Understaffing In Nursing Homes

The question as to why nursing homes are so understaffed lies in the for-profit nature of most nursing home facilities in the United States. According to a litigation study carried out by Charlene et al., about 70% of nursing homes in the United States are for-profit facilities; therefore, staffing quotas are lowered to generate the highest profit margins1. Nursing home management might alter the residential to staff member ratios to maximize the profit that they receive. Research shows that nursing homes with the highest profit margins have an equally high staff turnover rate and are often the poorest quality1. Due to a high staff turnover rate, over-scheduling of current staff members occurs, further contributing to added stress levels on staff members as they are required to work longer hours.

The Connection Between Overtime and Inadequate Care

Overtime is very common and is masked as beneficial towards nursing staff members––increased wages and seen as a form of loyalty. In these cases, staff members feel that they have no choice but to work unreasonable hours to gain favor from administrators and keep their job. As a result, nursing home resident care suffers. 

Recent federal data, analyzed by Kaiser Health News, reflects that nursing homes are inadequately staffed, particularly on the weekends2. Based off of daily payroll records that Medicare began gathering as mandated by the Affordable Care Act of 2010, the figures reveal that most nursing homes shortcomings have led to the increase in nursing resident’s health problems. 

Nurse Home Staff Fatigue

Nurse home staff fatigue plays a significant role in nursing home resident safety as nurses are left concerned with their ability to perform their duties safely. According to a survey commissioned by Kronos Inc in 2013 that queried nurses, 54% of the participants stated that they had an excessive workload, while 77% commented that their facility had 12-hour nightshift3. Though U.S states have different rules regarding staff-to-patient ratio, it is clear from the statistics that nursing home understaffing might lead to the neglect of resident needs. 

Effects of Understaffing in Nursing Homes

Overworked and underpaid nursing home staff members are more likely to abuse and neglect nursing home resident; be it intentionally or unintentionally. The following are some of the effects of understaffing in nursing homes:

1- Immobile Residents

Because most of the nursing home residents have limited ability to move around by themselves, they depend on nursing home staff for the majority of their movement needs, as well as, their physiological needs. When a nursing home is understaffed, staff members are unable to turn the residents in bed enough times or to move them around to prevent bedsores and muscle atrophy. As a result, skin conditions and infections can occur. 

2- Neglecting Resident Needs

Understaffed nursing homes might have issues feeding and providing medications to the residents on a routine schedule4. This can lead to nutrition deficiencies, malnutrition and additional complications arising due to an untimely medication schedule.  

3- Resident Abuse

96% of the participants in the survey commissioned by Kronos Inc commented feeling tired at the beginning of the shift with 92% having to drive back home after work3. With the addition of stress-related issues in connection to understaffing, staff members have limited time. In such situations, staff members might be impatient when providing care to residents. Because of this, a nursing home resident might not be able to voice any issues for fear of being reprimanded and ridiculed. 

Handling and Preventing Nursing Home Understaffing Consequences

Reports concluded that understaffing directly impacts resident care and safety. According to Charlene et al., nursing homes are required to hire trained staff to attain and maintain “the highest practicable, physical, mental and psychosocial well-being of each resident as determined by resident assessments and individual plans of care” 1. However, the statistics tell a different story. 

Because it is a societal issue, increased awareness and the introduction of stricter penalties and laws might alleviate issues such as nursing home understaffing. Though many nursing homes have been taken to court, held accountable and paid hefty lawsuit fines, the issue of nursing home understaffing is prevalent in the United States. In cases where nursing home and understaffing is observed or suspected, seek advice from an attorney. In such a case, an attorney might be able to help victims of understaffing to recover funds and costs directly associated with intentional understaffing at nursing homes. 


1  Charlene Harrington, and Toby S. Edelman. “Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain.” (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055099/

2  Jordan Rau. “Most nursing homes are not adequately staffed, new federal data says.” (2018). https://www.pbs.org/newshour/health/most-nursing-homes-are-not-adequately-staffed-new-federal-data-says 

3  Julie Bird. “Survey: Nurse understaffing, fatigue threatens patient safety.” (2013) 


4   https://www.nursinghomeabusecenter.com/nursing-home-neglect/understaffing/

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