The Private Equity Giant KKR Bought Hundreds Of Homes For People With Disabilities. Some Vulnerable Residents Suffered Abuse And Neglect. – BuzzFeed News

Over five decades, the private equity giant KKR became famous — or infamous, depending on the observer — for a particular playbook. It acquired iconic companies such as RJR Nabisco, Duracell, and Toys R Us, loaded them up with debt, and sold them off.

In 2019, KKR took on a responsibility that was very different from selling cookies or batteries: caring for thousands of people with severe intellectual or developmental disabilities, some of whom cannot speak, wash, or feed themselves.

With its $1.3 billion purchase of BrightSpring Health Services, one of the nation’s largest group home operators, KKR became the owner of more than 600 residential facilities serving people from California to West Virginia. Many residents have no family to look out for them. Almost all need round-the-clock care. They all depend on the company to keep them safe.

Touting its financial success and BrightSpring’s mission to “help people live their best lives,” KKR has announced plans to take the company public. That development could yield windfall returns for investors and executives.

But a yearlong BuzzFeed News investigation found that KKR focused on expanding the business even as a crisis mounted in its group home division, where conditions grew so dire that nurses and caretakers quit in droves, a state prohibited the company from accepting new residents, and some of the most vulnerable people in its care suffered and died.

Reporters combed through hundreds of state inspection reports, internal company records, photographs, and videos, and conducted more than 170 interviews with regulators, clients’ families, and current and former workers. Again and again, they found residents consigned to live in squalor, denied basic medical care, or all but abandoned.

Overseen by KKR’s handpicked board of directors, BrightSpring executives in many cases kept wages lower than those at competing facilities or Walmarts, despite pleas from local managers that they were unable to safely staff the homes. Some managers resorted to making employees work three days straight or threatening to have them arrested if they tried to leave. In several cases, state inspectors arrived at homes and found no staff at all.

The staffing shortage was compounded by inadequate training and pressure to keep beds full. At least three people died following alarming lapses in their care. One of them died after state authorities warned the company — twice — that she was in danger.

Group homes like these, which mainly rely on Medicaid funding, were designed as a humane alternative to vast state institutions, a way for people with profound needs to get intensive, personalized support. But on a single day at one eight-person BrightSpring home, a resident who had expressed suicidal thoughts swallowed a battery that was supposed to be kept out of her reach. Another resident was left alone in a hot car until his temperature reached 104 degrees. A third nearly died after drinking antifreeze and did not receive medical care for at least nine hours.

At another cluster of homes, inspectors found, staff “failed to administer over 1,000 medication doses,” in part because the KKR-owned pharmacy ran out and the company “failed to obtain these medications from a back-up.”

And BrightSpring executives were warned that some nurses were quitting because conditions in the homes were so bad they feared they might lose their licenses and clients might lose their lives.

State health inspectors discovered serious injuries that were concealed from families or authorities, and others that went untreated — as in the case of a Texas man whose nose had been broken so many times that a staff member decided it was “beyond repair” and therefore not worth a trip to the hospital.

From the time KKR took over BrightSpring in March 2019 through the end of 2021, its homes were cited for dangerous conditions at a rate well above the average for such facilities, according to a first-of-its-kind analysis by BuzzFeed News.

The analysis focused on intermediate care facilities, the type of group home with the most comprehensive state inspection reports, in the seven states with the most for-profit homes. In those states, KKR owns only 16% of the homes but racked up 40% of the serious citations — more than 500 in total.

Meanwhile, the KKR-controlled board approved a plan for BrightSpring to take on more than a billion dollars in debt, secured by the company’s assets, to buy more companies. It now operates in 50 states serving over 350,000 people daily across its different healthcare divisions.

But BrightSpring was left to pay more than $135 million a year in interest on the loans, and millions more to KKR itself for “transaction” and “advisory” fees, money that might otherwise have helped improve conditions in the homes.

In advance of this story, KKR and BrightSpring drew up a crisis response plan that included buying ads on Google, priming legislators for unfavorable revelations, and threatening legal action against BuzzFeed News, according to internal company documents and communications. The companies did not, however, agree to meet with reporters to discuss these issues on the record.

Instead, KKR issued a statement, saying, “We vehemently disagree with the grossly misleading narrative you presented.” BrightSpring sent a similar statement, and called BuzzFeed News’ findings “inaccurate, misleading, and fundamentally flawed.” It said the data analysis was unsound because the underlying government records were unreliable and were collected during a pandemic. Four leading academic experts consulted by reporters said BuzzFeed News’ methodology was sound.

A KKR spokesperson told BuzzFeed News it had invested $200 million per year in “quality first initiatives” at BrightSpring and increased total compensation to frontline workers by 28%. “Over 99.99% of care hours are completely incident-free,” said Leigh White, a BrightSpring spokesperson, and the company has “achieved 98% medication administration documentation compliance.”

She added, “In the comparatively rare case that an incident of inadequate or improper care occurs, we take prompt action and have rigorous and comprehensive policies and procedures in place to address it.”

The challenges of running these group homes were clear to KKR before it bought BrightSpring. During internal discussions about whether to make the purchase, high-level executives were told about instances of abuse, neglect, and staffing shortages under its prior owner, a Canadian private equity firm called Onex, according to a person familiar with the deal. (Onex did not respond to questions from BuzzFeed News.)

Announcing the purchase, BrightSpring CEO Jon Rousseau promised that the KKR deal, which included merging with a pharmacy, would “have valuable benefits to our clients, patients and customers.”

KKR installed its own executives in four of the company’s seven board seats and oversaw BrightSpring’s rapid growth, despite mounting evidence of peril for those in its care.

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The conditions in KKR’s BrightSpring homes deteriorated dramatically in West Virginia, where the company controlled more than two-thirds of all the federally certified group home beds in the state.

Regulators called out a “pattern of increased significant and serious deficient practices” over the period since the homes had been taken over by KKR.

The situation in West Virginia spiraled so far that in July 2020, the state forced BrightSpring to stop accepting new clients. After continued failings, West Virginia and BrightSpring reached a settlement in which the company did not admit to wrongdoing but had to close or sell a fifth of its federally certified homes in the state.

For the company, the West Virginia crackdown was just a bump in the road.

BrightSpring went on to purchase hospices and home healthcare companies and moved further into services for “waiver homes” — residences for people with disabilities that are sometimes subject to fewer government inspections.

This expansion is part of a vast transformation in healthcare. KKR and other private equity firms have quietly acquired enormous portions of this sector, from entire hospital chains to addiction treatment centers to women’s health clinics. In 2021 alone, private equity firms invested about $172 billion — more than 10 times the budget of the Centers for Disease Control and Prevention — in US healthcare companies, according to the industry tracking group PitchBook.

Often, private equity firms promised that their management expertise would make things better for employees and patients. And to be sure, some struggling companies have benefited from being taken private, removed from the quarterly demands of shareholders, and turned around with new leadership.

KKR’s ownership of group homes, however, offers a cautionary tale about what can happen when a private equity firm’s playbook is brought to bear on people whose lives hang in the balance.

In December 2015, George Roberts, one of the founders of KKR, and others from the firm boarded a plane for Olympia, Washington, to pitch pension fund managers representing the state’s teachers, firefighters, and police officers.

“You’ve had to put up with us at least 100 times during the last 34 years,” Roberts told the group with a chuckle, according to an audio recording. Investments from the pension fund in Washington, as well as those in Oregon and other states, had helped KKR become one of the largest private equity firms in the world.

KKR’s reputation for aggressive tactics was cemented by its 1988 takeover of RJR Nabisco, later chronicled in the book and movie Barbarians at the Gate. More than 1600 RJR Nabisco employees soon lost their jobs, while the company’s ousted CEO got a $50 million “golden parachute.”

More than 30 years later, when KKR made its pitch to the Washington pension fund, it wasn’t just promising to make money. Roberts, who together with Henry Kravis stepped down as co-CEO last fall but still serves as co–executive chair, said that the firm had warmed to issues beyond mere dollars and cents — issues such as social responsibility, environmental protection, and diversity.

That kinder, gentler philosophy has become an important part of the public image of KKR, and of Kravis himself, whose name now appears over a wing at the Metropolitan Museum of Art, a building at Columbia University, and a children’s hospital at Mount Sinai in New York City. Noting the new direction, a glowing 2019 profile in Forbes magazine called him “Mr. Nice Guy” and referred to Kravis and Roberts as no longer barbarians but rather “gentlemen at the gate.”

The Washington pension fund managers responded to Roberts’ pitch by handing KKR $750 million. Another $13 billion rolled in from other investors, including state pension funds from New York, Oregon, and California.

The pension funds in Washington, New York, and Oregon did not respond to detailed messages seeking comment. The California teachers’ union, which contributed $300 million, said it “does not discuss specific holdings or managers. We actively monitor all our investments for financial, strategic, and environmental, social and governance (ESG) risks.”

KKR set about using the money to acquire an emergency room staffing company, a chain of surgery centers, and several other businesses. One day in 2018, Kravis, Roberts, and other senior executives at KKR convened to discuss the possibility of acquiring BrightSpring.

According to a person familiar with the deal, a team run by Ken Mehlman, KKR’s head of public affairs and the former White House director of political affairs under then-president George W. Bush, helped flag issues from past news stories and state inspection records, the same kind of documents used by BuzzFeed News for its analysis. They included instances of abuse and neglect as well as dangerous staffing shortages.

KKR told BuzzFeed News that the company had been performing better than most in the field. “At the same time,” Kristi Huller, a spokesperson, said, “we recognize there are opportunities for improvement and we saw that opportunity at BrightSpring.”

Just a year earlier, KKR and Walgreens Boots Alliance had paid $1.4 billion for a company headquartered down the road from BrightSpring in Louisville, Kentucky. PharMerica delivered drugs to long-term care settings, and many of the residents in BrightSpring’s homes were on eight or more medications. To KKR executives, two people familiar with the deliberations said, the synergy was clear: PharMerica could supply those drugs, relying on bulk discount prices available through Walgreens Boots Alliance.

So, despite the reports about staffing challenges and poor client care, on March 5, 2019, KKR acquired BrightSpring for $1.3 billion and merged it with PharMerica.

As the ink on the deal was drying, the company took out $1.1 billion in new loans, using BrightSpring’s assets — pharmacies, real estate, and medical supplies — as collateral.

It was a classic leveraged buyout. The interest payments from those loans, plus others the company took out, amounted to more than $135 million a year. KKR and Walgreens Boots Alliance, a minority shareholder, billed BrightSpring $8.1 million for a “transaction fee.” They also charged an ongoing “monitoring” fee of 1% of its earnings.

Then the firm announced the new board of directors: three executives from Walgreens Boots Alliance and four KKR executives, led by Max Lin, the head of its Americas private equity healthcare team. (The other three KKR seats are now held by Patricia Ludwig, Hunter Craig, and Johnny Kim). Lin and Walgreens Boots Alliance did not respond to detailed messages seeking comment.

Lin, whose background was in finance, had also served on the board of Envision, an emergency room staffing company owned by KKR. It came under congressional investigation for concerns about the “devastating effect” of “surprise billing.”

With the new board installed, BrightSpring’s KKR era was underway.

In April 2021, in Lubbock, Texas, a 51-year-old man with bipolar disorder and schizophrenia wandered more than 3 miles from a BrightSpring group home, down a road with six lanes of traffic. A car going 45 miles per hour struck him, breaking his leg, his pelvis, and his collarbone. He was rushed to the hospital for emergency surgery.

Federal rules required the company to have at least one staff member at the home for every six residents. But the 41st Street Community Home, where the man lived, had been without a single staff member at least seven times in 2021, inspectors found. So the company had been shuttling him and other residents to nearby facilities, where the staff-to-client ratio sometimes rose to as high as 1 to 21.

