Brown, who was born Sept. 7, 1908, at 7 W. Elm St. in Norwalk, was inducted to the Pro Football Hall of Fame in 1967, according to a news release from Mark Hazelwood, media coordinator for the Paul Brown Birthplace Committee.

The fundraising efforts began in 2022, and the statue as well as a new Ohio Historical Marker commemorating his birth in Norwalk, were unveiled Oct. 21 at Suhr Park, 29 W. Main St. across from the Norwalk Public Library.

The event, hosted by the committee, included Brown’s family members in addition to a large number of citizens.

“The statue is just amazing,” said Norwalk Mayor Dave Light. “I’m just astounded at what a good likeness it is of Paul Brown.

“It’s remarkable, and the whole thing will be a great addition to uptown Norwalk.”

Fundraising by the committee kicked off in September 2022, with a campaign that included corporate sponsorships along with engraved paving bricks and granite blocks.

“I’m pleasantly surprised by how quickly it all happened,” Light said. “I really didn’t think it would go this fast, and a big thank-you to everyone who participated.

“It’s just great.”

Approximately 200 individual donations were collected toward the $100,000 goal to commission the statue and pay for other elements, including the granite wall that lists information about Brown’s career in football, the release noted.

“That, too, is a good-looking addition to the streetscape,” said Kathy Root, chair of the Paul Brown Birthplace Committee. “It provides context and information about Paul Brown that is perhaps not so widely known by everyone.”

Sponsors who donated $1,000, $2,500 or $5,000 have their business or name engraved on the front of the stadium wall.

Three of the 23 benefactors wished to remain anonymous for their combined total of $105,000.

Dozens of donors bought a brick paver or a granite square, the release noted.

“We’re so grateful to every single donor for their generosity,” Root said.

The life-size likeness of Brown stands nearly 7 feet tall.

The design was approved by Mike Brown, owner and general manager of the Cincinnati Bengals.

Mike Brown is the only surviving son of Paul Eugene and Ida Belle Brown, who lived on West Elm Street.

The likeness of Brown is based on an artist’s rendering created by Norwalk business owners Kevin Hipp of Franklin Monument and Trevor Rood of Foghorn Designs, the release stated.

The granite wall behind the statue lists the coach’s notable accomplishments and innovations to the game of football.

The back side of the wall is etched to look like the façade of a football stadium.

“I think people will really enjoy having this here,” Light said. “I hope that visitors to Norwalk take advantage of the opportunity to see the statue, read about Paul Brown and his impact on pro football, and learn something.

“We want people to come here and see this.”

First coach of the namesake Cleveland NFL team, and a co-founder and first coach of the Cincinnati Bengals, Brown began his Ohio coaching career at Massillon High School before moving on to Ohio State University.

Brown led the Buckeyes to the first of their eight national championships in 1942.

With the Cleveland Browns, Brown was the team’s general manager, head coach and part owner from 1946 until 1962.

During that time, the Browns won four All-America Football Conference championships and three National Football League championships, the release stated.

With the Bengals, he retired from coaching in 1975, but remained as president of that organization until his death in 1991.

The Bengals reached two Super Bowls during his time with the team.

Brown’s all-time coaching record in the NFL stands at 167-53-8 over 17 seasons, with eight league championships.

After a closed executive session that lasted nearly 40 minutes, the regular meeting began starting with election of board officers.

Benjamin Fligner was re-elected board chairman and Don Ortner was re-elected to his spot as board vice chairman.

The board then ratified the recent hiring of five new faculty and staff members: Helen Tagliaferro as the professional practice clinician; Brenda Bergman as assistant professor of health and wellness sciences; Annalise Gatautis as coordinator for the University Partnership Ridge Campus Outreach Learning Center; Bradley Ball as director of the culinary program; and Ariel Powell as program developer for the Engineering Business and Information Technologies department.

The board then voted to approve a policy change regarding rank, tenure and promotion.

The update to the policy permits faculty to provide alternative qualifications when applying for promotion to the rank of assistant professor.

Tracy Green, vice president of Strategic and Institutional Development at LCCC, said this change specifically is for faculty in fields that are not common in the highest levels of education.

“Typically, to move up in rank, a faculty member has to have a doctorate or other academic credentials in their field,” Green said. “We have some fields where there is not advanced education in such as our EMT and paramedic program.”

Green said there are no specifics to what kind of alternative application materials faculty can provide, but they will have to prove how their education or work experience has provided them the necessary qualifications.

The board approved bank depository agreements for nine different banks for the next five years.

It also approved a resolution that will allow for the college’s finances to be received electronically.

The meeting finished with a report from LCCC President Marcia Ballinger.

One of the highlights of the report was a presentation on a program that LCCC has partnered with Midview High School.

