The Ensign Group
Skilled nursing facilities and assisted living communities operator.
PE-OWNED
Acquired by Sun Capital Partners2017-04-06
What Made It Great
Post-acute care facilities with rehabilitation and skilled nursing services
What PE Will Likely Do
Staffing levels at Ensign's skilled nursing and assisted living facilities will be reduced, with more lower-skilled and lower-paid nursing assistants replacing registered nurses (RNs)
The quality of clinical care and rehabilitation services at Ensign's facilities will decline, with longer wait times for appointments, shorter visit durations, and reduced access to specialized therapies
Ensign will aggressively 'upcode' billing, seeking higher reimbursements from Medicare and Medicaid by exaggerating the acuity of residents' conditions
Ensign will seek to extract maximum profits by selling off its real estate assets through sale-leaseback arrangements, reducing its capital investments in facility maintenance and upgrades
Expected Timeline
“0 to 6 months months”
Cosmetic changes and 'efficiency' announcements, potential leadership changes at Ensign
“6 to 12 months months”
Staffing reductions begin, with fewer RNs and more nursing assistants in Ensign's facilities
“12 to 24 months months”
Residents and families begin to notice declines in care quality, longer wait times, and reduced access to therapies
“24 to 36 months months”
Major quality-of-care issues emerge, with potential department closures, care scandals, and resident complaints
“36+ months months”
Potential bankruptcy, facility closures, or sale of Ensign to another operator
Similar Cases
Other companies that followed a similar path after PE acquisition
What You Can Do
Actions
Closely monitor the quality of care and staffing levels at Ensign's facilities, and be prepared to advocate for your loved ones if you notice declines
Familiarize yourself with Ensign's historical quality metrics and be vigilant for any changes or negative trends
Consider alternative care options and be ready to transition your loved one to a different provider if Ensign's service quality deteriorates significantly
Alternatives
Community-focused healthcare
Integrated managed care consortium