Understaffing in Nursing Homes: A Hidden Crisis Leading to Neglect and Abuse

As the aging population in the United States continues to grow, the demand for quality nursing home care becomes increasingly important. Unfortunately, many nursing homes are chronically understaffed. The lack of staff significantly compromises the quality of care residents receive, sets staff up or failure, and puts residents’ lives in jeopardy. This article explores how insufficient staffing levels in nursing homes contribute to neglect and abuse, and what legal recourse may be available for affected individuals and their families. 

Understanding Understaffing in Nursing Homes

Understaffing in nursing homes occurs when there are not enough caregivers–nurses, nursing assistants, and support staff–to meet the needs of residents adequately. This shortage can be due to various factors, including budget constraints, high turnover rates, and difficulties in recruiting qualified personnel. Regardless of the cause, the impact of understaffing is profound and far-reaching.

The Direct Impact of Understaffing on Resident Care

1. Increased Risk of Nursing Home Neglect: When nursing homes are understaffed, caregivers often have to manage an unmanageable number of residents. This can lead to significant neglect, as staff may not have sufficient time to assist each resident with daily activities such as bathing, eating, and personal hygiene. Neglect can result in severe physical and emotional harm, including malnutrition, dehydration, and poor personal hygiene. Residents may suffer from bedsores, infections, and a general decline in health due to the lack of adequate care.
2. Higher Incidence of Medical Errors: Adequate staffing is crucial for proper medical care. Understaffed facilities often see a rise in medication errors, improper administration of treatments, and delayed medical interventions. These errors can have fatal consequences, especially for residents with complex medical conditions. For instance, missed doses or incorrect medication can exacerbate health issues, leading to severe complications or even death.
3. Physical and Emotional Nursing Home Abuse: Stress levels among overworked staff can lead to frustration and burnout sometimes resulting in abusive behavior. Residents may suffer from verbal, physical or emotional abuse, as overstressed caregivers might lash out or use excessive force in handling residents. This abuse can leave lasting psychological scars and significantly reduce the quality of life for elderly residents.
4. Increased Likelihood of Falls and Injuries: Nursing home residents often require assistance with mobility. Insufficient staffing means fewer staff members to help residents move safely, leading to an increased risk of falls and injuries. These incidents can be particularly dangerous for elderly residents, who may suffer serious complications from even minor injuries. Broken bones, head injuries, and other trauma can severely impact an elderly person’s health and independence.
5. Increased Likelihood for Infections and Delayed Diagnoses: Nursing homes are required to provide a safe sanitary environment that is free of infections. Proper infection control practices, including keeping surfaces and cooking areas sanitary, following infection control protocols, recognizing signs of infection, responding to signs of infection, and treating infections all require sufficient and well-trained staff. There is a direct link between a lack of nursing home staff and infections at nursing homes. 
6. Increased Likelihood of Bedsores: Bedsores, also called pressure wounds, pressure ulcers, pressure injuries, and decubitus ulcers, can usually be directly tied to a lack of staff. Bedsores form when pressure is placed on an area of the body for so long that blood flow is limited. Without adequate blood flow, the tissue begins to open up and the tissue breaks creating a wound. The wound increases in depth, oftentimes exposing ligaments, tendons, or bones. The most basic way to prevent bedsores is by keeping the resident clean, dry, and turned. This means that the nursing staff needs to: (1) make sure the resident does not go to the bathroom on themselves or quickly change them if they do; (2) make sure the residents body, usually there buttocks and genitalia, are dry because moisture weakens the skin; and (3) making sure the resident is being turned or repositioned in their bed or wheelchair at least every 2 hours. Many nursing homes lack the staff to ensure that these most basic needs are met resulting in residents developing bedsores that are not only painful but life threatening. 
7. Increased Likelihood of Choking: Nursing home residents should never choke or suffocate at a nursing home. Choking or suffocating is a surefire sign of nursing home neglect and abuse. The reason nursing home residents choke or suffocate is usually rooted in a lack of staff. Some residents are at a risk of choking because of underlying medical conditions that make swallowing difficult. These residents need a combination of speech therapy to help improve swallowing, diagnostic studies like a modified barium swallow (MBS) or fiberoptic endoscopic evaluation of swallowing (FEES) study, staff supervision, and food alternatives. All of these measures require staff to recognize these concerns, assess the resident, inform a physician or therapist of the problem, create a treatment plan for the resident, and then implement that plan. These steps cannot occur when a nursing home is understaffed. 
8. Increased Likelihood of Dehydration or Malnutrition: Every nursing home resident is entitled to adequate hydration and nutrition. These are basic necessities of life. As we age, the level of assistance we need with eating and drinking increases. For some elderly patients with dementia or other cognitive limitations, they may need help even remembering to eat and may need encouragement when eating. Other residents may require hand-over-hand assistance because they do not have the physical ability to manipulate utensils. Other residents may need little more than the food being set up in a way that they can assist themselves. Understaffed nursing homes have a much higher rate of malnutrition and dehydration of residents because each of these tasks requires staff to present to assist the resident. 
9. Increased Likelihood of Wandering or Eloping: Many nursing home residents are at risk of  wandering away from the facility. This is referred to as eloping. Eloping occurs when a resident wanders away from the building without a clear, coherent purpose. For example, a resident may simply exit the building with no purpose at all. Another resident may exit the building with the intention of going to work, even though he might have retired 30 years ago. Nursing homes are required to assess residents to determine their risk of eloping. If they are at risk, those residents need to not only be supervised but measures need to be taken to ensure that there is proper surveillance and security equipment to prevent the resident from wandering away. This requires enough staff to perform the assessment, create and implement a plan with the correct surveillance and security measures, and ensure that those measures are working. There is probably no clearer sign of nursing home abuse and neglect than when a nursing home resident wanders away. 

