After hospital discharges or medical crises, many Cleveland families must quickly place loved ones in nursing homes—often in a system where state and federal data show wide variation in staffing and quality.
Data from LeadingAge Ohio and the Skilled Nursing Facilities Data Center indicate that some Cleveland-area nursing homes perform at or below state averages in key measures, including staffing and health inspections.
Federal inspection records show repeated deficiencies in some facilities. According to the Office of Inspector General, “During our onsite inspections, we identified deficiencies related to life safety, emergency preparedness, or infection control at 18 of the 20 nursing homes that we audited, totaling 160 deficiencies.”
For families, those gaps are not abstract. They shape where loved ones will live, recover and, in many cases, spend their final years.
A system under strain
Residents, families and workers across Northeast Ohio are navigating a long-term care and assisted-living health care system under sustained pressure.
Older adults with complex medical needs depend on nursing homes for daily care. Families often must make placement decisions quickly and with limited access to clear, comparable information about facility conditions.
Workers inside those facilities describe another layer of strain. Staffing shortages have increased workloads for nurses and aides, contributing to burnout and heavy turnover.
The Department of Health and Human Services has identified health worker burnout as a growing national concern tied to patient safety risks. “There are a range of societal, cultural, structural, and organizational factors that contribute to burnout among health workers. Some examples include: excessive workloads, administrative burdens, limited say in scheduling, and lack of organizational support.”
Staffing shortages and safety risks
Across Cleveland and Cuyahoga County, staffing shortages remain one of the most persistent challenges facing nursing homes.
Fewer staff members can lead to delayed care — from assistance with basic hygiene to medication management. For residents with serious medical conditions, those delays can lead to falls, infections or preventable hospitalizations.
“There are currently around 9,000 registered nurse positions open across the state,” said Chairman Char Miller of Ohio University College of Health Sciences and Professions in a 2024 Ohio Today community report. Miller added, “The shortage has impacted every clinical partner we work with.”
Inspection data compiled by ProPublica show that some Ohio nursing homes have been cited for deficiencies ranging from infection control lapses to failures in basic care — issues that can directly affect resident health.
Oversight gaps and uneven quality
While all nursing homes operate under federal and state regulations, enforcement and outcomes can vary widely.
Analysis of federal ratings and reporting by KFF Health News shows significant variation in staffing levels, inspection results and overall ratings among Ohio facilities. Some maintain strong performance, while others accumulate repeated citations.
That unevenness creates a fragmented system where quality is inconsistent — and not always easy for families to assess in real time.
Public tools such as Medicare’s Care Compare database, maintained by the Centers for Medicare & Medicaid Services, provide access to inspection reports and ratings. But the volume and complexity of the data can limit its usefulness during urgent decision-making.
Policy response — and its limits
State officials have acknowledged the need for reform. In May 2023, the Ohio Department of Aging released recommendations from its Nursing Home Quality and Accountability Task Force, including stronger oversight measures and increased transparency requirements.
Some policy changes have followed.
Esther’s Law, signed by Ohio Gov. Mike DeWine in 2021, allows residents and families to install cameras in nursing home rooms with proper consent from roommates.
A report by WKYC News in August 2018 states that “the law is associated with the case of Esther ‘Mitzi’ Piskor, whose abuse in a facility was documented by her family,” drawing attention from advocates including AARP Ohio.
Cost, capacity and care decisions
Even as concerns about quality persist, nursing homes remain a central part of the health care system.
They provide 24-hour supervision and skilled care for individuals who cannot safely live independently, and they serve as a key step in the transition from hospital to home.
Health systems such as the Cleveland Clinic rely on these facilities as part of that continuum. Speaking of post-stroke patients, Dr. Shumei Man said, “These patients are the most vulnerable.”
“When a skilled nursing facility is independent with no close collaborations with acute care hospitals, the adverse event rate is usually higher. With collaboration, readmission rates are driven much lower.”
But cost continues to shape access and options. According to U.S. News & World Report, “long-term care can cost thousands of dollars per month,” leaving many families dependent on Medicaid.
“The urgency of this need is not something we can put aside,” said Larke Recchie, CEO of the Ohio Association of Area Agencies on Aging, in a report by Crain’s Cleveland Business. “We need more ability to keep people in their homes — it’s what they want, and it is also the most cost-effective way of caring for people.”
What families can do
Families play a critical role in navigating the system. The National Institute on Aging recommends that families visit facilities when possible, reviewing inspection reports and maintaining regular communication with staff after placement.
As demand for long-term care grows alongside an aging population, pressure on Ohio’s nursing home system is expected to increase. In that environment, choosing a facility is not simply a matter of availability — it is a decision made within a system still struggling to deliver consistent care.
Renee Matthews Jackson has a master’s degree in new media journalism and a bachelor’s degree in nonprofit administration and is a poet, playwright, actor and community activist.
