According to the U.S. Centers for Disease Control (CDC), there are more than 1.3 million nursing home residents across the country living in 15,600 care facilities. With the large baby boomer population aging, these numbers will keep growing over the next several years. The option to place a loved one in a nursing home is arguably a luxury compared to families’ options several generations ago. However, it is not without problems. Nursing home residents are more likely to face abuse and neglect than their aging peers who remain at home or with family members.
Staffing Problems Can Cause Abuse, Neglect, and Health Concerns for Residents
Abuse and neglect happen for a variety of reasons. One of the significant contributing factors is the lack of staff and inadequate training for staff members. The nursing staff can’t give each resident adequate attention. They are often overworked and overwhelmed, which increases the risk of mistakes, neglecting the residents, and committing abuse.
Studies show that residents who live in understaffed facilities are at an increased risk of:
The CDC reports that nearly 70 percent of all nursing homes are for-profit, creating some conflict of interest. Unfortunately, this often means pressure on the administration not to exceed tight budgets. The more a nursing home spends on staffing or staff training, the less profit they make.
Staffing is arguably the most critical factor in nursing home residents’ ability to live with dignity and quality of care. Inadequate nursing home staffing is an ongoing problem throughout the nation. Weekend and holiday staffing are especially problematic.
Care facilities must staff an adequate number of registered nurses (RNs) or licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) to perform and oversee specific tasks. They must also staff certified nursing assistants (CNAs) or other types of aids to help with daily hygiene, feeding, mobility, toileting, and other needs.
Nurses in these states report staffing ratios for long-term care facilities as the following:
- 32:1 nurse and 16:1 CNA- Ohio
- 44:1 nurse and 44:2 CNA- Tennessee
- 50:2 nurse and 15:3 CNA- New York
- 66:2 nurse and 66:4 CNA- Illinois
- 50:1 nurse and 30:1 CNA- Georgia
- 60:1 nurse and 60:3-4 CNA- Nebraska
Office of Inspector General Investigation into Nursing Home Staffing
In 2018, the inspector general at the Department of Health and Human Services (DHHS) completed an investigation into federal oversight of skilled nursing facilities based on signs that some aren’t meeting the minimum staffing requirements put forth by Medicare.
It was spurred in part by an investigation by Kaiser Health News and New York Times, which found almost 1,400 nursing homes report having fewer RNs on duty than the Centers for Medicare & Medicaid Services (CMS) mandates or failed to provide consistent staffing data to the government.
Nursing homes are required to have an RN on staff a minimum of eight hours each day, no matter what day it is. They must also have either an RN or LPN/LVN at the facility around the clock and “sufficient” nursing staff, such as CNAs, to meet residents’ needs.
However, as a result of their investigation, the Office of the Inspector General (OIG) found that seven percent of nursing homes reported at least 30 days in 2018 with staffing that didn’t meet these federal requirements. An additional seven percent reported that they had between 16 and 29 days with staffing under the requirements. Furthermore, 65 percent of the days with staffing inadequacies were on the weekends. With these numbers, you can assume that car facilities are not meeting the needs of residents.
Lack of Training
When a care facility is already on a tight budget or short on staff, they are in a hurry to hire staff and get them working. Training can stand in the way of this objective and is often not a priority. However, this harms everyone. Onboarding and routine training should be mandatory for every staff member.
Without training, staff members can make critical mistakes that impact the health and safety of the residents, lack the confidence to perform the care they need to, lose their professional licensing, cause others to lose their licensing, and cause problems for the nursing home itself.
Adequate training for nursing home staff can:
- Grow a positive staff culture: Staff members should have an annual review of the policies and procedures, as well as upon hiring. This review should also reiterate that abuse and neglect are not acceptable and the facility will not tolerate such conduct.
- Provide staff members outlets and coping mechanisms for their frustrations: There’s no doubting that nursing home staff have demanding jobs, making it easy to become frustrated or overwhelmed. Through training sessions, nursing homes can arm their staff with practical solutions, so they avoid expressing their frustrations by taking them out on residents.
- Set expectations: No matter where someone works, they need to know what the expectations are. This is especially true in the nursing home environment. Most abuse in nursing homes is, sadly, intentional. However, some neglect can arise from staff simply not being aware of expectations. Reviewing basic care procedures, such as how often staff need to turn or adjust a resident or who needs help with eating, can clear up any misunderstandings and help prevent neglect in the care facility.
State Required Training
Some states mandate compliance with staff training, giving nursing homes yet another reason to conduct them.
- The Illinois Administrative Code requires the nursing home administrator to have the facility’s supervisors attend “appropriate educational programs…” every year. Under the law, there must be new employee training and ongoing training, or all employees, at least once per year. Even the volunteers must receive training on the topic of residents’ rights in care facilities.
