Understaffing in nursing homes

Written By Jeff Gutkowski

Of the 76 million baby boomers born in the United States between 1946 and 1964, nearly 71 million are still alive, and getting older by the day. For years, boomers have been the dominant population group in our country, but it’s only now that “boomers” are aging into nursing homes and other long term care facilities. When combined with increased incidences of sedentary lifestyles and the prevalence of chronic diseases, the demand for nursing homes and long term care will continue to rapidly increase.

If you have a loved one in a nursing home, you already know the importance of good systems and proper staffing in providing safe, effective and dignified elder care. Problems arise when corporations and conglomerates place the importance of their bottom lines above the importance of caring for our elderly. As with any business, a nursing home’s biggest operating expense is the cost of its staff, which must include the appropriate number of registered nurses, licensed practical nurses, and certified nursing assistants. 

To qualify for payments from Medicare or Medicaid, a nursing home must comply with Federal regulations. Those regulations include the patient’s right to a dignified existence and for the nursing home to care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life. 42 CFR §483.10 and §483.15. To achieve these mandates, the nursing home is required to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.  42 CFR 483.25

Unfortunately, the corporations which own nursing homes are incentivized to cut corners and minimize the amount and quality of the staff because the less they spend on staff, the more is left for profit.  Many corporate owners treat the federal regulations as the maximum care that must be provided, when in fact, the federal regulations require additional staffing when a patient requires it. Eldercare advocates estimate that 90% of nursing homes are currently understaffed. Under the federal regulations, nursing homes must have adequate staffing not only in numbers, but in quality, to properly care for each resident based on the resident’s needs. 42 CFR 483.30. It’s not just about numbers, but about qualifications, too, because not all patients have the same nursing needs and nurses are not equal. Different nurse qualifications have different competencies in the nursing home. For instance, only the registered nurse is allowed to continuously assess the patient’s needs and develop the care plans that the licensed practical nurses and nursing assistants must implement.  And if your loved one has a tracheotomy, intravenous medications, or wound care, a properly trained and certified nurse is needed.

Some of the potential signs of understaffing to look out for, include:

  1. Patient complains about the length of time he/she waits after pushing the call bell;
  2. Patient is positioned in a way to restrict access to call bell;
  3. Patient urinates or soils him/herself because no one responds to call bell in time;
  4. Meals are left uneaten because no one assists the patient with eating;
  5. Food left over from a meal sits in the room long after meal time;
  6. When you need answers, you have to go wandering the halls looking for help;
  7. Patient complains of too much time in a chair or in bed;
  8. Medications not given on time;
  9. Not getting the therapy ordered by the physician.

It is well established and well known that understaffing in nursing homes leads to malnutrition, pressure ulcers (bed sores), falls, and dehydration, any of which can be fatal.  To protect your loved one, make sure that you visit often and make specific notes of the conditions and complaints which concern you, including dates and times. The most successful cases of nursing home and elder neglect involve clients who a jury loves and life changing injuries caused by the neglect and greed of a corporate owner.  If you suspect that your loved one was injured or died due to this type of neglect, call an attorney like those at Atlee Hall to get to the bottom of the nursing home’s bottom line. 

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