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Many nursing homes and assisted living facilities are grossly understaffed. They promise to provide excellent, personalized care in a home-like environment. In reality, however, the actual care provided is non-existent. 

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Nursing Homes Are Chronically Understaffed

Nursing homes and assisted living facilities make promises to solicit new residents through sophisticated marketing schemes. Once in the nursing home, those promises are often broken, and it becomes apparent to families that the nursing home never intended to keep those promises. 

Researchers estimate that as many as 95% of nursing homes in the United States are understaffed. There are 14,000 nursing homes in the United States. That means that of the 14,000 nursing homes in the United States, 13,300 do not have enough staff to meet the needs of their residents. These numbers do not include assisted living facilities. Although they are also often understaffed, they have not been studied as robustly. 

Nursing Home Understaffing Causes Abuse and Neglect

When there are not enough staff to provide care to residents, staff often become stressed and burned out. This leads to a culture where staff lose interest in providing care to their residents because they know they are not able to. As that frustration rises, nursing staff sometimes “snap” by acting out in inappropriate ways. This can include becoming verbally abusive to residents, such as yelling, cursing, or name calling. It also results in physical abuse, including being too rough with patients when moving them or providing basic care. It can also result in staff pushing, punching, or kicking residents. 

Abuse does not have to be intentional. The definition of abuse that applies to nursing homes and assisted living facilities does not require intent. It only requires that the caregivers deny the resident goods and services that are necessary to promote their well-being.

When nursing homes and assisted living facilities are understaffed, the staff are unable to provide basic care. For example, many residents need extensive oral care. These residents need someone to brush their teeth, rinse their mouths, and use a form of mouthwash. This is both a matter of resident dignity but also health and safety. When a person’s mouth is not kept clean, bacteria grows and causes a severe and sometimes deadly lung infection called aspiration pneumonia.

Many other residents need help moving or repositioning in bed. These residents need one or two people to physically turn or reposition them in bed. If this does not happen and they are left in one position, it can cause the skin to die and ulcers to form called bedsores.

When there are not enough staff, call lights go unanswered for extended periods of time. While call lights are often used for non-emergency situations, a timely response can sometimes be a matter of life and death. If a person is choking or their respiratory equipment becomes dislodged, there may only be a minute or two to respond before the brain begins to die because it does not have enough oxygen. 

bruises on elderly person due to understaffing in nursing home

Many residents need help getting to the bathroom. Other residents may be incontinent and need to be checked and changed regularly. When a facility is understaffed, these patients are neglected. Patients who can control their bowel and bladder are often forced to go to the bathroom on themselves and lay in their own waste for hours. Other residents may go unchecked for hours causing them to suffer embarrassment and cause them to develop bedsores and infections.

These are only a few of the many scenarios we see when a nursing home or assisted living facility is understaffed.

Why Are Nursing Homes Understaffed? 

The main reason that nursing homes are understaffed is because the nursing home and its corporate ownership prioritize profits over resident care. It is estimated that paying staff accounts for 65% of the cost to operate a nursing home.

There are several ways that nursing homes reduce overhead by understaffing the facility.

One way to reduce overhead is to reduce the number of registered nurses who work at the nursing home and assisted living facilities. Registered nurses are the most expensive nurses to employ because they have extensive training. Nursing homes understaff their facilities by employing few registered nurses.

Instead of registered nurses, they employ what are referred to as licensed vocational nurses (LVNs) or licensed practical nurses (LPNs). LVN and LPN nurses are essentially the same thing. The names are typically used interchangeably. LVN and LPNs are significantly less expensive to employ than registered nurses because they lack the training and certifications that registered nurses do.

Every state has some form of a nursing practice act that determines the limits of what nurses can do. Registered nurses are permitted to assess patients, make nursing diagnoses, and write nursing orders. LVN and LPNs are not permitted to do this. As their name implies, they are vocational or practical nurses. They are only permitted to work under the direction of a registered nurse. Nursing homes often ignore these rules by having LVN and LPNs assess patients and determine the care that they need. This is against the law and dangerous.

Another common way that nursing homes attempt to save money is by reducing the number of certified nursing aides (CNAs) or State Tested Nursing Aides (STNAs). CNAs and STNAs are the same thing.

CNAs and STNAs provide the bulk of the day-to-day care that residents need. Those care needs include assisting the resident in and out of bed, in and out of wheelchairs, and on and off toilets. They also include oral care, toileting care, along with dressing, showering, feeding and supervising residents. By limiting the number of aides to dangerously low levels, nursing homes and assisted living facilities are able to maximize their own profits.

In addition to reducing the numbers of nurses and aides, nursing homes often underpay and overwork their staff. This results in an undertrained and underperforming workforce.

How Can You Prove that A Nursing Home is Understaffed?

Violation of Federal and State Staffing Regulations

Federal and state regulations require that nursing homes have “sufficient” staff to meet the residents’ needs. 

Medicare Fraud

The vast majority of nursing home care is paid for by Medicare or Medicaid based on taxpayer money. Medicare fraud occurs when nursing homes engage in a dishonest practice to bill the government for care that is either unnecessary or care that they do not provide.