The program gives Midview High students experience learning about micro-electromechanical systems (MEMS), which is an area of study that has taken off at LCCC after receiving funding through a program by Intel.

Ballinger also highlighted U.S. Congressman Bob Latta’s visit to LCCC to learn about the MEMS program.

She also noted that the college’s practical nursing program was named as the No. 2 program in Ohio by Practicalnursing.org for 2024.

Ballinger concluded the meeting by announcing the creation of the LCCC Hall of Fame.

Nominations can be made until Feb. 28 for the June inauguration.

To be eligible for induction, a nominee must have a degree or certificate from LCCC, have completed one year at the school before earning a bachelor’s degree from another institution or completed 30 credit hours at the college.

“The other part of the application is about how have they have exemplified our mission and values in their community by making extraordinary contributions through their professional career or volunteer work,” Ballinger said.

Mark Adams, commissioner of Lorain County Public Health, told the commissioners during their meeting that the state’s plan to begin inspections of residential septic tank systems has been in the works for years.

The primary concern of not inspecting the septic tank systems can result in negative impacts on local watersheds with the addition of harmful bacteria and pollution, Adams said.

In fact, several counties adopted the new unfunded mandate in 2019 that was handed down by Ohio Department of Health in 2015, but Adams said he decided to hold off due to the coronavirus pandemic.

The county has drafted a map of the residences with septic tanks, he said.

A significant number of properties contain the tanks which haven’t been registered with the county, and subsequently, officials have no knowledge of the condition of the septic systems, which is the goal of the new program, Adams said.

The health department has been tasked with verifying each septic tank system in the county, whether it’s contacting the homeowner personally, or via telephone, he said.

“We have to do that,” he said as part of the new mandate.

Homeowners now are required to purchase permits for their septic tank systems, which has brought criticism from several residents.

A handful of residents spoke at the county commission meeting Jan. 16 regarding their opposition and concerns about the new program.

Lorain County Public Health has received about 2,600 voicemails since residents began receiving notice of the new fees.

A one-year fee costs the homeowner $40 and a three-year permit can be obtained for $120, due by April 30.

Adams maintains that the new mandate is not a plan to force people to replace their septic tank systems.

However, if a problem is discovered, it’s the homeowner’s responsibility to correct the problem, he said.

Those homeowners who have abandoned septic tank systems on their property are legally responsible to report them to the health department.

The health department’s goal is to have each system inspected and catalogued, Adams said.

Additionally, the health department will test waterways around the individual septic systems as part of another phase of the project, he said.

While financial assistance is available for those who qualify, the health department thus far only has $100,000 to work with, Adams said.

The health department estimates there are 20,000 home sewage treatment systems throughout the county.

The health board meets at 6 p.m., every second Wednesday of the month, at Lorain County Public Health, 9880 Murray Ridge Road in Elyria.

Lorain County Public Health also can be contacted via email at EH@loraincountyhealth.com or by phone at 440-322-6367.

PORTLAND, Ore. — Two weeks of storms that have turned roads into icy death traps, frozen people to death from Oregon to Tennessee and caused power outages that could take weeks to fix continued to sock both coasts with another round of weather chaos on Friday.

The rain, snow, wind and bitterly cold temperatures have been blamed for at least 50 deaths in the U.S. over the past two weeks as a series of storms moved across the country. Schools and roads have closed and air traffic has been snarled

There is hope. The forecast for next week calls for above average temperatures across almost the whole country, according to the National Weather Service.

Snow was falling in New York City, Baltimore and Washington, D.C., on Friday. But the biggest problems remained in places hit hard by storms earlier in the week.

On the West Coast, Oregon’s governor declared a statewide emergency Thursday night, nearly a week after the start of a crippling ice storm.

Thousands of residents have been without power since last weekend in parts of Oregon’s Willamette Valley because of the freezing rain.

“We lost power on Saturday, and we were told yesterday that it would be over two weeks before it’s back on,” said Jamie Kenworthy, a real estate broker in Jasper in Lane County.

More than 100,000 customers remained without electricity Friday morning in the state after back-to-back storms, according to poweroutage.us.

Portland Public Schools canceled classes for the fourth straight day amid concerns about icy roads and water damage to buildings, and state offices in Portland were also ordered closed Friday.

Ice was also a problem in the South. Snow and freezing rain added another coat of ice in Tennessee on Thursday. More than 9 inches of snow has fallen around Nashville since Sunday, nearly twice the yearly average.

Authorities blamed at least 17 deaths on the weather in Tennessee. Several were from traffic wrecks. In Washington County, a patient in an ambulance and someone in a pickup were killed in a head-on crash when the truck lost control on a snowy road.

