A $45 Million Settlement, Four Nursing Homes, and 82 Days Below the Staffing Floor: What the Centers Health Care record tells New York families about how accountability actually works

In November 2024, one of New York's largest nursing home chains signed a settlement that was supposed to fix things.

Attorney General Letitia James had sued Centers Health Care and its owners, Kenneth Rozenberg and Daryl Hagler, alleging that they had pulled more than $80 million in Medicaid money out of four nursing homes while residents were neglected. The settlement required a $45 million payment, higher nurse staffing, and independent monitors to watch the company from the inside. The owners admitted no wrongdoing and stayed in control of the company.

Twenty months later, we have something rare in this field: a detailed public record of what a major settlement actually delivered. Two things are now documented, and they do not comfortably agree with each other.

An independent monitor's final report, issued this month, found the settlement worked. Investigative reporting by New York Focus found that at one home, and at several homes outside the settlement, residents were seriously harmed after it was signed.

Both are true. For families with a parent in a New York nursing home, understanding why both can be true at once is more useful than picking a side.

What the settlement required

The agreement did four main things.

• A $45 million payment. Most of it — $35 million — went into a "resident care fund" earmarked for improvements at the homes rather than into the state's general coffers.

• A staffing floor at four homes. The four facilities with the worst records had to provide at least 3.5 hours of nursing care per resident, per day. Worth noting: that figure sits below the roughly four hours a federally sponsored study identified two decades ago as necessary for safe, high-quality care. The floor was a compromise, not a standard of excellence.

• A ban on robbing Peter to pay Paul. Centers was barred from cutting staffing or quality at its other homes in order to fund improvements at the four targeted ones.

• Independent monitoring. The Attorney General appointed David Hoffman and Associates, a health care consultancy, to oversee compliance. Its term ended in July 2026.

  
  

Keep the third item in mind. It is where much of what follows went wrong.

What the monitor found

The monitor's final report, summarized by New York Focus on August 14, is genuinely positive, and it deserves to be stated plainly rather than buried.

Across the four target homes, registered nurse staffing nearly doubled. Falls became less frequent at all four. Residents developed far fewer new pressure wounds. Food satisfaction improved. The monitor described the results as <cite index="10-1">"real and sustained care improvements"</cite> affecting more than 1,100 residents daily, and suggested the model could be used in other states. As of mid-2026, all four homes were meeting the 3.5-hour requirement.

Some of the fixes were unglamorous and effective. At the Buffalo facility, one reason staff could not reliably show up on weekends was the absence of nearby public transportation. Settlement money paid for rideshares, subsidized staff meals, and a pause on weekend admissions.

Turnover at that home, once approaching 100 percent annually, dropped to about 56 percent.

That is what a well-designed settlement with an inside monitor can accomplish. It is a real answer to people who assume enforcement never changes anything.

Now the other half.

What happened inside the facilities

Buffalo Center for Rehabilitation and Nursing

Buffalo Center was one of the four homes bound by the 3.5-hour staffing floor. Between November 2024 and December 2025, it fell below that floor on 82 separate occasions.

The reported consequences, drawn from state and federal inspection records:

Nonconsensual photography. A nurse aide concerned about conditions photographed four residents who were partially undressed and heavily soiled, then texted the images to a supervisor and posted them on social media. Some images showed residents' genitals and buttocks. The facility did not report the incident for three days. The state Department of Health fined it $8,000 — $2,000 per resident.

A fly infestation. Inspectors that same month documented dozens of flies in residents' rooms, crawling on residents' bodies. Asked about it, an administrator told the inspector the flies were not a dignity concern, while conceding the environment was not homelike — a standard federal regulation requires. New York law separately guarantees residents individual dignity.

A facial injury. In August, a nurse aide attempted to change an incontinent resident alone, despite documentation that the task required two people. The resident — severely cognitively impaired, rarely able to communicate, and flagged as a falls risk — was rolled out of bed onto the floor. The wound ran from mouth to eye and required surgery.

An abuse allegation that went nowhere. In September, a resident's guardian emailed an administrator alleging that a nurse aide had threatened the resident with a cold shower and withheld food, and had stepped on the resident's foot, as punishment for vomiting. The facility neither investigated nor reported it. The administrator later told inspectors they had missed the allegation and should have read the emails more carefully.

