Understaffing in Nursing Homes Lowers Quality of Patient Care

Medicare recently implemented new reporting requirements that utilize daily payroll records to calculate staffing, instead of the self-reporting that was previously used. Despite these new procedures, one-fourth of these facilities had no registered nurses working on at least one day during the last quarter of 2017, according to a recent study reported in The New York Times. This is an absolute violation of Medicare regulations, which require that every facility has a licensed nurse on the premises at all times and a registered nurse for at least eight hours each day, including weekends.

No Minimum Requirements Cause Understaffed Nursing Homes

Medicare has so far refrained from setting minimum staffing requirements, leaving it to the individual facilities to determine their own needs. This could explain why one in eight nursing homes has been consistently cited by federal inspectors for having an insufficient number of nurses in the last few years.

One nursing home resident, who frequently has to roam the halls looking for an available aide to help him dress, told reporters his facility is often “like a ghost town,” especially on weekends.

Because the government does not mandate specific staffing minimums, some nursing homes will cut corners in order to save money. Putting profits before patients is a practice that can result in serious or even deadly consequences for the residents in these homes.

High Turnover and Low Wages Lead To Understaffing in Nursing Homes

The caregiver “business” is known for its high turnover, which exacerbates the problem of understaffed nursing homes. When an employee leaves, it takes time to hire and train a replacement, leaving many homes with insufficient staff members for extended periods of time.

There is also a general shortage of qualified and interested caregivers, an issue that affects residential facilities for individuals with developmental disabilities as well as nursing homes. This situation is largely due to the low wages aides and other caregiver workers are paid relative to the nature of the work.

“These caregivers are expected to perform functions a family member would do – bathing, dressing, feeding and other personal care – yet they are often paid little more than a worker in a fast food establishment,” said Mark Bernstein of The Sam Bernstein Law Firm. “It’s a lot of responsibility, which increases when a nursing home is understaffed.”

Consequences of Understaffed Nursing Homes

When a nursing home operates without sufficient staff, it is the residents who suffer. The risk of neglect is greater in homes with lower staff-to-resident ratios. Supervision is often inadequate, and mistakes are more likely to occur when staff members are overworked.

Here are some of the serious consequences that can result from understaffing:

• Increased incidence of bedsores  
• More health code violations
• Increased falls and other accidents due to insufficient supervision
• Greater likelihood of malnutrition and dehydration
• Medication errors
• Lower resident morale
• Increased anxiety among residents who cannot get assistance when they need it
• Higher risk of infections and hospitalizations
• New employees are poorly trained due to time constraints

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Sources

• https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html
• https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf