Understaffing: A Major Nursing Home Red Flag


Laura Schaefer

If someone you love is a victim of nursing home neglect, then you may be reeling. How could this happen? What can be done to prevent it in the future? One reason to file a nursing home neglect case is to force the facility’s owners and administrators to change the way they operate. This ensures there won’t be more victims in the future. To prevent neglect, many facilities need to hire more people. Why?

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Recent in-depth reporting as well as academic studies show understaffing issues may be responsible for many nursing home neglect injuries:

  • Staffing shortages often violate state standards and staffing levels result in omitted care.
  • Many facilities showed lower-than-needed staffing levels, according to nursing directors.
  • Studies found one specific nursing home chain’s management (as well as the regulatory system at the state and federal level) failed to ensure adequate staffing levels. This resulted in violations of residents’ rights, health, safety, and well-being.

What Level of Staffing Should Exist at a Nursing Home?

According to federal public health law 42CFR 482.23(b), hospitals must: “Have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed” to participate in Medicare.

This law also covers supervisory staffing, stipulating that: “There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.”

The federal government also sets recommendations for nurse-to-patient staffing ratios, which the American Nurses Association (ANA) agrees with. In many scenarios, the ratio is one nurse for every two patients. Each state is responsible for setting its own standard for nurse-to-patient staffing ratios, however.

California is the only state with laws and regulations in place that set nurse-to-patient ratio minimums. Twelve other states introduced statewide regulations designed to prevent nurse understaffing issues:

  • Connecticut
  • Illinois
  • Nevada
  • New Jersey
  • New York
  • Ohio
  • Oregon
  • Rhode Island
  • Texas
  • Vermont
  • Washington

The Nursing Home Reform Law of 1987 currently regulates long-term care facilities. However, the law doesn’t set specific guidelines to help prevent understaffing issues. Instead, it says that long-term care facilities must ensure that:

  • A Registered Nurse (RN) is present for eight consecutive hours, seven days a week
  • Licensed nurses are on-site 24 hours a day
  • There is a sufficient level of nursing staff available to meet facility residents’ needs

Facilities Shown to Misreport, Hide Understaffing Issues

Despite these standards and recommendations, a 2018 Kaiser Health News study revealed many differences between state regulations and some nursing home facilities’ staffing records. In other words, facilities fudged their numbers to appear to meet requirements even when they did not.

The report found understaffing issues were most prevalent on weekends.

The COVID-19 Pandemic Often Made Understaffing Issues Worse

The pandemic revealed that many privately owned facilities lied to state and federal regulators about their staffing levels. Unfortunately, this was also a problem before to the pandemic.

Now that Covid-19 is on its way to being endemic, New York and other states are setting new nursing home staffing regulations. There is more attention on this issue now as a result of the pandemic’s revelations. A bill passed by the New York Senate and Assembly is just one recent example. If passed, this bill requires nursing homes to provide an average 3.5 hours of daily per-patient care by a nurse or nursing assistant.

New Jersey leaders also passed a bill during the pandemic establishing minimum direct care staff-to-resident ratios. Now, New Jersey state law requires the following staffing requirements for all long-term care facilities:

  • One certified nursing assistant must be present for every eight nursing home residents during the day shift
  • Either one nurse or one CNA for every 10 residents during evening shifts
  • One staff member for every 14 residents during the night shift

Change is Necessary

Why is nursing home understaffing such a big problem? Because inadequate staffing often leads to:

  • Medication errors
  • Higher patient mortality
  • Longer hospital stays
  • Higher patient care costs due to readmission
  • More nurse fatigue and burnout
  • Decreased patient satisfaction
  • Nursing home neglect injuries

What Should I Do if My Loved One Suffers Neglect or Harm?

If your loved one has an injury or prolonged illness due to nursing home neglect, it may be time to take legal action. Do not delay. Reach out to an attorney in our network who specializes in nursing home neglect cases. Learn what evidence or documentation you need to gather and get a free, no-obligation case review now.

Ready to see if you may qualify? Complete your free online nursing home neglect case evaluation now!

Laura Schaefer

Laura Schaefer is the author of The Teashop Girls, The Secret Ingredient, and Littler Women: A Modern Retelling. She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Visit her online at lauraschaeferwriter.com and linkedin.com.