How Much Staff Must A Nursing Home Have?

Nearly 1.4 million people are cared for in over 15,600 nursing homes around the United States according to the CDC. These elderly loved ones need compassionate and competent care by nursing home staff, and that type of care cannot be properly administered when staff is overworked and stretched thin due to understaffing

As disclosed in an explosive report by PBS news, federal records show that since 2014, health inspectors have cited numerous nursing homes, as high as 1 out of every 8, for having too few nurses on staff. The data, analyzed by Kaiser Health News, show that numerous nursing homes have fewer nurses and caretaking staff than what was previously reported to the government.  

Understaffing in nursing homes can have drastic and numerous negative impacts on the residents, leading to neglect, and even abuse in some cases. If you suspect your loved one is in a dangerous situation due to understaffing at a nursing home, you should immediately report it to the authorities; after that, your next step is to call an experienced nursing home lawyer.

Photo by Sheila Sund from PxHere


How Often Are Nursing Homes Understaffed?

Kaiser Health News estimated that on the worst-staffed days at an average facility, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was full. This means residents were receiving half the attention and time they should have been given on these days. Yet somehow, these facilities had been operating with the approval of Medicare. 

The federal data analyzed by Kaiser revealed that each facility’s staffing levels had previously been based on the homes’ own unverified reports, making it possible to game the system. When staffing levels were verified by outside sources, of the more than 14,000 nursing homes submitting payroll records, 7 in 10 had lower staffing using the new method, with a 12 percent average decrease. 


Nursing Home Staffing and the Law

Given these troubling numbers, if you or a loved one are about to come under the care of a nursing home – whether it is for a permanent or short term stay – you may have concerns if there are any standards for nursing home staffing they must follow under the law.  

The laws regulating nursing homes are under the Nursing Home Reform Act, otherwise known as the Omnibus Budget Reconciliation Act of 1987 (OBRA), 42 CFR 483, et. seq.  According to § 483.35 a nursing home must have sufficient nursing staff with appropriate competencies and skill sets to provide nursing and related services, to assure resident safety, and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individual plans of care.


The Nursing Home Reform Act

  • 483.35(a) of the Act requires a nursing home to provide sufficient numbers of licensed nurses and other nursing personnel – including but not limited to nurse aides – on a 24 hour basis to provide nursing care to all residents in accordance with resident care plans. §483.35(b) requires the nursing home to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. §483.35(c) requires the home to ensure its nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs.

The law does go into more detail about adequate staffing at a given nursing home. §483.5(g) of the Act requires the nursing home to post staffing information on a daily basis at the beginning of each shift in a prominent place readily accessible to residents and visitors.  Specifically the home must post the total number and actual hours worked by registered nurses, licensed practical nurses or licensed vocational nurses and certified nurse aides.  The nursing home must also post the resident census (the number of residents in the nursing home).  The nursing home must maintain the posted daily nursing staffing data for a minimum of 18 months, or as required by State law, whichever is greater.


How Many Staff Must Be Present During a Shift at a Nursing Home?

You may have noticed above that “sufficient numbers of licensed nurses” isn’t a very specific figure. Unfortunately there are not specific numbered requirements set out in the Act on staffing.  What constitutes sufficient staff then? It will depend on the size of the nursing home, number of residents there, and the time the nursing staff is able to spend with each resident. If residents are being neglected and not treated well this will be a strong sign of understaffing at the nursing home.

This means that the family of the nursing home resident must be on the lookout for signs of neglect or abuse, as well as signs of chronic understaffing at a facility. It’s important to promptly bring these matters to management at the facility, local elder care advocates, or if needed, a lawyer, in order to secure a safe place to live for residents at understaffed facilities. 


Why are Nursing Homes Understaffed?

While understaffing at nursing homes can occur for a variety of reasons, there may be actual intentional reasons that owners or managers at a nursing home facility will keep the residence understaffed. Common reasons for understaffed nursing homes include:

  • Staffing shortages: Some facilities may have problems finding or retaining adequately trained nurses to provide care.
  • High turnover: High turnover among staff may lead to over-scheduling staff that remain and cause them to be overwhelmed.
  • Cost of labor: Management may keep a home purposefully understaffed in order to save money.
The Pennsylvania Soldiers’ and Sailors’ Home in Erie is one of six extended care facilities for veterans located throughout Pennsylvania. “Soldiers’ & Sailors’ Home” by padmva is licensed under CC BY-NC-ND 2.0.


What Happens When Nursing Homes Are Understaffed?

When a nursing home is understaffed, this can directly affect the level of care that the nursing home residents receive. This can include:

  • Falls: If a resident tries to get up, for instance to use the bathroom, and no one is available to assist them, they can fall and injure themselves.
  • Dropping residents: Sometimes two or more staff members are needed to move a resident. If only one is available, it can cause injuries not only to the resident, but to the staff member as well.
  • Bedsores: If there are not enough staff on duty to turn residents who are bedridden, they can develop painful or infected bedsores. 
  • Inadequate nutrition: Without enough nurses on staff, residents may not receive adequate food or water throughout the day. They may also receive the wrong medications, leading to potentially fatal complications. 

Lower staffing can unfortunately lead to health code violations, patient neglect, injuries, violations of dignity, abuse, and even to the deaths of residents in a nursing home.


Elder Abuse: What Percentage of Elders are Abused?

The National Institute on Aging (NIA) estimates that 1 in 10 people aged 65 or older will experience some form of elder abuse in any given year. Many elderly adults will sadly experience more than one type of abuse simultaneously. 

Yet these abuse cases are often unnoticed, and therefore go unreported. To prevent elder abuse, family members have to know what to look out for, and need to report any signs of elder abuse to the proper authorities as soon as possible. 


Reporting Elder Abuse or Neglect

If you suspect that low staffing levels at a nursing home are causing your loved one or other residents in a nursing home to suffer neglect or abuse, you should immediately report it to the authorities. Urgent situations should be handled by dialing 911. You can also report suspected elder abuse by connecting with your local Adult Protective Services agency. Your state’s agency can be found by calling the eldercare locator at 1-800-677-1116. After reporting suspected abuse, your next step is to get an experienced team of PA nursing home lawyers to investigate your case.

The attorneys at the Thistle Law Firm are experienced at handling nursing home malpractice claims.  If you feel a loved one or member of your family was seriously harmed or died due to neglectful care and understaffing at a nursing home the attorneys at the Thistle Law Firm are here to take your call at 215-525-6824. You can also reach us at any time of day by filling out our online form here.


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