Understaffing in Nursing Homes

When we think of nursing home abuse, we often think of wrongful action, but understaffing is a less obvious cause of nursing home abuse and neglect.

It’s estimated that 95% of nursing homes in the US are understaffed, and the implications can be enormous.

This problem is compounded further in states like Arizona, that have a large elderly population. Approximately 20% of Arizona’s population is over the age of 60, and this number is steadily increasing.

While understaffing is often unintentional, it can cause extensive damage. To avoid becoming a victim of nursing home abuse, it is essential that you know your rights and understand routes to recovery under Arizona law.

Understaffing defined

There are 1.4 million people in nursing homes worldwide, many have moderate to severely limited mobility and require specific care.

Proper care not only maintains the health of residents, but also their quality of life.

When a nursing home does not have enough staff to provide adequate care for their residents this constitutes understaffing.

Causes of Understaffing

Nursing homes operate on limited budgets and while mismanagement of resources can play a part, it is not the only potential cause of understaffing.

An organization must care for patients, maintain facilities, pay wages, provide medical care and meals, maintain facilities, and maintain profitability.

Many nursing homes aren’t fully occupied, which means the cost for maintaining facilities can encroach on profitability.

Often one of the first things elder care organizations cut down on when the budget is limited is staffing. Even if understaffing is not the ultimate goal, limiting staff can have unintended repercussions.

Some nursing homes will keep a minimal staff, hoping that their employees will fill any staffing gaps as they arise. This, too, can have unintended side effects on both the employees who are stretched to thin, the nursing home operations, and ultimately on the patients themselves.

When Understaffing Equals Abuse

Understaffing allows for gaps in care, and whether intentional or not, such lapses can be detrimental to a patient’s health and wellbeing. When these lapses are ongoing and repeated it constitutes neglect.

Nursing homes that maintain minimal staffing, also have an affect on their employees as well as patients. Care providers who are overworked are more likely to unintentionally neglect a patient. The responsibilities of a nursing home care provider are numerous, and patient care suffers when the staff is overtaxed, overstressed, and disgruntled.

In other cases, understaffing may simply mean that care providers have too many patients in their charge and cannot provide adequate care.

There is a delicate balance required when it comes to meeting a patient’s medical, physical and mental needs. Neglect can easily result when the ratio of patients to nurses is too high. Patients are the first to suffer as a result.

Signs of neglect

If you suspect that a loved one is being neglected as a result of nursing home understaffing, you may feel challenged to find evidence to support your claim.

The first step is informing yourself about nursing home neglect and what to look for. These are the more common signs of neglect and abuse in long-term care facilities:

• Bed sores: patients who lack mobility require frequent care to mobilize their bodies. When neglect is occurring, it is more likely for patients to develop bed sores from being left in one position for too long.
• Injuries: when patients are neglected, they may feel prompted to do things on their own. This can result in increased falls, bumps, and bruises that would not have occurred had a provider been attending to their needs and providing adequate observation.
• Malnutrition and dehydration: a rapid change in weight, and other physical signs may indicate malnutrition or dehydration. In overstaffed nursing homes, provision of meals and water may be one of the first things to slide.
• Change in behavior: a patient who is neglected may feel the burden of the neglect but not know how to qualify or express what is happening. Neglect can be profoundly saddening for an individual in a care facility and can ultimately overlap with emotional abuse. Any changes in your loved one’s demeanor should be explored.
• Changes in health: a rapid decline in health or new health issues may indicate a lapse in medical care. Frequent infections are another warning sign. When nursing home staff are overworked, medications and routine care may be forgotten or withheld.
• Unsanitary/unhygienic conditions: If you notice a change in general sanitation of either the facility, or the hygiene of your loved one, this bears further investigation.
• Suspicious deaths or illnesses of other residents: Untimely deaths, illnesses, or injuries among other residents may indicate a larger problem within the organization. A suspected lack of care among other patients can ultimately affect your loved one as well.

Nursing home staffing laws

There are measures in place to determine what constitutes understaffing, but few of them offer quantifiable standards.

The Arizona State Department of Health Services is responsible for licensing facilities and setting and enforcing assisted living facility regulations.

A.R.S §36-401 specifies operating requirements for adult care facilities but does not mandate specific staffing requirements.

The Nursing Home Reform Act of 1987 provides federal regulations for nursing home staffing. 42 U.S. Code § 1395i–3 provides the “Requirements for, and assuring quality of care in, skilled nursing facilities.” The specific provisions for staffing are as follows,

“A skilled nursing facility shall post daily for each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. The information shall be displayed in a uniform manner (as specified by the Secretary) and in a clearly visible place.

“A skilled nursing facility shall, upon request, make available to the public the nursing staff data described in subparagraph (A).

“A skilled nursing facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident (consistent with requirements established under subsection (f)(5)).”

