Ohio nursing home deaths clustered in 25% of facilities

This story has been updated and clarified.

At least 250 nursing homes in Ohio have had residents die due to COVID-19 or its combination with other health problems. The deaths were concentrated in a quarter of those facilities, accounting for 60 percent of all coronavirus fatalities in the state’s nursing homes, an Enquirer analysis of federal data shows. Nursing homes have held the majority of the state’s coronavirus deaths, Ohio records show.

The Enquirer made the analysis of federal data after Ohio officials refused to identify nursing homes where residents have died. The federal database only includes about 60% of all the 2,710 deaths at nursing homes and other congregate care facilities in the state. That’s because of a loophole that didn’t require nursing homes to report deaths before May 1 – and because the federal data doesn’t include assisted living or group care homes.

Nursing homes account for 64% of all of Ohio’s coronavirus deaths, the most recent state data shows.

The analysis of the federal data also reveals:

• Four nursing homes had per capita death rates so high that 1 of every 2 residents succumbed to the coronavirus. The facilities are located in Coshocton, Monroe, Ottawa and Wayne counties.
• Fourteen facilities had more than 20 deaths. One of them had 42, another 30.
• Nineteen workers at 10 nursing homes have died due to the coronavirus. One of the facilities is Lakeridge Villa Health Care Center in North College Hill, which lost two staff members (plus four residents) to the novel coronavirus.
• A quarter of the nursing homes with deaths had only one fatality.
• Two nursing homes that have had at least 10 deaths are candidates to be placed on the federal government’s special focus facility list of nursing homes. The list is for facilities with a history of poor care.

Thirty-three nursing homes in Southwest Ohio account for 118 of the death totals in the state’s database.

Cottingham in Sharonville (Photo: The Enquirer)

Four of the local facilities had more than 10 deaths: Cottingham in Sharonville had 13 deaths; Mercy West Park in Westwood had 13 deaths; Carecore at the Meadows in Forest Park had 11 deaths; and Burlington House Rehab & Alzheimer’s Care Center in Springfield Township had 11.

This is the first time the full list of the 250 plus nursing homes with deaths has been published.

While the Enquirer used the federal tracking system to help with its reporting, the database has holes.

For example, The Enquirer in August uncovered a state report detailing 16 deaths and 100 more infected at Mercy Park West, also known as Mercy Franciscan at West Park, instead of the 13 found in the tracking system. It’s unclear why there’s a discrepancy in the death tolls.

The newspaper has written about how the federal tracking system undercounts the number of deaths statewide. The Enquirer discovered at least three nursing homes in the Cincinnati region with a total of five COVID-19 deaths that weren’t reported in the federal database.

The Enquirer found the five deaths through its ongoing review of death certificates since the pandemic began. The five deaths occurred in April; the federal Centers for Disease Control and Prevention only required nursing homes to report deaths after May 1. 

Christine Colella, professor and executive director of graduate programs at the University of Cincinnati’s College of Nursing, believes the public should have been told of the deaths.

“Absolutely. I think the more knowledge anyone has, the better decisions they can make. I think we need to be as transparent as we can. People need to know,” Colella said. “We all hear about nursing homes in a general sense but nothing specific.”

Why are the deaths concentrated?

So what contributed to 42 deaths at a nursing home in Mahoning County, 30 at a facility in Wayne County and 29 at a location in suburban Columbus?

Failure of workers to follow infection control procedures is one reason why nursing homes, virtually sealed off from all outsiders since early in the pandemic, have had recent COVID-19 infections and deaths.

The three nursing homes couldn’t be reached for comment. But the CEO of Crandall Medical Center, the Sebring, Mahoning County facility with the 42 deaths, acknowledged it was unprecedented for so many patients to die in such a short period of time.

“They will not be the same after this,” CEO David Mannion said of his staff during an interview with the Canton Repository in June. “I won’t be the same after this.”

“(The) COVID-19 disease has put the nursing home industry in crisis,” wrote Dr. Joseph G. Ouslander, a nationally-known professor of geriatric medicine at Florida Atlantic University, in a report he co-authored on COVID-19 earlier this year. “The combination of a vulnerable population …staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a ‘perfect storm’,” wrote Ouslander. “From a public health standpoint, nursing homes must maintain intensive infection prevention and control education and procedures with continuing ongoing screening of all individuals who enter the facility.”

“Staff have been the primary vectors by which the virus has come from the community” into nursing homes and other congregant living locations, said David Grabowski, professor of health care policy at Harvard Medical School, responding to Enquirer questions in August.

Most of the infections at nursing homes are coming from staff and people who are employed by the facilities, said Pete Van Runkle, executive director of the Ohio Health Care Association, which represents more than 1,100 assisted living communities, home care and hospice care providers in Ohio.

“Typically, it’s staff members but sometimes it’s even consultants or contractors (therapists or lab technicians) who are going from one facility to another,” Van Runkle said.

