Getting to the restroom on one leg can be challenging, according to Bruce Reed, of Mogadore.
"I lost the leg shortly after moving to Mogadore and have been there six years," he said.
Since then, he said, he’s spent time in rehabilitation several times at Heather Knoll in Tallmadge.
"I’ve been in rehab for the most part," he said. "They have this difficulty of getting to you when you need to go to the bathroom. It makes you want to put your leg back on and go over there, but when you can’t put your leg back on, it’s a problem."
He also said wound cleanings didn’t happen often enough during a recent visit, but he said he doesn’t place the blame on the Tallmadge facility.
"As far as I’m concerned, I blame the state for that," he said. "I’m on Medicaid, and [Heather Knoll is] dealing with Medicaid [funding] standards. They’re doing the best they can with it."
According to Medicare’s star rating system of nursing homes, Heather Knoll Retirement Village gets two out of five stars for its staffing levels, which is not uncommon in the area.
Administrators from Heather Knoll and several other nursing homes did not return calls seeking comment.
Until recently, nursing homes self-reported unverified data for two weeks and were then inspected, meaning homes could potentially anticipate an inspection and temporarily bring in more staff and "game the system," the analysis said.
Now all nursing facilities must provide daily payroll records to verify their staffing levels, following a mandate from the Affordable Care Act of 2010, that more accurately illustrates how staffing levels vary from day to day. Data from 2017 became publicly available earlier this year and is now being factored into facilities' overall five-star ratings.
The ratings are listed on the Nursing Home Compare website created by the Centers for Medicare and Medicaid Services to help consumers compare facilities.
About 70 percent of the nation's nursing homes reported lower staffing using the new data-reporting method, with an average decrease of 12 percent, the analysis found.
Among 69 nursing homes within 25 miles of Kent, there were 14 with two stars out of five for staffing levels, according to Medicare’s star rating system. There were also 17 with one star, 21 with three stars, 12 with four stars and three with five stars. Two facilities were too new to rate, according to data posted on the Medicare site.
Advocates in Ohio said they weren't too surprised by the findings.
"We suspect insufficient staffing is the root cause of a number of our complaints," Erin Pettegrew, Ohio's acting long-term-care ombudsman,said.
The second-highest statewide complaint received by ombudsmen in 2017 was staff members failing to respond to residents' requests for help, with 428 complaints filed. The office receives about 11,000 total complaints a year, ranging from issues with eviction and discharges, the most common complaint, to poor resident hygiene, stolen property, injuries and medication errors.
Facility operators say they're not able to pay higher wages because a majority of their funds come from Medicare and Medicaid, at a rate set by the government. The median wage for a nursing assistant in Ohio was $13.37 an hour in 2017, according to the federal Bureau of Labor Statistics.
They say recruiting and retaining enough qualified caregivers is difficult because of the field's stagnant pay and physically and emotionally tolling work. National unemployment is also low, about 4 percent, leaving nursing facilities competing with better-paying employers, such as hospitals and retailers, where work is less strenuous.
"No matter what you do, you can't manufacture bodies that don't exist," said Peter Van Runkle, executive director of the Ohio Health Care Association, a nursing home industry group.
Mike Dinallo, an administrator with Ravenna’s Woodlands Health and Rehab Center, which receives a two-star ranking for staffing, agreed that finding qualified state-tested nursing assistants is a challenge.
"You have more nursing homes going up every day that require STNAs," he said. "We’re competing against UH Portage Medical Center."
He said nursing students who have completed some of their core competency classes can take a test to become STNAs for $100, but for others the cost for a full STNA course is $500 to $800.
"That’s a challenge for people of that income level to pay for an STNA," he said.
Dinallo also agreed with Reed that funding changes from Medicare and Medicaid have had an effect on nursing homes’ ability to hire.
"From the funding standpoint, there have certainly been changes in the funding structure over the past several years," he said. "It’s been more of a challenge in the last one to two years."
Being short-staffed can become a management challenge, but Dinallo said a nurse can cover shifts if a nursing assistant calls off.