In the past years, understaffing dangers in nursing homes have increased dramatically. A sharp increase in elderly residents dubbed the “silver tsunami” combined with troubled nursing home staffing levels has created a troubling environment for loved ones looking for end-of-life care.
Part of the prevalence of understaffing dangers comes from the lack of regulation to accompany this increase in nursing home populations. The official federal stance on nursing home staffing levels still relies heavily on the Nursing Home Reform Law of 1987 which has a very narrow definition of adequate staffing for long-term care facilities and nursing homes.
According to the Reform Law, a registered nurse must be on-site for eight consecutive hours, seven days a week, there must be access to a licensed nurse 24 hours a day, and there should be “otherwise ‘sufficient’ nursing staff to meet residents’ needs.” This law has not been updated in over 32 years and those standards are no longer adequate to keep understaffing dangers at bay as corporate nursing home companies maintain low staffing conditions as a cost-saving measure.
Unfortunately, part of the reason that previous legislation is inadequate to prevent understaffing dangers comes from the nature of modern nursing homes. Unlike in previous years, a modern nursing home takes care of not only aging residents but also residents who need:
- Complex wound care
- Assisted ventilation
- Jackson-Pratt drains
- Life vests
- IV medications
These medically complex residents not only require nurses for the administration and operation of these devices but also to monitor their use for complications and comorbidities that may occur over the course of their use.
Nurse.org conducted an interview with nursing home nurses to address understaffing dangers in a nursing home. In an interview, several nurses were asked what they did in a typical eight-hour shift. Their answers were that a nurse is expected to do the following:
- Distribute medications a minimum of two times per shift
- Monitor resident blood sugar levels and administer insulin
- Administer vital sign checks
- Manage the Certified Nursing Assistants (CNAs)
- Monitor mealtimes
- Perform initial or follow-up wound care
- Receive and transcribe doctor’s orders
- Complete and file incident reports
- Fill out documentation
- Oversee the transportation, diagnostic testing, and appointment schedule of residents
- Ensure their residents are safe and cared
- Notify physicians and family members of any concerns
That is an expectation of 10-12 tasks per 8-hour shift for all of their assigned residents. It is here that appropriate staffing becomes necessary to prevent mistakes or oversight issues. Without proper staffing, understaffing dangers present almost immediately.
The ratios of residents to nurses show how understaffing dangers can present in otherwise adequate facilities. Will all of the tasks expected of them, understaffing can become a serious issue when a resident has a specialized issue that requires a nurse’s training to identify and treat. The states where understaffing dangers from low nurse populations is worst are:
- 25:1 – New York
- 32:1 – Ohio
- 44:1 – Tennessee
- 50:1 – Georgia
- 60:1 – Nebraska
- 66:2 – Illinois
The situation is similarly troubling with the ratios of Certified Nursing Assistants (CNAs). Although they do not perform all of the advanced tasks of a nurse, the understaffing dangers of CNAs come from a shortage of clean linens and undersupplied nurses in a time of need. Though New York is better in this respect, with a CNA-to-resident ratio of 5-1, the other five states still show a significant shortage of staff.
- 33:2 – Illinois
- 16:1 – Ohio
- 20:1 – Nebraska
- 22:1 – Tennessee
- 30:1 – Georgia
Unfortunately, these low numbers have consequences. The Journal of The National Medical Association found that understaffing dangers took the form of malnutrition, unhealthy weight loss, bedsores, increased falls, and infections as nurses and nursing assistants fail to give proper attention to each resident.
For this reason, it is vital to properly vet a nursing home with in-person visits when possible. By examining the halls and talking to residents, families can determine whether there is an adequate number of nurses at a facility to ensure that their loved one is not lost in an overworked nurse’s duties and neglected.
For more information about the signs and dangers of nursing home neglect, visit the National Association of Nursing Home Attorney’s Neglect Page.