The Shmooze sits down with one of Colorado's longest-standing SNF operators , a Boro Park kid who followed his wife to Denver and never looked back.
Jay Moskowitz is 68 years old, has been in this business for 45 years, and still wears his yarmulke when he chairs the Colorado Healthcare Association. He is, by his own admission, a storyteller. By anyone else's measure, he is one of the most experienced Jewish SNF operators in the country - and one of the most honest about what those 45 years actually cost him.
"Back in '81, my wife wanted to move back to Denver. Didn't like Brooklyn." Jay had gone to yeshiva in Denver in the '70s , that's where he met her , and when she said she wanted to go back, he went.
His in-laws were already in the SNF business in Colorado. He got his NHA license. He worked for his in-laws for a few years. He learned from the floor up , actually ran buildings as a licensed administrator, knew every resident by name, wore a name badge before it was policy. "I didn't just buy a building and start operating it," he says. "I learned from the bottom up."
His father, meanwhile, had assisted livings in Long Island and later one called the Regency in Boro Park with Jay's brother. Healthcare was just what the family did. "My dad worked until he was 92. COVID slowed him down. I think if he hadn't passed away, he'd still be working." Jay pauses.
"He would've been 96 now."
The First Deal
Jay bought his first facility in 1987. It was in bankruptcy. He found out about it the way you find out about things in this industry - from a supplier who was owed money and wanted someone new to pay the bills.
He used CW Capital to do a HUD deal. The whole process took four months to close.
"Was it easier back then?" The Shmooze asks.
"Different. Not easier. But four months to close a facility - you try doing that today."
Building It Up
What Jay built over the next four decades is genuinely impressive. Vivage Senior Living became one of Colorado's largest SNF operators. At its peak, Jay had 30-31 skilled buildings in Colorado - and 19 of them were four or five stars. "I took a lot of pride in that number," he says. The pride in his voice when he says it is real, and the grief in his voice two sentences later when he talks about giving them up is just as real.
He also built WellAge for assisted living and memory care, Bridges Home Care, Bridges Hospice, and a closed-door pharmacy that serves not just his own buildings but other facilities across multiple states. "The ancillary business is set up to provide services to our communities and others. The pricing has to be appropriate to do that. It's not a game." He's clearly been asked about the ancillary model before by people who've seen it abused elsewhere.
His answer is clean: the services have to be priced fairly enough to compete for outside business, which means they can't be a hidden subsidy or a margin extraction vehicle. "I hear stories," he says. "But I live in the Midwest. This is a different way things are done."
"The biggest challenge in 40 years was COVID."
Vivage, because of the structure and number of employees they had, didn't qualify for the standard level of COVID relief dollars. At the same time, they had 11 buildings leased from Omega Healthcare , buildings they'd run successfully for years, buildings they were proud of. Half of those buildings were five-star rated. During COVID, they gave all 11 back.
"Those are buildings we leased for many years. We were very successful in those communities. It was very hurtful to give them back."
Out of 30 buildings, he gave back more than a third. Half the ones he gave back were five-star.
And then, almost in the same breath: "My wife passed away during the same period."
Shoshana Moskowitz - an RN who worked at a hospital, not in his facilities, the woman he'd followed from Brooklyn to Denver forty years earlier - passed away two years ago, in the same stretch of time that Jay was giving up a third of his portfolio. "It really threw me for a loop," he says quietly. "Very, very hard."
He didn't quit. "Did you think about it?" The Shmooze asks. "After my wife passed, yeah. It crossed my mind." He pauses. "But I still feel young. I still have the energy. And I love what I do. That's the honest answer. I love going to work every day."
On the Business Today
Jay is, at 68, still actively building. Vivage merged with Beecan Health Colorado in 2023 to create a combined network of 42 skilled nursing communities and nearly 3,600 licensed beds - urban and rural, covering the entire state. WellAge continues to grow on the assisted living side. The goal, he's said publicly, is two or three new communities a year.
On the staffing crisis: "The shortage of RNs will continue being a problem." He rattles off the structural issues like someone who's been living them for decades - average RN age is now over 50, competition from hospitals, Filipino nurse immigration restrictions, wages that Medicare and Medicaid rates simply can't keep pace with. "Hospitals are a more attractive place to work. We're competing directly with them and losing."
His solution - building internal float pools, investing in retention, knowing your staff by name - is the same solution every good operator eventually lands on. It's just harder to execute at 3,600 beds than at 300. "If you can retain your staff, you can be successful. That's the key. Five stars or not."
On oversight: "More today than in the eighties and nineties. States are always looking at what providers are making. Audited financials. Squeezing margins. It's not getting easier."
On bad actors: "Are there bad players? Sure. There are in any profession. Have people not paid their bills? Yes. Not much I can do about that except hope people are who they say they are."
The Story About Helen White
Jay was at the Smithsonian in the early nineties for a national ombudsman conference. They were selling replica vintage newspapers - the kind that had headlines like PRESIDENT ROOSEVELT DIES or WAR ENDS IN EUROPE printed to look authentic. Jay thought they'd be perfect for the hallways of his buildings. Better than the French provincial pictures and generic art. He bought a bunch, framed them, hung them up.
A few weeks later, he was walking through one of his buildings and turned a corner to find a 103-year-old resident named Helen White sitting in front of one of the papers, weeping.
"Helen, what's wrong?" "He died." "Who died?" "President Roosevelt."
She had been sitting in front of the framed headline and fully believed, in that moment, that the President had just died.
"I love my residents," he says. "I could sit here and tell stories all day."
The Bottom Line
Jay Moskowitz is not the loudest voice in the room. He's not making headlines with nine-figure deals or REIT partnerships or flashy press releases. He's a 68-year-old Boro Park kid who moved to Colorado for his wife, got his NHA license, learned the business from the floor up, built something real over 45 years, lost a lot of it in one brutal stretch, lost his wife in the same stretch, and came back to work anyway.
He chairs his state association. He sits on the national board. He wears his yarmulke to both. His staff has been with him 10, 15, 25 years. His vendors got paid when he gave back those buildings. He knows his residents by name.
Not easy to find them made like this anymore.
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