The Broader Impact of Understaffing on Nursing Home Operations

Understaffing not only affects the immediate care residents receive but also impacts the overall operation and atmosphere of nursing homes. The consequences can include:

1. Decline in Quality of Life: Residents in understaffed nursing homes often experience a decline in their overall quality of life. Social activities, recreational programs, and individual attention from caregivers are often reduced or eliminated. This can lead to feelings of isolation, depression, and a sense of abandonment among residents.
2. Staff Burnout and Turnover: High levels of stress and burnout among staff can lead to increased turnover rates. Constantly training new staff members further strains the resources of the facility and can lead to inconsistent care. Experienced staff may leave, taking with them valuable knowledge and skills, and leaving the facility with a workforce that is less capable of providing high-quality care.
3. Regulatory and Legal Consequences: Nursing homes that fail to maintain adequate staffing levels may face regulatory fines and sanctions. These facilities are often subject to increased scrutiny from state and federal oversight bodies. Repeated violations can lead to severe penalties, including the revocation of licenses and closure of the facility.

Legal Implications and Recourse

Families entrust nursing homes with care of their loved ones, expecting a safe and nurturing environment. When nursing homes fail to provide adequate care due to understaffing, they can be held legally accountable. Here are some legal avenues for addressing neglect and abuse resulting from understaffing:

1. Filing a Complaint with State Agencies: Many states have regulatory agencies that oversee nursing home operations. Filing a complaint with these agencies can prompt investigations and lead to corrective actions against the facility. State agencies can impose fines, mandate improvements, and monitor the facility closely to ensure compliance.
2. Pursuing a Nursing Home Neglect Lawsuit: Victims of nursing home neglect and abuse, or their families, can file a nursing home neglect lawsuit against the facility. Successful litigation can result in compensation for medical expenses, pain and suffering, and other related damages. Moreover, it can lead to systemic changes within the facility to prevent future occurrences. Legal action can help bring attention to the issue and pressure the facility to improve its standards of care.
3. Advocating for Policy Changes: Beyond individual cases, families and advocates can work towards legislative changes that enforce stricter staffing requirements in nursing homes. Such policies can ensure that facilities maintain adequate staffing levels to provide high-quality care consistently. Advocacy efforts can include lobbying for laws that set minimum staffing ratios, improve caregiver training, and increase funding for long-term care facilities.

Preventative Measures and Solutions

Addressing the issue of understaffing requires a multi-faceted approach involving regulatory changes, increased funding, and a commitment to improving the working conditions for nursing home staff. Some potential solutions include: 

1. Implementing Minimum Staffing Ratios: States can enforce minimum staffing ratios to ensure that nursing homes have enough staff to meet residents’ needs. These ratios should consider the acuity and complexity of residents’ conditions to provide adequate care.
2. Increasing Funding for Nursing Homes: Additional funding can help facilities hire more staff, offer competitive wages, and provide better training and support. Investing in the workforce can lead to improved care and reduced turnover rates.
3. Enhancing Training Programs: Providing comprehensive training programs for nursing home staff can equip them with the skills and knowledges needed to deliver high-quality care. Ongoing education and professional development opportunities can help staff stay updated on best practices and new care techniques. 
4. Improving Working Conditions: Addressing the root causes of staff burnout and turnover, such as long hours, low pay, and inadequate support, can help create a more positive work environment. Offering benefits such as mental health support, career advancement opportunities, and better staffing models can enhance job satisfaction and retention. 
5. Promoting a Culture of Care: Encouraging a culture that values and prioritizes the well-being of both residents and staff can lead to better outcomes. This involves leadership that is committed to high standards of care, open communications, and a supportive work environment. 

Understaffing in nursing homes is a critical issue that directly contributes to neglect and abuse, severely impacting the well-being of residents. Legal action is a vital tool for holding facilities accountable and ensuring that vulnerable individuals receive the care they deserve. If you or a loved one has been affected by nursing home neglect or abuse, pursuing a nursing home neglect or abuse lawsuit can provide the justic and compensation needed to address the harm caused. 

Our law firm is dedicated to helping victims and their families navigate the complexities of these legal challenges. We are committed to advocating for the rights of nursing home residents and ensuring that facilities are held to the highest standards of care. If you need assistance, our experience legal team is ready to provide the support and representation you need.

Questions About a Potential Lawsuit Involving a Nursing Home Facility? 

Michael Hill is a nationally recognized attorney who handles exclusively cases against long term care facilities. Michael and his firm, Michael Hill Trial Law, handle cases across the country. 

Disclaimer: This information is provided for informational purposes only. Nothing in this article should be construed as providing legal advice or the creation of an attorney client relationship. Laws are updated frequently and change from state to state. If you desire legal advice, you can contact Michael Hill Trial Law at www.protectseniors.com, send an email to info@protectseniors.com, call (800) 659-2712 to begin an investigation, or contact another attorney.