- Iowa law requires nursing home administrators to ensure that all department managers obtain a minimum of ten hours of educational programming each year. Additionally, they must provide organized and continuing in-service programs to all personnel in every department and establish written personnel policies.
- Under Wisconsin laws, nursing care facilities must provide all new staff training (unless there’s an emergency). All staff members who provide direct care to residents must have ongoing education “as often as is necessary to enable staff to acquire the skills and techniques necessary to implement the individual program plans for each resident under their care.”
These are only some examples, and each state will have different requirements.
How to Identify Staffing Issues in a Care Facility
If you have a loved one in a care facility, these facts and figures are likely astounding, but how can you tell if there are problems with staffing at your loved one’s facility? There isn’t one blanket answer. Instead, there are a variety of factors to consider.
Use Nursing Home Compare
You can start with Medicare’s Nursing Home Compare.
This user-friendly tool provides charts for every state that include the following information for each care facility in compliance with the reporting requirement:
- Resident census (population)
- Direct care staffing levels (RN, LPN/LVN, and CNA)
- Care staff hours per resident per day for all care staff and specifically for RNs
- Other non-nursing staff hours each day, such as administrators, activities staff, and social workers
This tool allows you to look at information for more than three care facilities at a time on LTCCC’s tool. You can see how your loved one’s care facility compares with others in the area to make decisions about their care.
While this website is a useful resource, remember that this is only a tool, and may contain inaccurate information. You must also compare the information it provides with other factors such as what you observe.
Observe the Nursing Home Staff
Sometimes merely watching the nursing home staff will provide you with some significant clues as to whether or not the staffing ratios at the care facility are up to par. When you visit your loved one or are touring nursing homes as a part of your decision to place a loved one in a facility, take time to observe the staff.
Observe for the following:
- How do the staff members interact with each other? Are they courteous and working as a team?
- What is the attitude of the staff members? Do they seem like they like their job?
- Do they frequently complain about other staff members calling in sick or not doing their share of the work?
- Do they verbalize problems with staffing ratios?
- Do they appear overworked and overwhelmed by their duties?
- Do residents seem to have their personal hygiene needs met? Are they toileted at regular times?
- Do they respond to call lights and other requests promptly?
- Do residents who need help eating get the help they need?
- Do residents get what medication they need at the times they need it?
- What is employee morale like?
- What is staff turnover like?
- Were they given training upon hiring, and do they receive additional training on an ongoing basis?
- Do they have the appropriate licenses and certifications, such as a CPR card?
You can even ask them some of these questions to get a feel for their opinion. Sometimes they are quite honest.
Observe the Nursing Home Residents
It’s just as crucial to observe the nursing home residents to determine any staffing issues at the care facility. The first signs of understaffing or lack of staff training often show up in the care that residents receive. Neglect is common when there are staffing problems. The National Center on Elder Abuse (NCEA) reports that about 95 percent of nursing home residents have been neglected or have witnessed neglect.
The following signs are possible clues that the care facility has staffing issues:
- Failure of a care facility to appropriately attend to or prevent a resident’s medical issues, which can lead to bedsores, infections, inadequate diabetic care, mobility problems, and other complications.
- Failure to provide residents with sufficient water and food, or a clean and safe environment
- Failure to properly help a resident with personal hygiene, such as dental care, laundry, toileting, and bathing
- Ignoring a nursing home resident, leaving them alone excessively, constant hostile treatment, and other failures to deliver adequate emotional and social care
More specifically, observe residents and the environment for:
- Adequate and regular grooming
- Clean clothing, bedding, rooms, and living areas
- Any pests, infestations, mold, or outbreaks of communicable diseases
- Signs of malnutrition such as irritability, constant tiredness, constant complaints of being cold, hair loss, and papery skin
- Residents who lose most or all of their mobility because they are left sitting or lying in bed for long periods nearly every day
- Frequent falls and injuries
- Emotional issues, for instance, a fear of caregivers, a hesitancy to open up to staff, or resentment, anger, depression, and intentional distancing from friends and family
If you can speak candidly with your loved one, ask them about the care they receive and if they feel that staffing is adequate.
No care facility is 100 percent without problems. However, nursing home residents move into care facilities for a reason – because they cannot adequately care for their needs on their own. They need ongoing medical care, supervision, and help with daily tasks such as getting dressed and eating that they cannot receive elsewhere.
If a nursing home doesn’t have staffing that meets or exceeds federal requirements, they cannot provide the care that residents need to maintain their health, well-being, and safety. When a nursing home is short on staff, the risks of abuse and neglect increase, leading to severe injuries or even deaths.
If you have questions or concerns about staffing in your loved one’s care facility, speak with a supervisor. If your loved one has suffered because of staffing issues, it might be a good idea to speak with an attorney to find out what your best next steps are. Pursuing a legal claim can help you or your loved one seek financial recovery. It can also help other residents from the problems that come with understaffing or lack of staff training in the future. Contact Brauns Law, PC today!