On this day, one worker had been left to care for 11 residents with severe disabilities.

Staffing shortages have affected the entire healthcare sector, especially during the COVID-19 pandemic, but under KKR, BrightSpring’s record has been particularly abysmal. According to reports in the seven states analyzed by BuzzFeed News, inspectors found 118 instances of dangerously low staffing since KKR bought the company — double the rate of all other facilities.

“The staffing issue was the root cause for every problem I encountered while I was there,” said Perry McAfee, a manager who oversaw about 60 homes around Houston. “If you pay $7.50 an hour, you’re not going to get a lot of people when they can go to Walmart and make $10.”

McAfee, who left in September 2020, said the company “was not focused on quality of services, but on the revenue generated each month. I’m not saying that’s not important. But that was the sole focus.”

Staffing is one of BrightSpring’s biggest expenses, accounting for about half the total cost of running some of its group homes. Its nurses and “direct care” staff members give residents their medicine, help them take showers, change their bandages and sometimes their diapers, and cook their meals. It’s hard work that comes with grave responsibility.

Before KKR bought BrightSpring, the company’s wages were low, even by the standards of a notoriously ill-paying industry. KKR said it increased employee compensation by 28%.

McAfee and four other former managers, however, who collectively oversaw nearly 100 homes until as recently as January 2022, said they told executives that they could not safely staff the homes at the rates BrightSpring was offering.

Even when they could get people in the door, keeping them was a challenge. In Texas, BrightSpring lost as many direct care workers in a single year as it employed in these homes in the entire state — 1,500 in 2020 alone. That turnover appears to be confined to a slice of its workforce. (The company said turnover is an industry-wide challenge and that nearly three-quarters of the staff lasted a year or more.)

In 2020, the company reported paying Texas direct care staff a starting wage of just $8 an hour, $1.50 less than most other group home businesses in the state, according to government records. BrightSpring said that compensation is often higher, and “current average pay, including incentives and excluding benefits, for frontline employees in Texas is over $12 an hour.” The company did not explain how it calculated that average or which employees it categorized as frontline.

Inadequate training exacerbated the problem of staff turnover.

According to BrightSpring, every employee gets at least 57 hours of training when they start and an average of more than 14 hours of follow-up each year, on topics such as first aid and “treating people with respect and dignity.”

More than 100 inspection reports, however, confirm what six managers and direct care workers told BuzzFeed News: Many staff members were not properly trained, and patients were in danger.

Internal company emails show that managers had been repeatedly warned that nurses in Orange County, California, were quitting because they feared that working amid such conditions might cost them their licenses. In late 2021, those concerns made it directly to Bob Barnes, the president of BrightSpring’s group home division, which often goes by the name ResCare Community Living. Residents were sitting in soiled clothes for hours on end, nurses were stretched too thin to keep them safe, and staff didn’t know how to properly care for them, according to the nurses’ accounts described in the emails. A nurse said clients could die.

Warren Chapman III, who lived in a group home in Abilene, Texas, was one such client.

A 6-foot-4 autistic man, Chapman loved playing jokes on staff, tucking his stuffed animals above cabinets where no one else could reach them. Chapman was unstable on his feet, and staff were supposed to make sure they were in “close proximity to ensure his safety,” according to a state inspection report. Since at least 2018, he had had trouble swallowing food, so a staff member was always required to watch him while he ate.

Managing Chapman’s needs wasn’t all that hard, said his father, also named Warren. He took his son to Outback Steakhouse or Ruby Tuesday every few weeks, and he would just ask the restaurant to cut up his son’s prime rib into small bites.

But at the group home, those measures and others weren’t followed. From March through November 2019, Chapman fell at least six times while staff weren’t nearby. A company nurse noted in his medical records that he had broken his nose “many times before and it was beyond repair” and therefore “did not warrant an ER visit.”

His father said the home struggled to retain staff because the pay was too low, and the churn of new faces had been hard. “Autistic people like my son don’t like change very much,” he said.

