthcare Group operates facilities in Pennsylvania and Rhode Island.
In October 2024, Pennsylvania bankruptcy court approved Kadima's $53 million purchase of nine nursing homes from Comprehensive Healthcare Management Solutions. This wasn't your typical acquisition.
The Backstory: Comprehensive Healthcare and 15 of its nursing homes were hit with a $35.8 million judgment after a judge found they "routinely" and willfully failed to properly compensate nearly 6,000 workers over six years. Employees had been illegally denied some $17.9 million in pay, with violations including failing to keep accurate payroll records and denying overtime. You know, all the things you are not supposed to do.
This caused a unique situation where "Mordy" Lahasky was an owner of Comprehensive and also had a separate 5% ownership in six facilities operated by Kadima in eastern Pennsylvania. The Department of Labor tried to block the sale, arguing owners were "trying to divert resources that could be tied to a future claim". Translation: "we don't like Mordy." I mean the guy only owned 5% in one of the companies my goodness. The sale required Lahasky to divest his 5% share of Kadima facilities "to avoid the involvement of existing company insiders".
The Rhode Island Expansion: Kadima applied for change-in-effective-control of six Rhode Island facilities, with financing consisting of 20% from Jonathan Strauss's side and 80% debt loans ranging from $4.5M to $9.8M per facility.
Here's where it gets interesting: Marquis initially acquired four facilities for itself, then identified Kadima to own and operate the remaining six facilities. So Marquis essentially hand-picked Kadima as a buyer for half the portfolio. With friends like these…a man could get stuff done!
Because Rhode Island publishes transcripts of these acquisition discussions there is lots of info on this deal.
Daniel Morris and Jonathan Strauss each hold a 50% ownership interest in Kadima Healthcare Group, Inc. Total Acquisition Cost: $49.3 million. 20% equity ($9.9M) from Morris and Strauss's personal funds. 80% debt ($39.4M) in loans. That's nearly $40 million in debt to acquire six facilities. Classic leverage play.
And by the way for all those geniuses out there who are dying to get into the SNF game:
All six facilities projected razor-thin operating margins for 2023:
Bayberry: $8.7M revenue, $8.5M expenses = $210K profit (2.4% margin)
Eastgate: $6.4M revenue, $6.2M expenses = $179K profit (2.8% margin)
Elmwood: $6.1M revenue, $6.0M expenses = $93K profit (1.5% margin)
South Kingstown: $9.4M revenue, $9.1M expenses = $292K profit (3.1% margin)
Village House: $8.8M revenue, $8.6M expenses = $172K profit (2.0% margin)
West Shore: $11.9M revenue, $11.7M expenses = $204K profit (1.7% margin)
Average operating margin: 2.3%
Now remember - they're carrying $39.4 million in debt to acquire these facilities. With 2-3% operating margins, servicing that debt load is going to be TIGHT. I really respect SNF owners because they do indeed have a huge tolerance for risk and its just nice seeing someone go for it (if it can be done responsibly within their financial situation).
LIVEWELL CENTERS - 13 Facilities
Next we have some fine upstanding citizens:
Daniel Gottesman
Yisroel Hertzka and Chaim Hertzka
Shaul Kopelwitz and Michael Berkowitz
And they also run WeCare - 12 facilities for a grand total of 25.
This is Chuny Hertztka's portfolio in PA which used to be called Imperial Healthcare Group. In typical Chuny fashion there's a million names and entities involved so good luck figuring it all out.
PRESTIGE HEALTHCARE
Prestige Healthcare is owned by Mark Stern. He was an RDO who bought some homes from Nathan Stern (a cousin) and expanded. Yitz bought one facility and shares resources with Mark. Both of them are great operators.
VALLEY WEST HEALTH - 11 Facilities 🔥
Ahron Franco and Isaac Rami
Next we have two upstanding gentlemen: Aharon Franco and Isaac Rami. Not much is known about Aharon who worked his way up from AIT to NHA and RDO and then joined with Rami.
But Isaac Rami had an interesting pathway into SNFs. Isaac Rami is not your typical nursing home operator. Based in New York, Rami made Forbes 30 Under 30 list as a serial entrepreneur who built and exited two consumer brands—Karity Cosmetics and Stryx—before pivoting into the decidedly unglamorous world of skilled nursing facilities.
Rami founded Karity Cosmetics after being shocked by makeup prices at the mall, turning it into an Instagram-famous brand beloved by makeup artists. His secret? Listen to customers, skip the mirrors in palettes to prevent shipping damage, and keep prices low. The brand exploded through word-of-mouth and influencer marketing without traditional advertising spend. Smart Jew.
In 2024, Oxford Valley Health (operating as Valley West Health) acquired 11 Pennsylvania nursing homes from bankrupt Guardian Healthcare. However pretty quickly issues developed.