Federal regulators fined the facility a total of $139,471 over the inspections covering the flies and the unreported allegation. For scale: the facility reported net income of nearly $5 million in 2023. The 2025 fines amount to under four percent of that.

Onondaga Center for Rehabilitation and Nursing

Onondaga was not one of the four settlement homes — which is precisely the point.

On July 21, 2025, a resident fell in the bathroom and reported dizziness. A licensed practical nurse was on duty; no registered nurse was, and an RN might have recognized the falls as a symptom of something more serious. That night an aide noted wet-sounding breathing and difficulty breathing. A nurse said the right staff would be told. The incident report reflects no follow-up.

At roughly 5:30 a.m., a nurse found the resident unresponsive, with no pulse. The resident's records called for resuscitation. The nurse had no documented CPR certification and performed no CPR — a violation of both state and federal requirements. Emergency responders arrived about fifteen minutes after the 911 call and pronounced the resident dead.

Lab results from the previous morning had shown serious risk of seizures and coma. No one reviewed them until two days later.

The facility then declined to report the CPR failure, as regulations required. An unsigned internal investigation concluded there was no evidence of neglect. Two months later, the director of nursing on duty at the time told state investigators that staff knew reporting was required but did not act following conversations with corporate personnel who did not want it reported.

Federal regulators fined Onondaga $177,790; the state added $10,000. That month, residents at the facility averaged under ten minutes of skilled nursing care and under three hours of total care per day — sharp declines from pre-settlement levels.

Washington Center for Rehab and Healthcare

At this Capital Region facility, average daily nursing care fell below three hours in January 2025 and stayed well under 3.5.

In February 2025, a dementia patient who was a known falls risk fell from bed. The care plan required the bed kept low, barriers on both sides, and mats on the floor. An aide left to get linens with the bed elevated and the barriers and mats missing on one side. A nurse heard shouting and found the resident on the floor with a bloodied head and bruises to both knees. The federal fine was $9,620; the state's was $2,000.

Ontario Center for Rehabilitation and Healthcare

At this Finger Lakes facility, a January 2025 inspection recorded incontinent residents waiting as long as 21 hours to be changed. Residents described emptying an overflowing urine container out a window. Two said that when they called for help changing out of soiled clothing, staff came, said they were too short-staffed to help, and left. Nurses also failed to change leg wound dressings on multiple days — an omission that invites infection and permanent tissue damage.

Staff were direct about the cause. An aide reported that a floor housing 48 patients was covered by two or three workers. Records showed night shifts where two nurses staffed the entire 98-bed building. An administrator's stated response to resident complaints was that some staff had been fired.

A March 2026 inspection found two residents at risk of hypothermia. One was shivering. Another lay under only a sheet while the heating unit blew cold air. The average outdoor temperature that day was 23 degrees.

Notably, several inspections in the two years before the settlement produced no serious citations at this facility. The documented decline came after.

The pattern worth understanding

Read together, the record suggests something more specific than "nursing homes are bad."

Oversight works where it is pointed, and only there. The four monitored homes improved measurably. The unmonitored homes in the same chain saw staffing fall and residents harmed. The Attorney General's office has noted that the settlement did not obligate Centers to implement the monitor's recommendations at facilities outside the four. That is a drafting reality, not an accusation — and it is the single most important lesson in the whole record for anyone negotiating a future consent decree.

Fines are priced in. A $139,471 penalty against a facility earning roughly $5 million is a line item. As one researcher quoted in the reporting put it, understaffing saves these operators far more than the fines cost them. Regulatory penalties are not designed to make a family whole, and they do not.

Escalation is rarely used. New York's health department can require independent monitors under Public Health Law § 2803-w; that tool has been used twice since taking effect in 2020. Barring an operator from Medicaid has happened about five times since 2005. Regulators hesitate because the credible threat from a failing operator is closure, and there is no line of better operators waiting to take over. The Attorney General's office says it is actively reviewing Centers' compliance. The settlement permits fines or reopening the case; as of the reporting, neither had occurred.