Exposure to cold was deadly, too. A 25-year-old man was found dead in a mobile home in Lewisburg after a space heater fell over and turned off.

“There was ice on the walls in there,” Marshall County Chief Deputy Bob Johnson said.

The cold broke so many water mains in Memphis that the entire city was placed on a boil water notice because the water pressure was so low, Memphis, Light, Gas and Water said.

Bottled water was being given out in at least two locations in the city Friday.

A significant drop in blood donations led Chattanooga, Tennessee-based Blood Assurance to recommend that more than 70 hospitals in five states halt elective surgeries until Wednesday to let the organization rebuild its inventory. In a news release Thursday, the group cited the weather and several massive blood transfusions in the previous 24 hours in its plea to the hospitals in Alabama, Georgia, Kentucky, North Carolina and Tennessee.

The cold in Washington state was blamed for five deaths. The people — most of them presumed homeless — died from exposure to cold in just four days last week in Seattle as temperatures plummeted to well below freezing, the medical examiner’s office said.

Two people died from exposure as far south as Louisiana, where temperatures in part of the state stayed below freezing for more than two days.

On Thursday, Will Compton of the nonprofit Open Table Nashville, which helps homeless people, stopped his SUV outside the Country Music Hall of Fame and Museum to hand out warm hats, blankets, protein drinks and socks as icy rain fell.

“People who are poor and people who are homeless are getting hit the hardest,” Compton said.

Aaron Robison, 62, has been staying at one of Nashville’s warming centers and said the cold wouldn’t have bothered him when he was younger. But now with arthritis in his hip and having to rely on two canes, he needed to get out of the cold.

“Thank God for people helping people on the streets. That’s a blessing,” he said.

On Friday, more bitterly cold air was spilling into the Midwest from Canada. Several states were under an advisory as forecasters warned wind chills dipping to minus 30 degrees Fahrenheit could be common through Sunday morning.

Since extreme cold weather set in last week, more than 60 oil spills and other environmental incidents have been reported in North Dakota’s Bakken oil fields. Wind chills dipped as low as minus-70 degrees F have strained workers and equipment and regulators said the extreme weather strained workers and made accidents more likely.

Lake-enhanced snow finally moved out of Buffalo, New York, late Thursday after burying parts of the city and some suburbs in five feet of snow in five days. The Buffalo Bills renewed their call for snow shovelers Friday, offering $20 an hour for help digging out Highmark Stadium before this Sunday’s divisional playoff game against the Kansas City Chiefs.

The West Virginia Legislature left after a brief session Friday because not enough lawmakers could get through snow-covered highways to the Capitol to vote on bills.

In Washington, D.C., snow fell softly and the streets around the U.S. Capitol were silent. Schools closed again for the second time in a week and the government was on a two-hour delay. President Joe Biden still planned to host mayors from around the country on Friday, though, and was still heading to his Delaware beach home for the weekend.

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Associated Press journalists Jonathan Mattise and Kristin M. Hall in Nashville; Adrian Sainz in Memphis; Carolyn Thompson in Buffalo, New York; Colleen Long in Washington, D.C.; and Jeffrey Collins in Columbia South Carolina, contributed.

SANTA FE, N.M. — A grand jury indicted Alec Baldwin on Friday on an involuntary manslaughter charge in a 2021 fatal shooting during a rehearsal on a movie set in New Mexico, reviving a dormant case against the actor.

Special prosecutors brought the case before a grand jury in Santa Fe this week, months after receiving a new analysis of the gun that was used. They declined to answer questions after spending about a day and a half presenting their case to the grand jury.

Defense attorneys for Baldwin indicated they’ll fight the charge.

“We look forward to our day in court,” said Luke Nikas and Alex Spiro, defense attorneys for Baldwin, in an email.

While the proceeding is shrouded in secrecy, two of the witnesses seen at the courthouse included crew members — one who was present when the fatal shot was fired and another who had walked off the set the day before due to safety concerns.

Baldwin, the lead actor and a co-producer on the Western movie “Rust,” was pointing a gun at cinematographer Halyna Hutchins during a rehearsal on a movie set outside Santa Fe in October 2021 when the gun went off, killing her and wounding director Joel Souza.

Baldwin has said he pulled back the hammer, but not the trigger, and the gun fired.

The charge has again put Baldwin in legal trouble and created the possibility of prison time for an actor who has been a TV and movie mainstay for nearly 40 years, with roles in the early blockbuster “The Hunt for Red October,” Martin Scorsese’s “The Departed” and the sitcom “30 Rock.”

The indictment provides prosecutors with two alternative standards for pursuing an involuntary manslaughter charge against Baldwin in the death of Hutchins. One would be based on negligent use of a firearm, and the other alleges felony misconduct “with the total disregard or indifference for the safety of others.”

