One of the most common complaints with skilled nursing care is that nursing homes are chronically understaffed. In 2018, Medicare changed the way they counted the staff at nursing homes, transitioning from self-reported and unverified staffing numbers from the facility itself to determining staffing levels based on payroll records. What the agency found is that many nursing homes had , often leading to dangerous outcomes for the residents of these facilities.
Reasons for understaffed facilities
There are many reasons why a facility is understaffed, including:
- The relatively low pay for Certified Nursing Assistants, which often results in losing staff members to hospitals or even to other industries.
- The lack of staff leads to double the work for those who remain, which often causes those employees to look for other opportunities as well.
- The cost of labor, which leads some facilities to focus on attracting new residents more than they focus on retaining quality staff.
The dangers of an understaffed nursing facility
Most nursing home residents require some type of assistance, whether it is help walking, eating, showering or toileting, or getting out of bed. Some residents require constant supervision to deal with cognitive declines, elopement, and other issues. If a facility is understaffed, there are fewer trained staff members to adequately meet the needs of the residents, which can lead to physical and emotional suffering including:
- Pressure ulcers (bed sores) caused by remaining in one position too long.
- Malnutrition and dehydration.
- Loss of mobility.
- Fractures and other injuries caused from mobility challenges and lack of assistance with daily activities.
- Loneliness and a sense of isolation.
- Lack of trust that staff will meet the resident’s needs in a timely fashion.
- Loss of dignity caused by not having assistance with toileting or showering needs.
What the federal government requires in terms of staffing
Surprisingly, the federal government does not require a specific number of certified or licensed staff members to meet the needs of nursing home residents, though it does require the presence of a registered nurse at the facility for at least eight hours a day and the presence of a licensed practical nurse at all times. Instead, it states that the staffing must be “sufficient” to meet the needs of the residents, and offers the following recommendation on minimum staffing levels based on a study that shows the minimum amount of time necessary to prevent dangerous conditions such as pressure ulcers, dehydration and malnutrition, and loss of mobility:
- Each resident should receive at least 4.1 hours of care each day.
- Of the daily care received by residents, 2.8 hours should be provided by certified nursing assistants, .55 hours from licensed practical nurses, and .75 hours from registered nurses.
Medicare has expressed concern about the need to reduce vast fluctuations in the amount of staff available. In a study of one nursing home, the staff to resident ratio was one staff member for every eight residents on some days, but on weekends — with the facility promising that each staff member would have every other weekend off — that ratio slips to one for every eighteen.
People with loved ones in nursing homes can look for signs of understaffing during visitation. A lack of staff presence or rushed staff can be obvious signs, along with residents showing physical and emotional trauma. Shedding light on these issues is the first step to creating change for victims.