‘I still pray every night.’ Troubled Fort Worth nursing home faces uncertain future

It had been 18 hours, and a resident at Remarkable Healthcare of Fort Worth was still sitting in the same pair of soiled briefs.

The resident, who had Parkinson’s disease and was bedridden, called her sister-in-law, Jean, to ask for help. It was a federal holiday — Martin Luther King Jr. Day in 2022 — and the nursing home was short staffed. No one had checked on the resident or her roommate in hours, Jean said. Jean asked to go by her middle name out of respect for her sister-in-law’s privacy and legacy.

Jean sent emails and calls to nursing home staff and administrators, and didn’t hear back. She decided to change the briefs herself, and drove to the nursing home, at 6649 N. Riverside Drive. She rang the doorbell and knocked at the main entrance. She called again. But no one responded, she said.

After 20 minutes, Jean left, defeated. Her sister-in-law’s briefs were eventually changed later that evening.

In total, the woman had spent 20 hours in the same soiled pair.

The experience was one of several Jean complained about to state regulators during the two and a half years her sister-in-law lived at the Fort Worth nursing home before her death in September 2023.

Most of the issues, Jean said, stemmed from the fact that the nursing home didn’t have enough staff. There simply weren’t enough people to clean the hallways, prepare meals, or help bedridden residents like her sister-in-law go about the activities of daily living. On average, about 76 residents live at the Fort Worth nursing home on a given day.

Nursing facilities throughout the U.S. are struggling to determine how to recruit and retain enough staff to keep residents safe and staff workloads manageable, particularly since the early COVID-19 pandemic began.

But Remarkable Healthcare’s staffing crisis is compounded by the company’s financial woes, which have gotten worse in recent months, according to current and former staff members and filings in bankruptcy court.

The nursing home’s management, which operates four nursing homes in North Texas, filed for bankruptcy March 20, and is headed toward an uncertain future as the nursing home’s parent company, its lenders and multiple creditors attempt to negotiate a resolution that will keep employees in their jobs and patients safely in their nursing homes.

The company that manages the Fort Worth facility as well homes in Seguin, Carrollton, and Dallas owes millions of dollars in unpaid bills to its landlord and vendors, as well as to a financial firm that has been loaning it money since 2019, according to filings in bankruptcy court.

The company’s complicated financial situation has meant that employees of the four locations have repeatedly received their paychecks late in recent months, according to court filings and five current and former employees the Star-Telegram interviewed. In addition, employees who received their health insurance through their jobs also lost their coverage because the company could not pay the premiums, leaving some with large medical bills, according to interviews and court filings.

The instability has left some of the Fort Worth nursing home’s lowest paid employees in crisis.

“Right now I’m living paycheck to paycheck,” said a certified nursing assistant at Remarkable. While she was waiting for her paycheck, she said she wasn’t sure how she’d get to her next shift, because she couldn’t afford gas. The Star-Telegram interviewed five current and former employees at the nursing home or its parent company. All employees asked to remain anonymous, because they worried that leadership at Remarkable Healthcare would retaliate against them or that discussing conditions at the nursing home would hurt their future job opportunities.

The Star-Telegram verified all employees’ identities.

All four of the Remarkable nursing homes are linked to limited liability companies owned or operated by Laurie Beth and Jon McPike of Southlake. In an interview with the Star-Telegram, Jon McPike said his nursing homes had maintained staffing levels and quality of care despite the ongoing bankruptcy case.

“Our staffing levels are extremely good right now and have been for quite a while,” McPike said.

He also said any allegations of neglect in his nursing homes were investigated and responded to quickly.

He also applauded his employees for continuing to work during the uncertainty of the bankruptcy case.

“There’s no way to express the gratitude that we have,” he said.

‘My scrubs were completely soaking wet’

A core feature of nursing home care, employees said, is provided by certified nursing aides or assistants, one of the lowest paid positions in a nursing home that nevertheless provide some of the most critical care.

CNAs, as they are known, change residents’ briefs, help residents shower, assist residents in eating, help them move from bed to wheelchair, and other aspects of daily living for residents who have limited or no mobility.

Remarkable Healthcare did not have enough CNAs to keep patients cared for, employees said.

The nursing home’s previous director of nursing said the facility was so short-staffed that she typically had only one CNA working with her to provide care for 30 patients. Charlene Harrington, an expert on nursing home safety, said staffing levels were closely linked to patient safety, and that research suggests the best ratio for residents was one CNA to seven patients.

