CINCINNATI — Ignored call lights. Cold meals. Soiled undergarments. Undispensed medicine. Bed sores. Isolation. Unanswered phone calls.

These are some of the 80 to 100 complaints that Bob Vines and other ombudsmen investigate each month at long-term care facilities through Pro Seniors, an advocacy group in Southwest Ohio.

“COVID didn’t create the problems in nursing homes, but it has exacerbated them,” Vines said.

As COVID cases in Ohio’s long-term care facilities rebound, Vines worries that more staff members will quit and family visitation will end, making things worse for the state’s most fragile who already endured months of isolation during the pandemic’s peak.

“Cases of COVID have spiked. That means the number of closings of nursing homes for visitation has increased,” Vines said.

Lot Tan

COVID cases inside Ohio’s long-term care facilities have increased by 45 percent in two weeks. The Ohio Department of Health’s most recent data shows 416 residents and 599 staff members have COVID.

“There’s ten times as many (COVID cases) as there were two months ago, in the early part of July,” said Ohio Health Care Association Executive Director Pete Van Runkle, who noted that cases are still dramatically lower than the 8,000 weekly case totals in December.

Open chart in new window.

One Clermont County nursing home, Batavia Nursing Care Center, has the most COVID cases of any long-term care facility in the state: 30 residents and four staff members, according to state health data.

No one from Batavia Nursing Care Center returned WCPO’s requests for comment.

A Clermont County Sheriff’s Department incident report from Sept. 10, shows deputies responded to the Batavia Nursing Care Center after a resident called the county’s Mobile Crisis Team to complain about his care.

“(He) stated he is frustrated with his treatment at the facility and wanted someone to talk to. (He) is a paraplegic and feels he is not treated well,” according to the incident report.

Deputies left the facility after the resident denied having any suicidal thoughts and did not want to be transported to a hospital, according to the report.

Health department reports show the Batavia Nursing Care Center, which specializes in patients who are on ventilators, had no violations during six inspections since last February.

Lot Tan

All long-term care facilities across Ohio are experiencing some degree of staffing shortages, Van Runkle said.

“People are leaving because they just can’t take it anymore. They can’t take having to deal with the pandemic. Because health care and long-term care, in particular, are on the front lines,” Van Runkle said.

Van Runkle expects more staff members will quit to avoid the COVID vaccine mandate that President Joe Biden announced last week. He is requiring vaccinations for workers in most healthcare facilities that receive Medicare or Medicaid reimbursement, including hospitals and nursing homes.

“Things just keep getting worse and there’s not really a lot of light at the end of the tunnel,” Van Runkle said. “Folks are already walking out the door. It’s like, okay I know this mandate is coming and I’m not going to comply with it, so I’m just going to go ahead and find another job now.”

Lot Tan

Recent data from the Centers for Disease Control show that 79 percent of residents in Ohio’s long-term care facilities are fully vaccinated for COVID. Yet just over half of health care workers inside those facilities, or 53 percent, have been fully vaccinated.

A nursing home near Xenia, Greenewood Manor, closed in July, Van Runkle said, and others are on the verge of shutting down because of staffing shortages.

Nursing homes owned by smaller companies with less flexibility to move residents around or summon corporate help, and those in rural areas where COVID vaccine rates are the lowest, are especially at risk of closing, he said.

“The tipping point is when you don’t have enough staff to take care of even a reduced number of patients,” Van Runkle said. “At some point it gets to where you can’t even meet their basic needs and then the provider has no choice but to shut down.”

WCPO has been following for more than a year the story of Dennis Paulik and his 100-year-old mother, Helen Paulik, who lives in a highly-rated Butler County nursing home.

Lot Tan

“The labor shortage in nursing homes is getting worse. As a result, my mom is back to eating most of her meals in her room and as a result is isolated once again with no social interaction except staff,” Paulik said. “Biden’s vaccination mandate is just going to make this worse.”

Van Runkle is hoping that state officials release federal pandemic funds to long-term care facilities so they can boost the pay of workers and hopefully quell the staffing exodus.

Lot Tan

Staffing shortages mean phone calls to nursing homes often go unanswered, even for an ombudsman like Vines.

“I had an ombudsman actually go to a facility this weekend and couldn’t get in,” Vines said. “The door was locked and nobody came to answer the door. That’s a problem.”

The Ohio Department of Health’s website lists which long-term care facilities have COVID cases. But it does not state how many people have died of COVID at each facility.

That is information WCPO has fought for since last year.

WCPO filed a complaint against the Ohio Department of Health in August 2020 for that public information and won in the Court of Common Claims.

The health department appealed its loss to the 10^th District Court of Appeals, delaying the release of that information if WCPO is successful by months, just as COVID cases in nursing homes are rising again.

WCPO obtained invoices through a public records request this week which show the Ohio Department of Health has spent $42,852 in legal fees, to date, to fight WCPO in court and continue to keep secret the locations of COVID deaths in nursing homes.

Meanwhile, Vines urged family members and nursing home residents to call Pro Seniors with concerns or complaints.