Judges recently agreed to put on hold several civil lawsuits seeking compensation from Baldwin and producers of “Rust” after prosecutors said they would present their case to a grand jury. Plaintiffs in those suits include members of the film crew.

Los Angeles-based attorney Gloria Allred, who is representing the slain cinematographer’s parents and younger sister in a civil case, said Friday that her clients have been seeking the truth about what happened the day Hutchins was killed and will be looking forward to Baldwin’s trial.

Neama Rahmani, a former federal prosecutor and president of the West Coast Trial Lawyers firm in Los Angeles, pointed to previous missteps by prosecutors, saying they will need to do more than present ballistics evidence to make a case that Baldwin had a broader responsibility and legal duty when it came to handling the gun on the set.

Special prosecutors dismissed an involuntary manslaughter charge against Baldwin in April, saying they were informed the gun might have been modified before the shooting and malfunctioned. They later pivoted and began weighing whether to refile a charge against Baldwin after receiving a new analysis of the gun.

The analysis from experts in ballistics and forensic testing relied on replacement parts to reassemble the gun fired by Baldwin, after parts of the pistol were broken during testing by the FBI. The report examined the gun and markings it left on a spent cartridge to conclude that the trigger had to have been pulled or depressed.

The analysis led by Lucien Haag of Forensic Science Services in Arizona stated that although Baldwin repeatedly denied pulling the trigger, “given the tests, findings and observations reported here, the trigger had to be pulled or depressed sufficiently to release the fully cocked or retracted hammer of the evidence revolver.”

The weapons supervisor on the movie set, Hannah Gutierrez-Reed, has pleaded not guilty to involuntary manslaughter and evidence tampering in the case. Her trial is scheduled to begin in February.

“Rust” assistant director and safety coordinator David Halls pleaded no contest to unsafe handling of a firearm last March and received a suspended sentence of six months of probation. He agreed to cooperate in the investigation of the shooting.

An earlier FBI report on the agency’s analysis of the gun found that, as is common with firearms of that design, it could go off without pulling the trigger if force was applied to an uncocked hammer, such as by dropping the weapon.

The only way the testers could get it to fire was by striking the gun with a mallet while the hammer was down and resting on the cartridge, or by pulling the trigger while it was fully cocked. The gun eventually broke during testing.

The 2021 shooting resulted in a series of civil lawsuits, including wrongful death claims filed by members of Hutchins’ family, centered on accusations that the defendants were lax with safety standards. Baldwin and other defendants have disputed those allegations.

The Rust Movie Productions company has paid a $100,000 fine to state workplace safety regulators after a scathing narrative of failures in violation of standard industry protocols, including testimony that production managers took limited or no action to address two misfires on set before the fatal shooting.

The filming of “Rust” resumed last year in Montana, under an agreement with the cinematographer’s widower, Matthew Hutchins, that made him an executive producer.

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Associated Press journalist Susan Montoya Bryan reported from Albuquerque.

KEOKUK, Iowa — Folks in this Mississippi River town hope a new federal program can revive the optimism engraved long ago in a plaque on the side of their hospital.

“Dedicated to the Future of Health Care in the Tri-State Area,” the sign declares. “May 11, 1981.”

More recent placards posted at the facility’s entryways are ominous, however. “Closed,” they say. “No Trespassing.”

The Keokuk hospital, which served rural areas of Iowa, Illinois, and Missouri, closed in October 2022. But new owners plan to reopen the hospital with the help of a new federal payment system. The Rural Emergency Hospital program guarantees hospitals extra cash if they provide emergency and outpatient services but end inpatient care.

“We’ve been without a hospital for over a year — and I don’t think anybody in Keokuk or the surrounding areas will be picky in any way, shape, or form,” said Kathie Mahoney, mayor of the town of about 9,800 people. She said residents would prefer to have a full-service hospital with inpatient beds, even though those types of beds had been used sparingly in recent years.

The revival of the Keokuk hospital would mark a small victory in the nationwide struggle to save rural hospitals, which continue to close due to staffing shortages, low reimbursement rates, and declining patient numbers. The new federal program, which went into effect in January 2023, is meant to stem the closures. But there have been growing pains, said George Pink, deputy director of the North Carolina Rural Health Research Program, which tracks hospital closures and conversions.

Just 18 of the more than 1,700 eligible rural hospitals nationwide have applied for and won the new designation. Many hospitals are reluctant to give up inpatient services entirely, and some are concerned about how other payment streams could be affected, rural health leaders say. The new designation’s unclear definition of “rural” has also caused confusion.