On Nov. 21, 2019, while unsupervised, his son shoved a fist-sized chunk of lunch meat in his mouth all at once and started choking. State inspectors found that there were only two staffers on hand; one was helping a client in the bathroom, and the other, who had just three weeks on the job, hadn’t been trained on Chapman’s needs.

When they found him, they panicked. With no training on how to identify a choking victim, they assumed he was having a seizure instead. They called a supervisor rather than 911, delaying the arrival of an ambulance.

Chapman was eventually rushed to the hospital, where he was pronounced dead.

BrightSpring did not respond to requests for comment about the treatment of Warren Chapman or more than a dozen other specific incidents, citing patient privacy laws.

Chapman’s father didn’t know the company had failed to properly train the employees until a reporter shared a copy of the inspection report with him. Now he thinks about the people who remain in the home, some of whom, like his son, can’t speak. He worries that they too may be in danger.

In homes from West Virginia to Texas, the staffing crisis grew so acute that managers turned to dangerous stopgaps.

A resident of a home in Beaumont, Texas, said that an employee had gotten in bed with her. The manager expressed concern that if he reported the alleged abuse to Adult Protective Services, as the law required, there wouldn’t be enough people to cover shifts, according to a text message a staff member later shared with a state inspector. The employee accused of abuse continued working in the home for at least a month after the allegation. It’s unclear what happened after that.

At a home in Arlington, just outside Dallas, an employee pulled a gun on a client’s relative. She was told to take a break, but then allowed to return to work at the home — on her own, with no other employees present — for another shift before being suspended, according to a state inspection report.

​State inspection reports document several instances in which staff had to work more than 16 hours and sometimes as long as three days straight without leaving the home. Some BrightSpring managers resorted to threatening employees, telling them they could be charged with criminal neglect if they left at the end of their shift, two staff members told BuzzFeed News.

“When you’re scared and tired and you want to go home and you’re being told you could be fired or come up with a job abandonment charge, you’re not going to leave,” said Megan Gierhart, who was a direct care staffer at a home in West Virginia until February 2021. She said working there left her exhausted and concerned that the company was neglecting clients’ needs. “We’re supposed to be keeping people safe.”

Alasia Hunt, who worked at a home in Temple, Texas, said she was often asked to work 24 hours straight. “Every single shift they would say we don’t have anybody so you’re gonna have to stay,” she said. She quit after four months.

Five times, inspectors showed up at homes in Texas and found no staff at all.

Basic maintenance suffered also. Alicia Reed, a former school principal who worked for BrightSpring in Houston around that time, showed BuzzFeed News photos of group homes with mold lining the windows and broken furniture littering the living room, and described other homes that reeked of urine and looked like they hadn’t been cleaned in weeks. State inspection reports mention bedbugs and cockroaches, as well as common areas splattered with feces.

Despite the shortfalls, under KKR’s ownership, BrightSpring executives pressured managers to keep beds full.

In mid-2020, McAfee, the manager of about 60 homes around Houston, said he got a referral for a new potential resident. She had previously been hospitalized for severe psychiatric issues, he said, so she would need extra attention.

He said he told BrightSpring’s Texas state director, Jodie Braden, that given how shorthanded his homes were, they couldn’t properly care for her. McAfee said Braden told him to take her anyway. (Braden did not respond to requests for comment made to her directly and through BrightSpring.) Almost immediately, McAfee recalled, the client became verbally and physically aggressive toward her roommates.

White, the BrightSpring spokesperson, said a team reviews each new potential client to “decide if we can meet their needs to safely support them.”

McAfee and several other managers told BuzzFeed News they felt pressured. “The beds generated the revenue,” McAfee said. “We were expected to take anyone available regardless of their appropriateness for the placement.”

The company, said two former managers who ran several homes, offered five-figure bonuses to local managers who came in under budget and avoided state citations. Managers who did not meet corporate targets were subjected to “focus calls” on which Rousseau, BrightSpring’s CEO; Barnes, the president of the group home division; or other executives would berate them. Rousseau and Barnes did not respond to detailed messages seeking comment.