“If someone calls us, we have a right to go into a home even if there is a COVID outbreak, and resolve it, and investigate,” Vines said. “We’d have a lot more cases I’m sure, if people knew about us, or if people weren’t afraid of what might happen if they called us.”

Pro Seniors of Southwest Ohio serves seniors in Butler, Clermont, Clinton, Hamilton and Warren counties. Complaints can be kept confidential. Call (513) 345-4160.

CINCINNATI — Many Tri-State nursing homes are already facing staffing shortages worsened by the pandemic and a tight labor market.

Now one industry lobbyist warns that a federal vaccine mandate for nursing home workers could make staffing shortages so extreme that it forces facilities, especially ones in rural areas, to close.

“If you don't have enough staff to operate, you basically have to close down. There's no in-between,” said Pete Van Runkle, executive director of the Ohio Health Care Association, which represents hundreds of nursing homes in Ohio. “The worst-case scenario is that we have significant closures across the state, and significant dislocation of residents.”

President Joe Biden announced on Aug. 18 that all nursing homes must require employees to be fully vaccinated against COVID-19 if they want to continue receiving Medicare and Medicaid funding – which most facilities rely on to stay open. The new rule could take effect as soon as next month.

Lot Tan

The mandate brought mixed reactions from those in the industry.

The AARP applauded the news with executive vice president and chief advocacy and engagement officer Nancy LeaMond saying it “is a significant step in the fight against this pandemic.”

Locally, Laura Lamb, president and CEO of Episcopal Retirement Services, also supported the vaccine mandate as “an important step toward eradicating COVID-19.”

ERS, which operates nearly 30 retirement communities across the Tri-State, was one of the first in the area to announce in July that it would require all workers to get fully vaccinated against COVID-19.

But Van Runkle warns that many nursing home workers will quit if they are required to take a COVID vaccine, which could ultimately exacerbate a staffing shortage, hurt patient care, and cause facilities to close.

“We have a lot of folks who work in long-term care, whether we like that or not, who are not vaccinated,” Van Runkle said. “It’s their body and their choice.”

Van Runkle and the latest federal data show that 46 to 47 percent of Ohio nursing home health workers are not vaccinated against COVID, which he estimates at 50,000 workers.

“Who’s going to take care of people if we have a mass exodus or even a partial mass exodus of staff?” Van Runkle asked.

Van Runkle warns that facilities in rural areas with lower vaccination rates could be the most at-risk for closing. In Southwest Ohio, the counties with the lowest nursing home worker vaccination rates are Brown, Highland, Adams and Preble.

The latest federal data put Ohio, Kentucky and Indiana in the bottom 15 states with the lowest percentage of vaccinated nursing home staff per facility.

Lot Tan

Dennis Paulik, of Butler County, worries that his near 100-year-old mother, Helen, could face cold meals and delays in receiving personal care if the vaccine mandate is enforced.

She lived in isolation for months when visitors were banned from nursing homes during the height of the pandemic. He saw firsthand how staffing shortages impacted her care back then.

“If you need help getting dressed, there's nobody to help you get dressed in the morning,” he said, noting that his mother would sit for hours in a chair waiting for breakfast, often falling back asleep. She used her walker to go to the bathroom alone, despite being a fall risk, because no workers were available to help her.

Courtesy: Dennis Paulik

“You need help going to the bathroom, and nobody answers the bell,” he said.

Paulik complained and the nursing home, which he said is one of the best in the area, made improvements. But now he worries that a vaccine mandate will cause an extreme staff shortage and make life much harder for his mother – again.

“Even outside of COVID times, nursing homes have a hard time retaining staff, especially the nursing assistants who are the primary caregivers,” Paulik said. “It’s a minimum-paying job. It’s hard work. And a lot of people kind of pass through and figure out it’s not for them … so when you compound that with COVID restrictions, it’s been tough.”

An average nursing home in Ohio has 19 job openings, out of roughly 100 to 125 employees at an average facility, Van Runkle said.

“And that’s before this mandate,” Van Runkle said. “We’re already very short and then looking at this would just be disastrous.”

In the meantime, Van Runkle said, his parent organization, the American Health Care Association, is lobbying the Biden administration for federal funding to boost nursing home staff wages. He hopes any vaccine mandate includes exceptions for religious beliefs and medical conditions, while offering an alternative of more frequent COVID-19 testing for those who are opposed to taking the vaccine.

Paulik, who has been advocating for nursing home residents since the pandemic began, urges families to ask questions of nursing home administrators and stay in touch about staffing concerns or worries that a facility could close.

“Family councils may be another way of addressing the issue,” said Bob Vines, managing ombudsman at the nonprofit Pro Seniors Inc. “These are groups families have the right to form without interference to address any issue of concern to residents. We encourage all families to start one in the facility where their loved one resides.”

In the meantime, Paulik is planning a small outside picnic with a few family members to celebrate his mother’s 100^th birthday on Saturday and is hoping for the best.

“If I was an administrator and a director of nursing, I’d be really scared,” Paulik said.