“We are still in an era of rural hospital closures,” Pink said. Nine hospitals closed in 2023, and that number could rise in 2024, he said. An influx of federal relief funds during the pandemic kept struggling hospitals afloat, but now that money is largely gone.

The Rural Emergency Hospital program is the first new federal payment model for hospitals since 1997. Dora Hughes, acting chief medical officer of the Centers for Medicare & Medicaid Services, said the new model’s criteria are outlined by statute and “hospitals should consider specific circumstances before making the decision to apply.”

The federal agency is providing outreach to rural communities and welcomes feedback, Hughes wrote in an email to KFF Health News.

Now, rural health leaders and federal lawmakers are working quickly to tweak the new program to attract more applicants, said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association.

Currently, facilities that convert to rural emergency hospitals receive a 5% increase in Medicare payments, plus an average annual payment of about $3.2 million, in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds, like Keokuk’s, that closed after the law was signed on Dec. 27, 2020, are eligible to apply for the program and reopen with emergency and outpatient services.

More than 100 rural hospitals nationwide have inquired about converting, said Janice Walters, interim executive director for the Rural Health Redesign Center, which has a federal grant to provide technical assistance to hospitals that want to apply.

But only about a quarter of those inquiries are likely to become a rural emergency hospital, and persuading more troubled hospitals to make the leap would require regulators to make changes, Walters said.

Her advice? “Give them 10 beds to just take care of their community.”

In a journal article published last year, general surgeon Sara Schaefer worried about the unintended consequences of getting rid of rural inpatient beds. Schaefer, who spent six months of medical school at a small rural Idaho hospital, said she saw firsthand how difficult it was for the hospital to transfer patients to bigger facilities, which were often too full to take them.

“There has to be a better way,” said Schaefer, who is also a research fellow at the Center for Healthcare Outcomes & Policy at the University of Michigan.

The rural health association’s Cochran-McClain said lawmakers are considering changes that could allow the hospitals to:

• Keep overnight beds for patients who need moderate levels of care, such as those with pneumonia or in need of physical therapy after surgery.
• Allow participation in a federal drug discount program called 340B, which provides hospitals with extra revenue.
• Keep inpatient psychiatric or rehabilitation units open.
• Clarify eligibility, including which facilities qualify under the definition of “rural” and whether the hospitals that closed before the 2020 date in the law can apply.

Updates to the law could affect communities nationwide. In Fort Scott, Kansas, where the hospital closed in late 2018, Mayor Matthew Wells said the community wants the eligibility date pushed back. U.S. Sen. Jerry Moran (R-Kan.) introduced a bill in December that, if passed, would push eligibility back to 2015.

“This is a matter of life and death to my community,” Wells said. “I see a clear path, but the federal regulations in particular make that path nearly impossible.”

In Holly Springs, Mississippi, hospital chief executive Kenneth Williams said he doesn’t understand the federal definition of “rural.” His hospital, Alliance Healthcare Hospital, was one of the first to win the new Rural Emergency Hospital designation in early 2023. He laid off staff and shut down his inpatient beds. Then, CMS officials called to tell him they had made a mistake.

“And I said, ‘Wait a minute,’” Williams said. The hospital, which is about an hour south of Memphis, Tennessee, doesn’t meet the current criteria of rural, they told him. Williams, an internal medicine doctor, bought the hospital in 1999 and has been trying to keep it running since.

Federal regulators are now asking Williams to convert the facility into another type of Medicare payment model, such as the sole community hospital with inpatient beds that it was before. Williams said that would be difficult: “What kind of transition can I make, especially with reduced services?”

In Keokuk, the hospital fits the current requirements. Insight Health Group, the Michigan company that bought the shuttered facility last March, plans to apply for the new federal designation as soon as it obtains state permits under new Iowa regulations tailored to rural emergency hospitals. It would be the first such hospital in the state.

Like many other rural hospitals struggling to survive, Keokuk’s shuttered several key departments years ago, including its birthing and inpatient psychiatric units. In 2021, the last full year it was open, the hospital averaged fewer than three inpatients per night, according to data posted by the Iowa Hospital Association.

More than half of the three-story building would remain mothballed if the facility reopened under the new designation, but the emergency department could serve patients again as soon as late summer, said Atif Bawahab, Insight’s chief strategy officer.

Bruce Mackie has worked 32 years at the hospital, including 10 years as director of plant operations. The new owners kept him on to watch over the building. Beds, high-tech scanners, and lab equipment remain, but most of the clocks have stopped. “It’s spooky,” he said.

Even if the services are more limited than before, Mackie said, “everybody wants the hospital to reopen. This city needs an ER.”

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

When 17 nursing homes closed in Ohio in fiscal 2023, the Ohio Health Care Association, which represents nursing homes in the state, echoed a refrain often used by the industry to explain closures and get more funding from the state: Medicaid reimbursement rates are too low and it is too hard to find staff.

It’s the same argument that the industry has made on a national scale for decades, but particularly since the COVID-19 pandemic, which saw thousands of residents die while facilities faced increased labor and supply costs.

While staffing and reimbursement issues have certainly contributed to closures in some cases, especially for smaller, rural facilities, experts say the debate often omits some important facts and nuance: specifically, that many facilities that close are poor quality, have high staff turnover and are located in areas where multiple other homes and alternatives exist, making it difficult to fill empty beds. Others turn into assisted living facilities, which are more loosely regulated. A handful were kicked off of the Medicare program for low quality.

“I think that’s one of the most powerful arguments that the industry has used to scare policymakers and senators and other decision-makers, and it’s really disconnected if you think about it,” said Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care. “When you actually look at the data, and you look at the homes closing, it’s really because they’re just bad homes providing bad care, and they can’t fill their beds so they’re just closing down.”

Yet, the industry continues to demand more funding from taxpayers. They’ve also used the closures to try to fend off a controversial Biden administration rule that would mandate minimum staffing levels in nursing homes, a standard that currently does not exist.

“We believe that if the Biden staffing mandate is finalized, that it will accelerate the closures of buildings,” said Mark Parkinson, president and CEO of the American Health Care Association, which represents the interests of the nation’s nursing homes.

“Very good nursing homes are closing because they can’t find workers and the reimbursement isn’t enough. And for people to just be out there making these subjective statements that it’s just poor buildings that are closing, it’s just not accurate. It leads policymakers to potentially make poor decisions, and it has real impacts on people’s lives,” Parkinson said.

A changing industry

There are about 15,000 nursing homes in the U.S., and dozens close every year. While experts believe there was likely an uptick in closures during the pandemic, experts think COVID-19 aid to the industry likely prevented more facilities from closing.

Nursing homes have long struggled to recruit and retain staff, largely because of low pay, and understaffing generally leads to poorer health outcomes. The industry has blamed low staffing on Medicaid rates, which are set by states.

And when nursing homes close, that is also blamed on reimbursement rates and workforce shortages.

But the truth is more complicated, experts say.

“In general, the lowest-quality care facilities are the ones that end up closing because they just have lower census,” meaning fewer residents. In those cases, facilities bring in less money, said Robert Applebaum, who studies nursing home closures and quality as part of his role as director of the Ohio Long-Term Care Research Project.

Once a nursing home has a low census or not enough staffing, it can become a spiral that can be difficult to get out of, he said.

“It is a bit of a chicken and egg problem,” he said. “Some are low quality and that reduces the census and revenue, and the spiral continues. Some experience census problems, and that results in lower revenue and cuts to staffing.”

The explosion of assisted living facilities and services that allow people to receive care in their home has also driven down the demand for nursing home beds, Applebaum said.

“It’s primarily a natural evolution of a changing industry,” he said.

There are still nearly 1,000 nursing homes in Ohio. The state’s facilities that shuttered in fiscal 2023 had an average occupancy rate of 60 percent, a rate that would make it nearly impossible to be profitable. Four of the 17 closed Ohio facilities were in the federal government’s special focus program or candidates for the program, which puts poor-performing facilities under extra scrutiny.

Seven had health inspection ratings of one star — the lowest possible rating, which takes into account surveys in a three-year period.

While Medicaid rates do likely play a role, particularly for rural and independently owned facilities, it is unclear how much. It’s infamously opaque how nursing homes spend Medicaid funds. Experts say facilities cut staffing to the bone to increase profits or channel funding into related-party transactions.

In Texas, nursing homes received increased payments during the pandemic, but that didn’t lead to improvements in quality, said Andrea Earl, associate state director of advocacy and outreach for AARP Texas.

“If we don’t know where the dollars went and there’s no accountability, it is really hard for us to say the reason for Texas closures is that they didn’t get enough reimbursement or money here,” Earl said.

Nationwide trends

In fiscal 2023, 188 nursing homes, also known as skilled nursing facilities, closed in the U.S., according to a CQ Roll Call analysis of government data.

Overall, facilities that closed were more likely to have had severe inspection violations, had racked up fines for providing poor care, were rated poorly by state and federal governments and were on lists for extra monitoring.

Some were facing wrongful death lawsuits or had stopped paying their bills.

While some 40 percent of those closed facilities were four or five star facilities, 31 percent of closed facilities were one star or part of the special focus facility program, compared with 23 percent of facilities overall.

The star rating system, created by the Centers for Medicare and Medicaid Services, is intended to help consumers identify poor and high-quality nursing homes; facilities with five stars are considered to be of the highest quality. But the rating system has faced scrutiny. Experts say it is easy for facilities to game the system to get higher ratings.