The monitoring ended. Hoffman's oversight concluded in July 2026. Once outstanding bills are paid, under $1 million is expected to remain in the $35 million resident care fund. Whether the improvements hold without a monitor and without the money is, at this writing, unknown. The monitor's own report was optimistic that the culture change would persist. The Buffalo record is a reason to check rather than assume.

Separately, in January, New Jersey's state comptroller sued Rozenberg and Hagler over allegations involving $124 million in diverted Medicaid payments at two facilities in that state. That case remains pending, and no findings have been made.

Where families fit in

Everything above is public enforcement: an Attorney General, a health department, federal regulators, a monitor. None of it is designed to compensate an injured resident or a grieving family, and none of it is controlled by them.

New York gives residents and their families something separate. Public Health Law § 2801-d creates a private right of action against a residential health care facility that deprives a resident of a right or benefit established by law, regulation, or contract. It permits recovery of compensatory damages and attorneys' fees, and in cases of willful or reckless deprivation it allows punitive damages. Critically, a § 2801-d claim does not require proving traditional negligence in the same way — the deprivation of the statutory or regulatory right is itself the wrong.

That matters here because so much of the documented conduct is regulatory in nature: staffing below a required threshold, failure to report abuse allegations, care plans not followed, dignity standards ignored, CPR not performed where records required it. Those are the raw materials of a private claim, not just an inspection citation.

The practical consequence is that the same inspection reports regulators use to levy a fine of a few thousand dollars are available to a family's attorney to build a case worth considerably more — and, more to the point, to establish a record of what actually happened to their relative.

If you are worried about someone in a facility right now

Do these things in this order.

1. Request the complete medical and facility record in writing. You are entitled to it. Do not accept a summary. The chart, the care plan, the incident reports, the physician orders, and the nursing notes are where a change in care shows up first.

2. Check the facility's public inspection history. Federal inspection reports and staffing data are published on Medicare's Care Compare, and New York posts facility profiles through the Department of Health. If your relative's home has been cited, you can read the citation.

3. Document what you see, with dates. Photograph wounds, room conditions, and equipment. Note who you spoke to and when. Write down what staff tell you about staffing levels.

4. File a complaint with the Department of Health. It creates an official record and can trigger an inspection.

5. Talk to a lawyer promptly. Deadlines in these cases are strict and vary depending on the claim, the defendant, and whether the facility is publicly operated. Do not assume you have years.

   
   

Records get thin and staff turn over. A month of delay costs more evidence than most families expect.

Frequently asked questions

Can I sue a nursing home even if the state already fined it? Yes. A regulatory fine is an enforcement action by the government. It does not compensate the resident and does not resolve or bar a private claim. In practice, inspection findings often help a private case.

Does a settlement between the Attorney General and a chain prevent my family from bringing a claim? No. The Attorney General acts on behalf of the state, not individual residents. A settlement of that kind does not release private claims for individual harm.

What if my mother's facility met its required staffing hours? Meeting an average staffing target does not establish that adequate care was provided to a specific resident on a specific day. The question in an individual case is what happened to that person — whether the care plan was followed, whether a change in condition was recognized and escalated, whether the required assistance was actually provided.

How do I find out whether the home is short-staffed? Facility-level daily staffing data is reported to the federal government and published. It is imperfect, but it is objective, and it is often the first place a pattern becomes visible.

Is understaffing itself something a family can sue over? It can be the foundation. Under New York's nursing home statute, the failure to provide services required by law or regulation can support a claim without a separate showing of conventional negligence. Whether it applies depends on the facts and the specific requirement at issue.

Talk to us

We represent families in nursing home abuse and neglect cases across New York City, Long Island, and the rest of the state. If the care your relative is receiving has changed, or if you have been told that an injury was unavoidable and it does not sit right with you, the records will tell you more than the facility will.

Case reviews are free and confidential.

Leitner Warywoda, PLLC 14 Penn Plaza, Suite 1718, New York, NY 10122 — (212) 671-1110 Long Island — (631) 240-4390

Prior results do not guarantee a similar outcome. This article is general information about New York law and is not legal advice. Reading it or contacting our firm does not create an attorney-client relationship. Do not send confidential information through a website form.