When a resident enters a nursing home, the nursing home is required to assess the resident to determine how much care they need. The nursing home then bills the government for that care. The more care the nursing home says the resident needs, the more money the nursing home receives for that resident.

Unlike when you go to the doctor and get a bill after the care is provided, nursing homes are allowed to bill the government before the care is provided. This allows nursing homes to bill for things like therapy or other services that the resident does not need or cannot do. For example, a nursing home may bill the government for therapy that is never provided. Or, the nursing home may have a disabled patient who will never benefit from therapy to go through therapy so that the nursing home can get paid for it, even if it never helps the resident.

Public Documents

Nursing homes are required to submit the number of hours that staff are on duty and being paid. Through a careful review of these documents with the help of experts, we are able to determine whether it is even possible for the nursing home to provide the care that residents need. For example, a nursing home may have only two nursing aides on duty to take care of twenty residents. If fifteen of those residents require two aides to help them with their care, such as oral care, moving in bed, or toileting or require supervision at meal times, we are able to prove that it is impossible to provide that care. 

Internal Documents

Nursing home internal documents provide evidence of their true motives. Nursing homes are required to provide enough staff to meet the needs of every resident. As the needs of the residents change or increase, the number of staff must also increase. The number of residents at the nursing home often change as residents move in and out. Residents’ care needs also change as their physical conditions change.

Nursing homes, however, often have predetermined staffing budgets. This means that the nursing home sets the budget for the facility at the end of the prior year. These budgets include a monetary budget for the amount of staff.

These budgets are almost always based on the budget from the prior year. 
The budget for staffing does not change throughout the year and is based on prior years. This proves that the nursing home is not staffing the facility based on the residents’ needs. The staffing should increase as residents’ needs increase. However, it doesn’t. 

Former Employees

Former employees of the nursing home are often essential when proving that a nursing home or assisted living facility was understaffed. Former employees have credibility with the jury because they have nothing to gain from the lawsuit. They are often able to describe the situation at the nursing home with insider knowledge. We often hear from the nursing staff that they frequently requested more staff because they were unable to perform their jobs. Those requests were denied by the nursing home. This proves that the nursing home knew that residents were being harmed by the lack of staff and chose to do nothing about it. Former employees are also able to describe how the residents suffered abuse and neglect as a result of not having enough staff. 

Family and Visitor Testimony

Family and visitors of the resident have first hand knowledge of the conditions at the nursing home. They are able to describe things like call lights going unanswered, food trays being left outside the resident’s reach, or finding their loved ones laying in their own feces when they visit.

Lawsuits about Understaffing at Nursing Homes

Several class action lawsuits have been filed across the country based on understaffing practices. The basis for these lawsuits is that nursing homes siphon funds that should be used for resident care and allow the owners to reap the benefits of this dangerous practice by increasing their profits. The lawsuits have been brought against the nursing homes themselves, along with the corporate parent companies and management companies that operate the nursing homes.

The basis for these lawsuits are that members of the community paid for services that could not be provided. This includes individuals who paid out of pocket for care and Medicare and Medicaid. Medicare and Medicaid, through our tax dollars, pay for the vast amount of nursing home care.

The lawsuits request reimbursement for money that was paid for services that were never provided. The lawsuits also seek to force the nursing homes to provide the amount of care that the residents need by increasing staffing.

Chancellor Senior Management

In a case against Chancellor Senior Management, a Columbus, Ohio based long-term care provider, the lawsuit alleges that Chancellor used a formula to determine staff hours based on resident needs but applied it only for billing purposes and not the actual care that was provided.

Brookdale Senior Living

In 2020, a federal class action was filed against Brookdale Senior Living, the largest provider of assisted living in the United States. Brookdale Senior Living is based in Brentwood, Tennessee. The lawsuit claims that Brookdale misled residents and their family members by failing to deliver care that was expected to be provided. 

Emeritus Corporation

In 2016, Emeritus Corporation settled a class action lawsuit for $13.5 million. The lawsuit alleged that Emeritus used a computerized system to determine resident needs and staffing. This computer model failed to accurately determine the residents needs or staffing levels, resulting in significant profits at the expense of resident care and safety. That same year, Altria Senior Living, settled a similar lawsuit for more than $6 million. 

Aegis Living

In 2021, Aegis Living settled two class action lawsuits for over $16 million. The lawsuit alleged that Aegis based its staffing levels on predetermined numbers and did not take the actual needs of the residents into consideration. Doing this violated consumer protection and elder abuse laws. 

Lawsuits Improve Staffing at Nursing Homes and Resident Safety

Understaffing at nursing homes is a financial decision. Nursing homes gamble that they will make significant profits by reducing staffing. When nursing homes are forced to pay significant amounts of money in a lawsuit for injuries they have caused, they are forced to reconsider their practices. A successful lawsuit costs the nursing home more money than it would to properly staff the facility. As a result, lawsuits result in more staffing, better working conditions for staff, and greater resident safety.

How Much is My Nursing Home Understaffing Case Worth?

Every case is unique and has to be evaluated on its specific facts. The only way to determine the value of your nursing home understaffing case is to begin an investigation.