Just months after the acquisition, 750 workers at 10 facilities voted 97% to authorize a three-day strike starting October 14, 2025. The company countered and threatened "any and all legal action" and accused union leaders of making "false and defamatory statements".
Talk about a rough start. Guardian had traditionally caved every time they threatened a strike and the union was able to walk away with amazing terms.
The union sent a strike notice 10 min before yom kippur started and the strike was set to go into effect on succos. Talk about not reading the room. Valley West managed to negotiate with them, sent daily videos to the union and prepped for the worst with agency etc…at the last minute they reached an agreement. Kol Hakavod Aharon and Isaac.
The Takeaway: Buying bankrupt facilities is hard. Buying bankrupt UNION facilities in Pennsylvania? That's expert mode. If you can figure that out you can figure out anything.
QUALITY LIFE SERVICES - 10 Facilities ✅
The Three-Generation Family Operation
The Tack family entered healthcare in 1973. Steven Tack joined his grandparents, parents, aunt, and uncle in 1989, and the third generation assumed operational leadership in 2009.
Family-owned and headquartered in Butler, PA, Quality Life Services operates 10 skilled nursing facilities, 7 personal care homes, 5 independent living locations, 1 pharmacy, plus home health and hospice.
In Pennsylvania's brutal market, a 50+ year family operation that's now on its third generation? That's staying power. Major points to the goyim on this one.
GARDEN / NORTHWOOD - 9 Facilities
This is a group owned by Sam Fuer, Mordy Klein and Mordy Lahasky.
Not much easily found on them - good job guys. But they're about 50 facilities in total and 9 in PA.
CENTURY HEALTHCARE CONSULTING - 9 Facilities
Founded: 2012
Headquarters: Pennsylvania (Wilkes-Barre/Scranton area focus)
Ownership: Shai Berdugo, Efraim Klein, and Kulanu Oc Trust (own 90%+ of affiliated facilities according to CMS data)
Growth Timeline:
2012: Founded
2023: Operating 9 facilities in PA
PRESBYTERIAN SENIOR LIVING - 8 Facilities
Founded: 1927 (originally Presbyterian Homes, founded by Ellen Parker)
First Location: Farmhouse in Newville, PA (started with 9 widowed women in 1928)
Headquarters: Dillsburg, Pennsylvania
Growth Timeline:
1927: Founded by Ellen Parker to house widowed women
1928: First 9 residents ("guests") moved in
1950s-1960s: Became national leader - hosted first educational programs in long-term care administration in Dillsburg (1,100+ people from 45 states trained there)
1990s: Expanded beyond PA
2019: Serving 6,000+ seniors in 30 locations (PA, MD, DE, OH)
2025: Now 97 years old, 27+ locations, 6,000+ seniors
The Story - The Good Guys: One of the few genuine nonprofits that isn't just playing nonprofit for tax benefits. This is a faith-based organization that grew organically over nearly a century. Started with Ellen Parker taking in widowed women, evolved as those women aged and needed more care.
Shmooze Angle: "Started in 1927 caring for widows in a Pennsylvania farmhouse. 97 years later, still caring for seniors in Pennsylvania. Either incredibly dedicated or incredibly stubborn."
PACS GROUP - 8 Facilities in PA
Built a nursing home empire by allegedly converting every cold and sneeze into billable Medicare Part A. Went public. Sponsored sports teams. Got Hindenburg'd. Classic.
ALLAIRE HEALTH SERVICES - 8 Facilities in PA
Founded: 2015
Founder: Benjamin Kurland, LNHA, CDP, RACT-CT (President & CEO)
The Reality Check:
Started just 10 years ago
Grew from 1 to 15 facilities
In Pennsylvania (one of the hardest markets)
Either genuinely good at turnarounds OR good at marketing turnarounds
Ben Kurland appears to be a genuine operator who saw opportunity in fixing broken facilities. Allaire's business model: Buy broken nursing homes, fix them, raise star ratings. In Pennsylvania, that's like being a mechanic who only works on cars that have been through demolition derbies.
ACTS RETIREMENT - 7 Facilities
The Story: Another nonprofit retirement community operator trying to do mission-driven work in Pennsylvania's nightmare regulatory environment.
Pattern Recognition: This is the third nonprofit in the top 10 (Presbyterian Senior Living, Acts Retirement, plus others). The fact that nonprofits make up significant portion of PA operators suggests:
For-profit operators avoiding Pennsylvania
Nonprofits' mission-driven nature makes them stay despite economics
Tax benefits help offset some of PA's costs
Nonprofit operators in Pennsylvania: Mission-driven enough to stay, but wondering if the mission includes financial martyrdom.
