Effects of Understaffing in Nursing Homes

Federal and state laws require nursing homes receiving federal funds to develop a plan of care and employ a sufficient staff to provide all of the care within the plan. Due to understaffing, many nursing homes, however, cannot provide all of the care listed on the plan. As a result, residents may not be fed properly, they may not be given sufficient fluids, they may be over- or under-medicated, they may be permitted to develop pressure sores, they may not be taken to the toilet and therefore may be left in bed all day to lay in their own feces and urine, and they may not be cleaned or groomed.

On July 27, 2000, the United States Senate Special Committee on Aging released some startling findings on the problems associated with the understaffing of American nursing homes.

The bottom line was that understaffing is directly linked to poor nursing home care, including an increase in severe bedsores and malnutrition and dehydration. Such incidents of nursing home negligence or abuse have led to increased hospitalization of nursing home residents.

Over half of American nursing homes are below the suggested minimum staffing level for nurse's aides. These workers are the lowest paid and least trained of all nursing home staff, yet they most often are responsible for feeding and bathing nursing home residents. Turnover among nurse's aides compromises the quality of care found in nursing homes.

In addition, more than one-third of nursing homes fell below the suggested minimum staffing level for registered nurses, which is only 12 minutes per resident per day. Of total licensed staff, nearly one-fourth of all nursing homes fell below the suggested minimum staffing level.

Understaffing Relating to Malnutrition and Dehydration

Inadequate staffing is a very serious problem in nursing homes. To hold down costs, many nursing homes employ nurse's aides to care for residents. These nurse's aides are usually overworked, underpaid, under-trained, and inadequately supervised.

Even though it takes 30 to 60 minutes to feed a person safely and sufficiently, nurse's aides may be assigned to feed 15 nursing home residents at a time. This understaffing can result in residents being fed quickly, forcefully, or not at all.

The effects of understaffing are even more severe when nursing home residents are cognitively or mentally impaired. It is estimated that 60 to 70 percent of nursing home residents have a mental impairment. Many of these residents cannot feed themselves. Overall, approximately 50 percent of all nursing home residents are unable to eat independently. Due to understaffing, some of these residents may not be fed at all.

In a report to Congress, the terrible effects of understaffing on nutritional disorders in nursing home residents was described as follows:

• [B]ecause the food carts had to be returned to the kitchen at a specific time, the staff had only 45 minutes to an hour to feed residents. Feeling pressured to finish within the hour, the staff became impatient with those who ate slowly; they spoke to them authoritatively: 'Open your mouth!' 'Don't talk, eat!' 'Laura, keep quiet. Quiet, Laura, you're eating!'... When residents ate too slowly, the staff often mixed the solid food... with the liquids... and residents were forced to 'drink' their meal. All of the food -- the entree, the vegetables, and the dessert -- were added to the milk, resulting in an unidentifiable, unpalatable mix... Sometimes residents were forced to eat rapidly against their wishes: huge spoonfuls of food were placed in their mouths. Some residents choked and coughed as they were fed large amounts of food too quickly. (1)

Another vivid description was related by an eyewitness in response to questions from the Senate Committee on Aging at a 1998 hearing:

• One resident two tables directly away from me was partly feeding herself and partly giving spoonfuls of food from the side by the dining room manager. The resident was choking periodically and at one point regurgitated all of her food onto her tray. The manager, who never smiled throughout the meal, looked in disgust at the mess, did not offer assistance and didn't even wipe the woman's face until five or so minutes later. The resident ate no more and was offered no more. (2)

Our Legal Evaluation of Cases Involving Injuries Due to Understaffing

Today, many nursing homes are a part of large chains that are public corporations who run the facilities more focused on profitability than quality of care. The corporation receives payment for services, and then it decreases the services provided to enhance its profits. Routinely, the corporations reduce its nursing and rehabilitation staff in order to improve profitability. This type of corporate greed results in poor care, or in some cases no care at all, to dependant residents that often times cannot speak for themselves and voice their needs.

In reviewing potential cases against nursing homes, more often than not, understaffing is the root of the problem. In evaluating a potential nursing home case, we look at the following factors:

• What is the nature of the injury?
• Who is responsible for the wrongdoing?
• Was the wrongdoing the cause of the injury?
• What injuries or what damages did the resident sustain?

If the injuries are minor, they may not justify the cost of bringing a lawsuit. If the injuries are serious, however, our law firm will critically evaluate the conduct of the nursing home staff as well as the conduct of the corporation that owns or manages the nursing home.