The sector also is graded on a curve, meaning the lowest 20 percent of nursing homes in a state are considered one star, middle-performing facilities receive three stars and the highest performing facilities in a state receive five stars.

Other metrics that nursing homes are graded on can be more useful to look at, experts say, like results of health inspections, which are unannounced.

Half of the facilities that closed in fiscal 2023 had received code J or higher deficiencies — which indicate serious immediate jeopardy to resident health and safety — compared with 11 percent of facilities overall, according to government data.

Ten percent of facilities that closed in fiscal 2023 had been cited for abuse, compared with 6 percent of facilities overall, while 13 percent of closed facilities were participants in or candidates for the special focus program, compared with 3.5 percent of facilities overall.

One of the most powerful tools CMS has to enforce nursing home regulations is Medicare payment denials. That tool is typically used as a last resort when facilities have otherwise failed to fix deficiencies.

Twenty-two percent of facilities that closed in fiscal 2023 had received at least one payment denial, compared with 13 percent overall.

Kelly Hughes, a research economist at RTI International, said despite the narrative that more nursing homes are closing, “the situation is not as dire as you’d think if you look at the data.”

The data shows there have been no persistent increases in closure rates from 2011 through 2019, although there were increases in 2018 and 2019, Hughes said.

“We’re having less closures than we did a decade ago,” she said.

The number of new facilities that open every year typically offsets the closures, Hughes said, though the impacts of the pandemic on closures are still unclear.

“The goal is not to have zero closures. There’s always going to be supply and demand. There’s going to be some facilities going out of business for reasons like poor quality or oversupply, and there’s also a lot of facilities entering [the market],” Hughes said.

More problematic, said David Grabowski, professor of health care policy at Harvard Medical School, is “when it’s a high-quality facility in a more rural area without any other options.”

Of the 188 nursing homes that closed in fiscal 2023, about 47 percent were in counties defined as rural by the Federal Office of Rural Health Policy.

Efforts to shore up nursing homes should be targeted at those that need it, especially in rural communities, Grabowski said.

“When it’s a closure in a more densely populated area of a lower-quality facility, that is actually good for the health of the residents,” he said.

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©2024 CQ-Roll Call, Inc. Visit at rollcall.com. Distributed by Tribune Content Agency, LLC.

During the Jan. 18 meeting, the board voted 9-2 against a motion that would have removed the 2006 John Green novel “Looking for Alaska” from the JVS ninth grade curriculum.

Diane Kerecz, the mother of a 14-year-old JVS student, brought up the issue to the board at a meeting last fall after her daughter notified her about sexual content in the book.

Kerecz attended the Jan. 18 board meeting and reiterated her issue with the book for the age group assigned to read it.

“I implore you, please do not give it to our 14-year-olds,” the mother said. “I never said to ban the book. I don’t believe it’s for 14-year-olds.

“If it’s essential to your curriculum, I implore you to give it to the older kids.”

Also in attendance at the meeting was Dick Polen, who echoed similar sentiments to Kerecz.

Polen said his main concern with the book is that he believes it does not provide value to students.

“What we are really asking for, is a better one,” he said. “This book, ‘Looking for Alaska,’ I don’t see the value in it.

“This is the United States of America, and we don’t ban books here; we’re just asking for something better.”

Polen said his stance against the book also is due to his family’s religious background.

“We want something with morals in it,” he said. “Something that doesn’t talk about God in a bad way.”

Lorain County JVS superintendent Glenn Faircloth responded to those concerns by affirming his belief in the school to handle difficult topics in literature in a productive way.

“One of our educational goals at Lorain County JVS is to foster and promote critical thinking,” Faircloth said. “Our students are thoughtful readers who have the intellectual capacity to explore difficult issues.

“Our English and language arts teachers are well trained to foster these conversations in the classroom.”

Faircloth also noted that parents have the right to speak up if they do not want their child to consume assigned material.

In such situations, a student may be assigned alternative material without penalty, he said.

Wellington board representative Ayers Ratliff supported the public’s concerns and made a motion to remove the book from the ninth grade curriculum.

The motion would have allowed the book to stay in the school’s library and be taught in other grades.

“There’s nothing in the book that the kids don’t know, I will say that,” Ratliff said. “The thing of it is, we learn to act different in different situations.

“A 14-year-old child that goes to church may do things a certain way. They go to school and things are done a certain way in the classroom. In the hallways or at lunchtime, I’m sure things aren’t the same.”

Ratliff said the material in “Looking for Alaska” is not appropriate for a classroom.

“When you take a book and break it down and start discussing it, then you’re talking about great literature,” he said. “That book is not great literature.”

Other board members spoke up against removing the book.

Oberlin City Schools board member Anne Schaum said many other topics taught in school could be considered sensitive and that is not practical to remove them from curriculums.

“We’re on a huge slippery slope,” Schaum said. “It’s not just going to be books. There could be an article.

“Back when I was in high school, we read ‘Macbeth.’ You’re talking about murder and that could be a sensitive topic to somebody. When you look at literature and art, and all kinds of topics, this is a tough thing.”

Avon Lake City School District board member Gail Soinski-Opaskar said encountering difficult topics in educational material can contribute to the strengthening of a student’s morality.

“I believe it is our job as educators to expose our children to many different issues that they will be exposed to in society and they need to be prepared to confront and understand their morality from their families,” Soinski-Opaskar said. “I believe children need to be strong in their belief system because they are going to encounter many of the issues that are in this book.

“Let’s develop strong individuals in their morality.”

The researchers tested the effects of a daily multivitamin on cognitive changes in older adults, as part of the COSMOS trial (COcoa Supplement and Multivitamin Outcomes Study).

COSMOS is a large-scale trial testing cocoa extract and multivitamin supplements, run by researchers at Mass General Brigham. Two previous studies in COSMOS suggested that a daily multivitamin has a positive effect on cognition.

COSMOS researchers are now reporting the results of a third study in COSMOS — which focused on participants who took in-person assessments. The results showed a statistically significant benefit for memory and cognition among participants taking a daily multivitamin compared to the placebo.

The study suggests that taking a daily multivitamin may help prevent memory loss and slow cognitive aging in older adults.

“Cognitive decline is among the top health concerns for most older adults, and a daily supplement of multivitamins has the potential as an appealing and accessible approach to slow cognitive aging,” said first author Chirag Vyas, instructor in investigation at the Department of Psychiatry at Massachusetts General Hospital.

“The meta-analysis of three separate cognition studies provides strong and consistent evidence that taking a daily multivitamin, containing more than 20 essential micronutrients, helps prevent memory loss and slow down cognitive aging,” Vyas said.

The researchers for the study conducted in-person cognitive assessments among 573 participants in the subset of COSMOS known as COSMOS-Clinic.

The scientists found that there was a modest benefit from the multivitamin on global cognition over two years. There was a statistically significant benefit from the multivitamin for change in episodic memory, but not in executive function/attention.

The researchers estimated that the daily multivitamin slowed global cognitive aging by the equivalent of two years compared to the placebo.

“These findings will garner attention among many older adults who are, understandably, very interested in ways to preserve brain health, as they provide evidence for the role of a daily multivitamin in supporting better cognitive aging,” said Olivia Okereke, senior author of the report and director of Geriatric Psychiatry at MGH.

In 2020, an estimated 5.8 million Americans aged 65 years or older had Alzheimer’s disease. This number is projected to nearly triple to 14 million people by 2060, according to the CDC.

JoAnn Manson, co-author of the research report and chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said, “The finding that a daily multivitamin improved memory and slowed cognitive aging in three separate placebo-controlled studies in COSMOS is exciting and further supports the promise of multivitamins as a safe, accessible and affordable approach to protecting cognitive health in older adults.”

At 3:22 a.m., firefighters responded to the 300 block of Parmely Avenue, according to a news release from Elyria fire Chief Joseph Pronesti.

Upon arrival, firefighters confirmed that all occupants were safe, uninjured and had evacuated the single-family residence, the release stated.

Moderate fire conditions were found on the exterior southeast corner of the residence, according to the release.

The fire was quickly extinguished, and crews checked the interior and attic for extension and none was found, the release stated.

Pronesti requested the state Fire Marshal office to take charge of the investigation.

“Subsequent findings revealed that the cause of the fire was attributed to an occupant smoking inside the residence and discarding the cigarette outside a window,” the release stated.

Damages to the residence are estimated at $3,000, the release stated.

The Elyria Fire Department emphasizes the critical importance of fire safety, particularly regarding smoking materials, the release noted.

Smoking remains the leading cause of fire deaths, making it imperative to share vital prevention measures.

Whether an individual smokes or hosts guests who smoke, the Fire Department recommends smoking outdoors because furniture, bedding and papers inside the home can catch fire from burning cigarettes.

Also, keep a sturdy ashtray or bucket of sand available for smokers, according to the release.

“Smoke only when you are alert; if you take medicine or get sleepy, don’t smoke,” the release noted.

And, finally, never smoke near anyone who uses medical oxygen, the release stated.

If a fire starts, the oxygen will cause it to burn hotter and faster, according to the release.

“There is no safe way to smoke when oxygen is in use,” the release noted.