Like Ouslander, Van Runkle noted most nursing home residents are susceptible to the coronavirus.

“Nursing facilities are full of people who are old and have medical conditions. That’s why they’re there.  And in many cases in the last years of their lives. If they get COVID, their bodies can’t fight off the disease,” he said.

One case study in how the disease was deadly in some nursing homes comes from Licking County’s Newark Care and Rehabilitation center, which had 23 deaths. Inspection reports show the Newark facility failed to perform adequate contact tracing to properly identify, quarantine, and appropriately test all residents with known exposure to a staff member who had tested positive for COVID-19.

“This resulted in immediate jeopardy” on July 1 when a licensed practical nurse (LPN) notified the facility she tested positive for COVID-19, according to a state report released after 25 deaths at the nursing home.

The nurse had last worked in the quarantine unit on June 25 where four residents resided but had been moved to other units in the facility between June 26 and June 30, health records show.

They had been placed in semi-private rooms with four other residents, resulting in the spread of COVID-19 and the death of residents.

“This resulted in the likelihood to cause serious harm injury or death and affected eight residents with the potential to affect all the residents in the facility,” according to the inspection report.

14 locations with at least 20 fatalities

Seven nursing homes stand out on the list for having 25 deaths or more. Another seven had at least 20 deaths.

Concord Care Center in Toledo had 22 resident deaths along with eight staff fatalities, health records how.

Forty-seven nursing homes were in the top 25% for the number of deaths and death rates (per capita fatalities), including Cottingham, Mercy and Care Core. There were 10 other nursing homes were staff members have died, health records show.

• Crandall Medical Center led the state on the federal list with 42 deaths. The nursing home with the top or five-star quality rating from the federal government paid a $1,363 fine in July of 2018 and has had 12 fire safety violations, health records show.
• Smithville Western Care Center in Wooster was second in the state with 30 deaths. The four-star facility was fined $6,500 in November of 2017. It has had six fire safety violations, health records show. Smithville Western is one of the four facilities statewide where the per capita death rate met or exceeded 1 of every 2 residents.
• Majestic Care of Whitehall, a one-star facility, had 29 deaths. The suburban Columbus facility had 38 violations in a November of 2019 report, health records show.
• Normandy Manor of Rocky River, a four-star facility in suburban Cleveland, had 27 deaths. The four-star facility had nine fire safety violations, health records show.
• The Colony Healthcare Center in Tallmadge, a two-star facility, has had 26 deaths. The Summit County center was fined $11,278 in May of 2019 and there were 10 health inspection violations in March of 2019, health records show.
• McNaughten Pointe Nursing and Rehab in Columbus, a two-star nursing home, had 26 deaths, health records show.
• Newark Care and Rehabilitation, a one-star nursing home, had 25 deaths. It was fined $139,797 in February of 2018. It has had 13 fire safety violations. There were 18 health violations in December of 2019, health records show.
• Jackson Ridge Rehabilitation and Care Center, a three-star nursing home in Canal Fulton, Stark County, was fined $8,775 in September of 2017, health records show.
• Pebble Creek, a five-star facility in Akron, had 23 deaths, health records show.
• Signature Healthcare of Coshocton, a one-star nursing home, had 22 deaths. It’s another is one of the four facilities statewide where the per capita death rate met or exceeded 1 of every 2 residents. A spokeswoman for the nursing home disputed the federal database’s accuracy, saying the facility had five resident deaths. The nursing home,  had no infection violations in its two inspections since the pandemic, the spokeswoman noted. But it was fined $76,567 in October of 2019 and had nine health violations in March of 2019, health records show. Signature Healthcare failed to notify the responsible party of a resident who tested positive for COVID-19 in a June infection report. The resident was admitted on March 21 with congestive heart failure, chronic kidney disease and other ailments. Family members said they were never notified about the positive test. The director of nursing said the facility attempted to call the resident’s wife but there was no answer and voicemail hadn’t been set up. However, the nurse admitted there was no written documentation of an attempt to notify the family.
• Concord Care Center of Toledo, a five-star nursing home, had 22 deaths, health records show.
• Briar Hill Health Care Residence, a three-star facility in Middlefield, Geauga County, had 20 deaths.
• Saybrook Landing in Ashtabula, a four-star facility, had 20 deaths, health records show.
• The Laurels of Norworth, a two-star facility in Columbus, also had 20 deaths. It had 15 health violations in December of 2019, health records show.

Where toll was highest in SW Ohio

Carecore is a one-star facility that has been  fined more than $88,000 since September of 2017, health records show. It had 21 health violations in an August of 2019 infection report, way above the state average of nine in addition to eight fire safety violations with the state average being 3.9.

Burlington House is a two-star facility that had a dozen health violations during a November infection report and was the subject of six safety violations, health records show.

Read or Share this story: https://www.cincinnati.com/story/news/2020/09/08/investigation-ohio-nursing-home-deaths-clustered-25-facilities/5705012002/