CINCINNATI — Kathy Lawson worries about her 83-year-old mother, Patricia, who suffers from Alzheimer’s disease and lives on the memory care floor of a Fairfield Township nursing home. Her biggest concerns used to be whether her mother had enough daytime activities or companionship.
Now her worries are much bigger.
Her mother recently got a double dose of medication, and on a separate night, spent nearly two hours without a nurse’s aide present on her floor, where nine others with dementia-related issues also live.
“Not one person came on the floor,” Lawson said, before deciding to check on the other residents herself that night. “One gentleman in particular was on the floor and needed assistance and I don’t know how long he had been there.”
No one from Gateway Springs Health Campus where Lawson's mother lives, or parent company Trilogy Health Services, returned requests for comment.
“I’ve been hearing for months — we’re working on staffing. We’re working on it. We’re working on it,” Lawson said. “I keep hearing we’re hiring people. Well, where are they?”
Lawson is bringing that question to the state’s new Nursing Home Quality and Accountability Task Force, which will visit the University of Cincinnati on Thursday for two listening sessions, as part of a statewide tour. Afterward the group will issue a report on its findings and recommendations to the state.
Gov. Mike DeWine created the task force in February to address lagging quality issues at many nursing homes. Only two states have more nursing homes than Ohio, with 960 facilities, yet most states have far better rankings for quality of care and staffing.
Ohio ranked 39th in the most recent Centers for Medicare and Medicaid Services overall quality ratings. And 40% of the state’s nursing homes earned worse ratings since 2018. Many nursing homes correct and repeat the same deficiencies when inspectors visit, according to DeWine’s executive order creating the task force.
“Sometimes we’ve seen where an aide comes into the room, turns off the call light and says I’ll be back,” said Linda Kerdolff, managing ombudsman for the Pro Seniors advocacy group. “They might come back an hour later. Sometimes they don’t come back at all.”
Staffing problems are at the heart of many complaints received by Pro Seniors, which serves seniors in Hamilton, Butler, Warren, Clinton, and Clermont counties.
“It could be anything. It could be I need water, or I need help getting to the toilet,” Kerdolff said. “Because of short staffing it’s a very lengthy time between when that call bell gets rung and when somebody actually gets help.”
Staff shortages are not new to the nursing home industry. Once limited to the lowest-paid positions, the pandemic has escalated the vacancies to every level including nurses and administrators, Kerdolff said.
“Even if you pay a lot of money this can still sometimes happen,” Kerdolff said. “We had my own mother in a nursing home, and it was a pretty big check that we wrote every month and we still saw some of the same things.”
Lawson doesn’t fault Gateway for its staffing shortages, which she described as a clean, new facility with abundant sunlight and lots of amenities. And she appreciated how executives responded after she called the company’s compliance line.
She’s hoping that the task force can provide some real solutions to the industrywide problems.
“All too often we hear of preventable tragedies occurring: medication errors, failure to provide care, poor infection prevention and control, and sometimes even elder abuse,” DeWine said when he announced the task force on Feb. 24.
More than 100 attended the first task force listening session at Youngstown State University on March 7, with administrators, nurses, elder advocates and residents and family members, and the same number is expected at UC on Thursday for each of the two sessions.
“There were some concerns about not enough staff, it being difficult to get ahold of people, difficult to get responses from staff members,” said Pete Van Runkle, executive director of the Ohio Health Care Association, who DeWine appointed to the 18-person task force.
Staffing is the number one concern for the 1,300 nursing homes, long term care facilities and hospice care centers that Van Runkle’s organization represents.
The cost of temporary agency staff that facilities sometimes use has gone up dramatically, Van Runkle said. He hopes the state will increase its share of reimbursement for Medicaid patients, which is still at 2019 levels and has resulted in a $70 per day gap in current costs.
“Quality comes from having enough staff and enough of the right kind of staff, people who are motivated to do a good job, who care about what they're doing,” Van Runkle said. “The only way that you can afford those kinds of people is if you have enough resources to pay them what they're worth. Right now, we just don't, and that's why we have the staffing problems that we do.”
And the problem is poised to get worse.
Currently 10,000 people live in nursing homes in the five Southwest Ohio counties that Pro Seniors serves. By 2050, that number is expected to double, Kerdolff said.
“We do anticipate that over the next 15, 20, 30 years, that we'll see a considerable increase in the number of people who use skilled nursing just because there's so many folks that need that level of service,” Van Runkle said. “At the same time, the percentage of the population of caregiving age is going to decrease. So you will see a greater and greater gap going forward.”
The task force will host two sessions at UC on Thursday for the public to attend. Afterward the group visits Dayton, Columbus, Cleveland, Bowling Green and other cities before presenting its findings and recommendations to DeWine.
“I wish there were a silver bullet. But there’s not. This is a complex problem,” said Kerdolff, who would like to see more federal CARES Act money and state dollars earmarked for direct care at nursing homes. “That’s why the governor’s task force is important because there’s many facets to this.”
For Lawson, she’s attending the task force meeting not just to speak for her mother, but to advocate for her own future.
“I’m 63 my generation is marching toward this care system, and I find that scary,” Lawson said. “If we don’t speak up — these people have lost their voices. Who’s going to speak up for them? Who’s going to speak up for me when I get there?”
Space is still available for the public to attend the 10 a.m. task force listening session at UC's Tangeman University Center, Room 400. Click here to register: https://www.surveymonkey.com/r/NHTaskForce