Four former managers, some of whom requested anonymity to protect their jobs, said supervisors kept the pressure on despite being warned about safety concerns in the homes.

In 2020, as a reward for hitting the entire company’s financial goals, the CEO doubled his salary, to $1.6 million.

After KKR took over BrightSpring, the state of West Virginia, where the company dominated the market, issued more than a dozen dire warnings of severe neglect and egregious abuse. Two of them concerned a particular resident in the Chafin Group Home in Huntington named Lisa Smith. The story of what happened to her — and how the company handled the warnings about her care — encompasses almost all the ways that residents have suffered in the company’s troubled homes.

Smith had been an energetic child who easily learned to count and sing the alphabet. But at age 5, she started having seizures. She stopped feeding herself or taking herself to the bathroom and never spoke again.

As she grew up, she paced constantly, unsteadily, and fell often. For more than 20 years, her mother caught only brief snatches of sleep on a couch outside Smith’s room, jumping up to help her daughter whenever she heard her stir. By the time Smith was 27, her mother, Elisabeth, who had health problems, and her father, James, who worked long hours in a coal mine, decided they needed to place her in the care of professionals.

To her parents’ surprise, she flourished. When her father visited her at the first group home she lived in, which was owned by a local nonprofit, he was amazed to see her feeding herself for the first time in two decades. Recounting that memory, recently, brought him to tears.

“I thought, My God, them people know what they be doing,” he said in a West Virginia accent. “They took real good care of her.”

But by March 2019, the home Smith was living in had become part of the KKR portfolio.

At first, her parents didn’t notice much of a change. Smith was still happy when they came to visit twice a month, jumping up and dancing whenever her favorite song, Billy Ray Cyrus’s “Achy Breaky Heart,” came on. But the staff turnover seemed new — her parents used to be on a first-name basis with most of Smith’s caretakers, and it was getting hard to keep track of all the new faces.

Ten months after KKR bought the home, Smith suffered several recent injuries, including a broken arm and bruises on her jaw and left eye. Despite a mandate to keep her under constant observation, staff members — who inspectors found hadn’t been properly trained — said they could not explain what had happened. Text messages that were later uncovered, however, showed that the house manager had seen one of Smith’s caregivers sleeping on the job and done nothing about it.

The state issued a dire warning, saying Smith and other residents in the home were in “immediate jeopardy,” and demanded BrightSpring act promptly to ensure better care.

It was just one of the urgent warnings BrightSpring received about its West Virginia homes. Again and again, the state sounded alarms about dangerous practices: failing to monitor a resident who had spent years in prison for sexual assault and then assaulted another resident, letting a nurse work without a valid license, and failing to purchase medicine elsewhere when the KKR-owned pharmacy ran out of clients’ medications.

Despite all these warnings, West Virginia found that BrightSpring did not adequately address the problems. So, in July 2020, state health authorities took an extraordinary step: They banned the company from accepting any new clients until the situation improved.

They found a “statewide pattern of increased significant and serious deficient practices and operations in ways that jeopardize the health, safety, welfare, and clinical treatment of consumers throughout West Virginia” since June 2019, three months after KKR bought the company. The report specifically cited the poor care that Smith had gotten.

Lawyers for the company immediately appealed the decision, and managers promised changes.

But those promises didn’t help Smith.

Because of the COVID-19 pandemic, some health inspections and family visits had been put on hold. According to federal regulations, Smith’s parents should have been informed of any significant incidents or changes in her well-being. But no one notified them when she fell in October 2020 or when she was taken to the emergency room two days later for a swollen knee. No one notified them about another fall two weeks after that.

Then, on Oct. 26, a nurse entered Smith’s room and found her in a shocking state: She had been put in a makeshift restraint, “tightly wrapped in a comforter,” according to a state inspection report, “with only her legs sticking out and her face visible, a body pillow to her left side, a couch cushion on her right side from her elbow to her head, and a large bean bag chair on top of the couch cushion.”

Unable to call for help, Smith had been struggling to free herself. As for the night-shift staffer who was supposed to be looking after her, he was nowhere in sight.