“Everything depends on” staffing, said Harrington, professor emeritus at the University of California San Francisco. “If you don’t have adequate staffing, the work doesn’t get done.”

On the weekends, when the nursing home was short on staff, Remarkable’s previous directing of nursing said she would sometimes show up to work by herself to check on patients. With no one else to help her, she could only do damage control, she said.

Residents would go so long without having their briefs changed that urine would seep into their sheets.

“Their sheets are soaked from their head to their feet,” the nurse said. By the end of her shift, “my scrubs were completely soaking wet.”

“I still pray every night for the residents there,” the former director of nursing said.

Remarkable has not submitted recent staffing data to the federal government, but its low staffing levels were noticed by a patient care ombudsman appointed during the company’s previous bankruptcy case from 2023. After visiting the Seguin and Dallas locations, the ombudsman wrote that without additional staffing, “continued resignations may occur, and safe delivery of clinical services will be challenged.”

The ombudsman also wrote that the homes still struggled to buy basic supplies, like paper towels, trash bags, COVID tests, and more.

The low staffing, infrequent showers, and other complaints of poor care have been repeatedly investigated by the Texas Health and Human Services Commission, which is responsible for inspecting skilled nursing facilities in the state and ensuring that they meet state and federal requirements.

In recent inspections, the Fort Worth facility has been cited for a routine happy hour that led to a pregnant employee being attacked by a patient; failing to give regular showers and timely incontinence care; and serving cold and lukewarm food to residents.

The long history of complaints against Remarkable led the federal government to designate it as one of 88 nursing homes in the Special Focus Facility program. The program is intended as the federal government’s stopgap measure to improve failing nursing homes before barring them from Medicare and Medicaid program, which is the main payer for most nursing homes.

But employees said they feared that the considerable record of complaints still didn’t accurately portray the situation at Remarkable.

McPike, the co-owner of Remarkable, disagreed, and said he thought state inspectors were tougher on Remarkable than they were on other facilities.

A woman who previously worked at Remarkable said whenever a state inspector arrived at a Remarkable nursing home, staff would use the messaging application GroupMe to alert colleagues about what the state inspector appeared to be investigating. The former employee said administrators would encourage employees to report similar stories to the surveyors.

The former director of nursing said that during an inspection in November, colleagues forged her initials on medical records for a patient who had fallen while being transported to a doctor’s appointment. Her colleagues had intended to indicate that required safety checks had been completed by medical staff when in fact they had not, she said.

“I’m not aware of anything like that and I certainly wouldn’t tolerate it,” McPike said.

Bankrupt nursing homes experience ‘mass’ staff walkouts

Many of Remarkable’s woes stemmed from its lack of operating cash.

Remarkable first filed for Chapter 11 bankruptcy in 2018, and reorganized in part through an agreement with Alleon Capital Partners, a short-term lender. Under the terms of the agreement, Alleon received all of the money Remarkable made, and returned cash on an as-needed basis.

The relationship between Remarkable and Alleon grew bitter last year, in part because Alleon seized $395,000 that the nursing home had received as a tax credit for retaining employees. In court filings, Remarkable’s attorneys said the tax credit was not Alleon’s to take; Alleon’s attorneys said Remarkable had attempted to use the tax credit improperly. The two companies also disagreed over the terms of their updated loan agreements, McPike said.

In all, the dispute has put the four nursing homes in a desperate position, with the company facing mounting bills. The company’s nursing home in Seguin faced a disconnect notice for unpaid water bills. The property owners of Remarkable’s nursing homes said the company owes more than $3 million in bank rent.

According to documents Remarkable filed in its bankruptcy case: The company has paid its nearly 500 employees late on multiple occasions, causing some “mass” staff walkouts and more than two dozen employees to quit, according to Remarkable’s court filings. In an interview with the Star-Telegram, McPike said the “majority” of employees who quit were rehired or replaced with new hires.

Health insurance coverage for all employees has lapsed, and staff have begun asking their supervisors what to do. One employee received back surgery after her health insurance coverage had ended, and now is faced with a “very large bill,” her supervisor wrote in an email to the McPikes.

On Wednesday, Chief Judge Brenda Rhoades of U.S. Bankruptcy Court for the Eastern District of Texas agreed to a temporary order that allows Remarkable to use a loan to pay employees and to keep the nursing homes operating until a final solution is reached. In her order, Rhoades wrote that members of the McPike family be excluded and go unpaid, although a final decision that could allow the family to be paid their wages is expected to be issued in early April.

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