TRANSITIONS HEALTHCARE, LLC - 6 Facilities
Founded: 2011
Headquarters: Westminster, Maryland
Status: Growing steadily
THE THREE MUSKETEERS:
Matthew R. Maurano - CEO & Co-Founder. The strategic guy with 25+ years in SNF. Master's in Healthcare Management. Licensed NHA in both Maryland and Pennsylvania. Keeps the company on mission while navigating PA's nightmare landscape.
Marc J. Feldman, CPA - CFO & Co-Founder. The money wizard. 25+ years in financial/operational consulting. The guy who somehow makes the PA math work.
Kevin Williams, RN - Clinical Founder. Started as a critical care nurse, became an LTC innovator. Designed evidence-based clinical programs for 25+ years. Retired from COO role in March 2024 but stayed on as "Clinical Founder" - the elder statesman role.
Three guys who actually know what they're doing, decided to operate in Pennsylvania anyway. Either very brave or very crazy.
PANACEA HEALTH CORP - 6 Facilities
THE HUMAN STORY:
Steven Rosenzweig - Founder and CEO. Columbia Business School MBA.
Recent lawsuit: McKesson Medical-Surgical Minnesota Supply sued them in January 2025 (U.S. District Court for Middle District of PA)
Glassdoor reviews are surprisingly positive - employees mention $50 commuter benefit and $250 monthly childcare stipend. Leadership "cares about staff and residents"
Company motto: "Your destination for progressive care"
The ghost operator. Runs 6 facilities in Pennsylvania, treats staff decently (rare!), and nobody's heard of them. In the world of Pennsylvania SNF drama, being boring might actually be the smartest strategy.
LECOM HEALTH - 6 Facilities
LECOM isn't your typical nursing home operator - they're an osteopathic medical school that decided to vertically integrate into senior care.
Nation's ONLY osteopathic academic health center. They're training doctors, running hospitals, AND operating nursing homes - complete vertical integration. Students get clinical experience, facilities get physician oversight, residents get academic medical center-level care.
Medical school realizes the best way to train geriatric physicians is to... own nursing homes. LECOM is basically building a healthcare empire in northwestern PA while everyone else is fleeing the state. They're up to 10 senior living communities and still growing. Either they've figured out something nobody else has, or medical school endowments can absorb PA's financial pain better than private operators.
CONCORDIA LUTHERAN MINISTRIES - 6 Facilities
Founded: 1881 (yes, one-eight-eight-one)
Headquarters: Cabot, PA
Status: One of the largest nonprofits in the country
Concordia survived:
The Civil War
Both World Wars
The Great Depression
The AIDS crisis
COVID-19
And 144 years of Pennsylvania regulations
They're proof that if your time horizon is measured in centuries rather than quarters, you can survive anything - even Pennsylvania. Started as Lutheran pastors caring for orphans on a farm, now running a healthcare empire. That's the longest long game in SNF history.
EDEN EAST HEALTHCARE MANAGEMENT - 6 Facilities
Headquarters: Skokie, Illinois (corporate office)
Status: Active and expanding into PA
THE STORY:
Eden East is part of a larger "Eden" family of operators:
Eden Senior Care - Wisconsin, Minnesota, Ohio facilities
Eden East - Now expanding to East Coast including Pennsylvania
Eden Healthcare - Rhode Island operations (founded 2014 in NY)
THE LEADERSHIP:
Mordy Polstein - COO, actively visiting PA facilities and "strengthening leadership"
Kerry Lasky, CPT - Regional Director of Business Development (PA region)
Midwest operator decides Pennsylvania looks like a good idea. Either they haven't read the news, or they're betting they can bring Wisconsin/Minnesota operational efficiencies to the PA market. Recent acquisitions suggest they're doubling down. Watch this space for either spectacular success or spectacular failure.
OUTCOME HEALTHCARE - 5 Facilities in PA
Headquarters: New Jersey (Lakewood, NJ area)
Founded: Active acquisitions 2023-2025
Status: Aggressive expansion
Father + Three Sons - Orthodox Jewish family from New Jersey
CURRENT PORTFOLIO:
Before Ohio/PA expansion: 9 nursing homes + 1 ALF
Mostly New Jersey
One each in Maryland, South Carolina, Georgia
BONAMOUR HEALTH GROUP - 5 Facilities ⚠️
Two Jewish brothers from out-of-state take on $30.6M in debt to acquire 6 facilities in Pennsylvania. Within 18 months:
Can't pay the mortgage
Can't pay the staff
Can't maintain regulatory compliance
Patients at risk
One facility shuttered
Remaining five in receivership
Stay tuned for Part 2 where we dive into Pennsylvania's regulatory nightmare: the bed tax debacle, rate freeze apocalypse, and why the state is basically designed to bankrupt nursing home operators.
