Would anyone want their family members living in the condition that inspectors found at Fairlawn Rehab and Nursing Center in March 2018?

The smell of a clogged toilet filled to the brim with urine, feces, toilet paper and yellow caution tape filled a community space at the care center in Copley.

Patient rooms were so cold — some only 50-some degrees — that one resident was completely wrapped in blankets with only her eyes visible.

And many residents — most with multiple chronic conditions including diabetes, kidney failure and dementia or severe mental health issues — were bathed only once per month, some with untreated bedsores and out-of-control glucose levels because of skipped doses of insulin.

Fairlawn Rehab — on Ridgewood Road at Cleveland-Massillon Road — is one of five Ohio nursing homes on a list of 88 federal “Special Focus Facilities” nationwide with the most serious history of quality of care issues.

Ohio has about 950 nursing homes. Three of the five on the federal government's list — including Fairlawn Rehab — are operated by Boulder Healthcare and Hillstone Healthcare, businesses that share leadership and an office address near Columbus.

It’s "pretty unusual" for the same operators to have three homes on the watch list, said Robert Applebaum, director of the Ohio long-term-care research project at Miami University's Scripps Gerontology Center in Oxford.

Calls and emails by the Beacon Journal to Matt Dapore and Paul Bergsten, who own both Boulder and Hillstone, were not returned.

But Dapore, chief operating officer of Hillstone and the administrator at Uptown Westerville, recently told the Columbus Dispatch that his companies acquire struggling facilities but shouldn't be accountable for problems that were created before they bought the properties.

“Yes, we take challenging buildings. That's what we do because we can turn them around and we can fix them," he said. "But to classify the company as a whole poorly because of the facilities we choose to take, I think, is a bad assessment."

Records show Hillstone bought Fairlawn Rehab in November 2017. Regular inspections are typically done once a year or any time a complaint is filed, but this facility has faced 26 inspections by state health inspectors since its new owners took over.

Federal regulators fined the the Fairlawn Rehab nursing home $142,973 during a six-month period in 2018 for not improving or correcting violations identified by state health inspectors.

But the troubles for Hillstone and Boulder — which own 39 Ohio nursing homes — go deeper. Hillstone also owns four other Ohio nursing homes — including Hudson Elms Nursing Home — that are on a second federal list of facilities that are candidates for the worst-five list.

Map KeyRed = 1-star | Blue = 2-star | Green = 3-star | Yellow = 4-star | Purple = Watchlist

>> See a map of Hillstone and Boulder Healthcare's 39 Ohio nursing homes and their star ratings.

Until last week, that list of 400 nursing homes nationwide was secret. Pennsylvania senators released the list to raise awareness and put pressure on the Centers for Medicare & Medicaid Services to be transparent. The agency now says it it also will release the full list.

The Columbus Dispatch analyzed federal information and found nearly 72% of the 39 Ohio nursing homes owned by Hillstone and Boulder scored only a one- or two-star rating on a five-star scale.

Dapore told the Dispatch that three companies, including Fairlawn Rehab and Hudson Elms, are no longer owned by Hillstone.

But state officials last week disagreed. Hillstone submitted only one change of ownership application to the Ohio Department of Health and that was for Fairlawn Rehab, which was to change hands June 1.

The application was incomplete, however, so the health department returned it, spokesman J.C. Benton said. Hillstone’s lawyer has since sent a letter to the state saying the change of ownership would be July 1, Benton said, but the company has still not not fixed the application.

One of the other most troubled nursing homes owned by the companies — Uptown Westerville in suburban Columbus — is closing after officials stripped its certification to accept Medicare and Medicaid payments.

Yet some advocates who work for better nursing home care say closing a poorly performing facility isn't always the best answer.

"We have worked with some of their facilities on quality improvement and we certainly do not want to have facilities close and have residents disrupted if we can avoid it," said Beverly Laubert, the long-term care ombudsman at the Ohio Department of Aging.

But she said, it’s clear "changes need to be made at the corporate level."

Sam McCoy, senior vice president of elder rights for Direction Home Akron Canton Area Agency on Aging & Disabilities, said his organization has been fielding lots of complaints about Fairlawn Rehab for the past six to eight months.

"We think it’s really important when facilities are struggling or having problems, we want to have stronger or deeper presence there," he said. “Being there means better care.”

That means more frequent, unannounced visits by an ombudsman, certified volunteers and student interns. Unlike state health inspectors who are looking for code violations, McCoy's group is working to make all aspects of nursing home life better, from food served to safety.

His group met with Fairlawn Rehab's management in the spring, aiming to help it improve, particularly with staffing, he said.

Fairlawn Rehab, for instance, provides only nine minutes of registered nursing care to each of its residents per day, according to the federal website Medicare.gov. The Ohio average is 38 minutes of RN care versus 41 minutes nationwide.

McCoy said last week that 63 or 64 residents still call Fairlawn Rehab home.

"This is the home where they have chosen to live," McCoy said. "This is one of the motivators that keep agencies pressing for improvement rather than shutting them down."