To document the scene, the nurse took out her phone. In the video she made, another staffer can be heard exclaiming, “Where is that little prick?”

(The video was filed as evidence in a wrongful termination suit by one of Smith’s caregivers. Immediately after BuzzFeed News requested access, the company settled the suit and fought to keep the video out of view. BuzzFeed News sued for access to it and won.)

Three days after that incident, Smith was taken to the hospital for intermittent nosebleeds. A day after that, back at the home, she fell again, according to a state inspection report, and was left unattended for hours because a staff member who was supposed to be watching her took a TV to the laundry room. When Smith was finally discovered, she was given no medical attention.

At 7:45 the following morning, Smith was found in her bed, breathing but unresponsive, and rushed to the emergency room.

Concerned that his bosses were trying to cover up what had happened, a staff member at the home broke with the chain of command and called Smith’s parents directly.

Her parents rushed to the hospital. Because of the pandemic, it had been eight months since they had been allowed to see Smith, and they almost didn’t recognize her. Her face was bruised and tubes ran into her nose. She had lost a significant amount of weight. Her hair had been haphazardly shaved off.

As Smith lay in the hospital, BrightSpring began an internal investigation, which would ultimately lead to two direct care staffers being terminated for abusing her. But managers who had overseen her care kept their jobs.

Twelve days after she was found, bound and struggling, she died from her injuries. She was 45.

Her father said he can’t get over the sight of Smith in her final days. At home, she had walked around so much that she “wore a circle” in a rug. “I only seen her still one time, and that’s when she was laying in the hospital, dying.”

According to a state inspection report, managers at the company did finally conduct training for the staff on how to care for Smith. It was 16 days after her death.

The report says that a staff member called a state inspector while driving to the company’s offices to quit in protest over the “unethical and fraudulent practices being committed” by management. “I don’t want to be a part of it,” the person said.

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BrightSpring did not report Smith’s death to the state health inspection office, as it was required by law to do. When asked why, a manager told the inspector the company was in the process of discharging Smith and removing her from their books — a practice that three former managers told BuzzFeed News the company has used to avoid scrutiny over a client’s decline.

In June 2021, eight months after Smith died, BrightSpring and the state of West Virginia reached a settlement agreement. The company didn’t admit wrongdoing but agreed to cease operating nine of its homes, reducing its stake of federally certified group homes in the state by 20%.

BrightSpring declined to comment on Smith’s care, citing patient privacy laws.

“Given our scale in West Virginia and the complex patient base that we serve, unexpected incidents do occasionally happen,” said White, the BrightSpring spokesperson, in a statement. She said the company has taken steps to “increase accountability” and has “implemented new technologies to further minimize already-rare errors in patient care.”

Smith’s former home was one that BrightSpring agreed to let go. It’s still in operation, under its new owner: Sevita, another private equity–backed healthcare company.

Tapping into a $1.5 trillion market

The loans that BrightSpring has taken out since KKR bought the company have funded a billion-dollar buying spree, including a home health organization, a small hospice operation in Georgia, another that serves people in 12 states, and brain rehabilitation centers in Texas. BrightSpring’s revenue grew from $2.5 billion in 2018 to $5.6 billion by the end of 2020, the most recent information available.

Now, after owning BrightSpring for just three years, KKR is carrying out the next step in its playbook.

Last October, the company filed paperwork with the Securities and Exchange Commission announcing its intention to go public. The documents paint a rosy picture of BrightSpring’s financial status and its “essential” role in American healthcare.

The company called its public offering a chance to tap into a “$1.5 trillion market opportunity” and said that, as the pandemic raged and businesses suffered in 2020, BrightSpring managed to increase revenue by nearly 25%.

As part of its pitch to investors, the company boasted that it now operates in all 50 states and serves 330,000 people every day. BrightSpring promised that it was able to “deliver optimal patient outcomes in lower-cost settings and help people live their best lives.”

With about 243,000 stock options, Jon Rousseau, the CEO who implemented KKR’s management strategy, could make millions. ●