The Nursing Home Reform Act of 1987 does not go so far as to regulate what constitutes sufficient staffing. However, it does outline the specific responsibilities facilities have to each patient:

• Providing residents with pharmaceutical care
• Providing residents with dietary and nutritional care
• Periodically assessing each resident’s health
• Providing a comprehensive care plan for each resident
• Providing residents with nursing services
• Providing residents with rehabilitative services
• Providing residents with social services

It also outlines the specific rights to which each resident is entitled:

• The right to communicate freely;
• The right to privacy;
•  The right to be treated with dignity;
• The right to freedom from restraints;
• The right to exercise self-determination;
• The right to accommodation of medical, physical, psychological, and social needs;
• The right to voice grievances without discrimination or reprisal;
• The right to participate in resident and family groups; and
• The right to participate in the review of one’s care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility.

Neither state or federal law specifies an appropriate ratio of patients to nurses, so what constitutes understaffing is somewhat ambiguous.

With the growing abundance of nursing home facilities in Arizona and nationwide, it is clear to see how significant a problem this can pose.

How to recognize understaffing

Despite regulations that nursing homes must disclose staffing numbers, the abundance of such facilities make it difficult to enforce standards across the board. Spotting understaffing can also be challenging:

• Staffing at a facility may be staggered, for example, there is often less staffing on weekends than during the week.
• Certain times of day or night may have more or less staffing, comparatively, so it is necessary to observe the nursing home at various days and times to obtain a clear staffing picture.
• Similarly, data and reports pertaining to a specific nursing home may be skewed depending on the measurements used.

If you suspect you or a loved one is being harmed by nursing home understaffing, rely on concrete evidence of staffing issues rather than claims or documents supplied by the nursing home.

Filing a nursing home understaffing abuse claim

If you or a loved one has been impacted by nursing home abuse as a result of understaffing, you can contact Thompson Law to help you build your case and settle your claim.

Likewise, if you suspect abuse and wish to immediately report it, contact local authorities at 911 or report your suspicions to the following agencies. Resources and assistance are available to you.

National Center on Elder Abuse

• 1-855-500-3537 (toll-free)
• ncea-info@aoa.hhs.gov
• https://ncea.acl.gov

National Adult Protective Services Association

• 1-217-523-4431
• www.napsa-now.org

Arizona Department of Economic Security – Aging and Adult Administration

Adult Protective Services

• 1-877-SOS-ADULT (877-767-2385) (toll-free)
• https://des.az.gov/services/aging-and-adult/adult-protective-services/adult-protective-services-central-intake-unit

Arizona State Long Term Care Ombudsman

• (602) 542-6454
• https://des.az.gov/services/aging-and-adult/long-term-care-ombudsman

Nursing Home Understaffing FAQs

I suspect my father is being neglected but I don’t know if understaffing is the cause. What can I do?

Regardless of the cause, you should report any suspected abuse right away.

You can do this by contacting local law enforcement or an Arizona nursing home abuse attorney who can assist you in getting the help you need.

Once your complaint is acknowledged, it will be investigated to determine the cause of suspected abuse and everything necessary will be done to pursue the compensation you deserve.

What is a Long-Term Care Ombudsman?

In addition to regulating nursing homes and specifying patient rights, Arizona, like many states, has adopted a Long-Term Care Ombudsman Program through the legislature.

An Ombudsman is “an independent impartial dispute resolver.” The ombudsmen can investigate and make recommendations in response to complaints by elders in nursing homes or other care facilities.

Among those issues an ombudsman can assist patients and family members with are the following:

• Knowing and interpreting the patient’s rights.
• Resolving billing or charge disputes.
• Resolving disputes involving changes in service or care.
• Investigating complaints regarding quality of care.
• Investigating complaints regarding mistreatment by a caregiver.

This independent resource is provided by the state and the ombudsman makes every effort to hear complaints, advocate, and intervene on behalf of the nursing home resident. If you have a complaint and would like to see how an advocate can help you, please call the number for the Arizona Long Term Care Ombudsman above.

Is there a statute of limitations on filing a nursing home neglect claim?

The nursing home abuse statute of limitations in Arizona is 2 years. This means that from the moment of violation, the victim has two years within which to file a claim against the offending party.

However, in cases where the effect of the abuse has occurred or been discovered after the act of abuse itself, the statute of limitations begins at the moment when the victim should reasonably have been aware of the adverse effects.

For more information on how this applies to nursing home abuse and neglect cases read our statute of limitations guide.

Can a nursing home be held criminally responsible for understaffing?

Yes. A nursing home and individual administrators or care providers can be held criminally and civilly responsible for wrongful action and abuse.

Criminal liability is reserved for situations involving egregious intentional wrongful action and/or willful disregard. An attorney and authorities working with you on your case will help you identify the liabilities in question and can help you file the appropriate claims.