PROMISE FOR THE FUTURE — Lakin Hospital in Mason County is one of four long-term care facilities owned by West Virginia and being sold to Majestic Care. -- Steven Allen Adams

CHARLESTON — The impending sale of four of West Virginia’s state-owned long-term care facilities is 34 days away, with a private company coming into the state for the first time excited for the opportunity.

But questions remain about what will happen for the population that will need the care these facilities offer.

Gov. Patrick Morrisey announced on Aug. 12 that New York-based Marx Development Group (MDG) will purchase Hopemont Hospital in Preston County, Jackie Withrow Hospital in Raleigh County, John Manchin Sr. Health Care Center in Marion County, and Lakin Hospital in Mason County for $60 million.

While MDG is conducting the purchase, the facilities will be managed by one of MDG’s subsidiaries. Majestic Care, a long-term care company with facilities in Indiana, Michigan, and Ohio, will take control of the four state-owned facilities.

“We call our employees care team members, so in our organization we’re all classified as care team members in our company,” said Paul Pruitt, CEO of Majestic Care, in a phone interview Monday. “It’s going right back to our mission, saying through the hearts of our care team members we provide excellent health care to those we serve, so that’s our ultimate goal.”

The company plans to invest in building between three and five new health care facilities in the state to replace the aging facilities at Hopemont, Jackie Withrow, John Manchin, and Lakin, potentially putting millions of dollars of investment in the state and creating additional jobs. Pruitt said that two out of the four facilities are past their life expectancies, while other facilities will have to be retrofitted and modernized.

Pruitt said his company was first reached out to last year by Lument Securities LLC, a company that the Department of Health Facilities (DHF) under former governor Jim Justice contracted with in August 2024 to develop a plan that included selling the four long-term care facilities to potential buyers while ensuring care for patients at these facilities remains uninterrupted. Negotiations were paused during the transition from Justice to Morrisey, who took office on Jan. 13, with negotiations picking back up again a few months later.

“They were looking to do something with the state buildings. We did take a look at them back then, but then at that point everything kind of got put on hold,” Pruitt said. “Several months ago, it came back up because now they were actively moving forward again. I know my COO David Alexander and a few others went out and did a tour of the facilities and walkaround, and the ball just started rolling.”

According to the Kaiser Family Foundation, there were 123 licensed nursing facilities in West Virginia in 2024, serving 9,422 residents with an average number of 87 certified nursing facility beds. According to the U.S. Census Bureau, nearly 28% of West Virginia’s population is age 60 or older. Marty Wright, chief executive officer for the West Virginia Health Care Association, said there was a need for a new provider, such as Majestic Care, to enter the market for long-term care in West Virginia.

“I’m very excited to have Majestic Care come into the state. I think they’re going to be a terrific provider and look forward to having them welcome with big arms into West Virginia,” Wright said in a phone interview last week. “I’m excited to see the four state facilities come more into a private aspect than having the state run them.”

Michael Folio, the legal director for Disability Rights West Virginia (DRWV), also agreed that having the state’s long-term care facilities in private hands could be for the best. DRWV serves as the designated federal Protection and Advocacy System agency that provides third-party monitoring of state agencies that serve the disabled.

The state-owned facilities have made headlines in recent years for being understaffed and not being properly maintained. There have also been noted abuses at these facilities. Last year, three contract nurses at Hopemont were fired after the death of an elderly non-verbal resident who was left in an overheated whirlpool too long that had a defective thermostat. According to reports, the facility staff knew about the issue but had never fixed the thermostat.

“I can tell you having been practicing law for over 30 years, I’ve prosecuted cases against private facilities the same as I have state facilities,” Folio said in a phone interview last week. “No facility, private or public, is immune from these types of violations. The complication with the state is the infrastructure of these facilities is so old that infrastructure itself creates a safety hazard. Bringing in a new provider can address that.”

But Folio’s agreement included concern about the care that will be available for future patients in the demographic served by the state-owned facilities. Many of the patients at these facilities are low-income and indigent, with no family members able or available to ensure their care. Other patients are people with intellectual and development disabilities. Some are older people with substance use disorder. Some are even older incarcerated patients or wards of the state.

“I think it’s a good. The state has a duty to explore privatization as long as it’s done the right way,” Folio said. “If the provider is unwilling to serve the population that requires service, then this is going to be a net loss for the state because the burden is going to continue to fall on the taxpayers to provide care and service for individuals unless this new provider…is going to do it.”

Wright said the majority of patients in long-term care in the state are already paid for through Medicare and Medicaid, so private facilities accepting more low-income patients should not be an issue. But Wright said that federal match and reimbursement rates need to increase to incentivize private facilities from taking risks and accepting more high-risk patients. Wright also said federal regulations need to change that sometimes penalize private facilities for taking in some of these patients.

“I definitely think there’s going to need to be some considerations and look at the federal level, especially as it translates down to the state level,” Wright said. “There has been a national discussion and national problem of trying to take care of individuals that have historically had either behavioral issues, long-term effects of substance use disorder or even mental health problems in which they present a potential risk to fellow residents like in a nursing home or assisted living.

“I think the state, especially the federal government, has to look at the regulations that underlie the care of these individuals,” Wright continued. “I think there needs to be a much larger discussion that happens nationally with respect to how we care for individuals that have substance use disorders, that have behavioral or mental health effects that pose, under the current regulations, potential threats or dangers to other individuals in those facilities.”

Pruitt said the goal of Majestic Care when it comes into a new area is to evaluate the needs in that area and tailor a program that works. Some of Majestic Care’s facilities focus on specific populations, such as those with mental health care needs.

“If you look at our population as an organization, 92% of our company is Medicaid, so when you look at that, we do take patients that are not your private pay or your patients that can afford a higher-end facility maybe,” Pruitt said. “We do take patients that are indigent or that require a different level of care. Our goal is to design programs and design our facilities to meet the needs of the population of the community.”

Still, Folio said the state may still need to provide some form of long-term care to this in-need population. Folio pointed to a 1981 report under former governor Jay Rockefeller by L. Clark Hansbarger, the former director of the state Department to Health, which determined that there will always be a need for a need for a state-owned long-term care facility.

“Even with the most optimistic projections for community placement…the state will continue to be responsible for an institutional population…These will be acute and chronic psychiatric patients, the criminally insane and that portion of the geriatric population that has no access to private nursing homes for medical or economic reasons,” Hansbarger wrote. “The state may also have to continue to provide care for many developmentally disabled.”

Another issue in transferring the state-owned facilities to Majestic Care is the status of the public employees at these facilities who receive health care benefits through the Public Employees Insurance Agency and pay into public pension plans. According to a 2024 report by the Legislature’s Post Audit Division, the four facilities are authorized for up to 266 full-time employees as of fiscal year 2023, though operate below that.

According to that report, the average annual salary of a full-time employee at one of the four state-owned long-term care facilities and three other hospitals operated by the state was $34,974. According to ZipRecruiter, licensed practical nurses at Majestic Care facilities in Ohio earn between $56,000 and $71,000 per year, with registered nurses earning between $75,000 and $95,000 per year and certified nursing assistants earning between $35,000 and $45,000 annually. The company also has a health insurance package with dental and vision, and a 401k retirement plan.

Pruitt said all state employees currently at the four state-owned long-term care facilities would be re-hired with Majestic Care, only needing to fill out a formal application but not needing to be interviewed. After the state closes with Majestic on Sept. 30 and once the transition happens, employees would clock out as a state employee and clock back in as an employee of Majestic.

“Obviously, we look at the market and we do a complete market analysis to make sure we’re paying fair wages within that market so we’re not underpaying,” Pruitt said. “We already have done that due diligence, and our HR team is out there this week actually meeting with the employees going through all that information with them.”

Folio said the kind of employment package Majestic offers to state employees will be important in order to ensure the facilities remain staffed through the transition and the patients are cared for.

“They might be willing to take the employees as they’ve said, but maybe these employees might not want to stay and that could cause some complications as well,” Folio said. “We all know a skilled labor force is the key component to providing quality care to individuals of this nature.

“I know there are some of the comprehensive centers that their employees were members or participants in the state’s retirement system,” Folio continued. “There was a grandfathering provision that allowed them to continue to participate and then pay into the retirement system to enjoy their full retirement benefits. It’s possible that the state could explore something like that, but at the end of the day if they don’t have a happy skilled labor force, you’ll have unskilled services being provided to this vulnerable population.”