Understaffing in Nursing Homes
- Reviewed By
Anthony C. Lanzone, Founding Partner
Understaffing in nursing homes is one of the most important predictors of abuse and neglect. According to the Centers for Medicare and Medicaid Services, 78 percent of California’s nursing homes are understaffed. Nursing home staffing shortages occur because owners choose to maximize profits rather than invest in staff.
Table of Contents:
- Reasons Why Nursing Homes Are Understaffed
- How Understaffing Leads to Nursing Home Abuse and Neglect
- State Regulations in California on Nursing Home Staffing Levels
- Nursing Home Understaffing in the News
- What to Do If Your Loved One Suffers Neglect from Nursing Home Understaffing
- Let Lanzone Morgan, LLP, Stand Up for Your Loved One
Lanzone Morgan, LLP, is a leading California nursing home abuse law firm relentlessly committed to safeguarding the rights and welfare of the elderly community. We can help you recover substantial compensation if your loved one has experienced nursing home abuse or neglect from nursing home understaffing.
Reasons Why Nursing Homes Are Understaffed
Nursing home staffing shortages occur because owners fail to invest sufficient funds to hire and retain nursing staff. They expect nurses and nursing assistants to work at an unreasonable pace and manage unreasonable workloads. They often have difficulty recruiting and retaining staff because the work is demanding and the pay is low compared to other health care settings.
Certified nursing assistants are the lowest-paid nursing staff with the least training, yet they provide the majority of direct care. They face high physical demands and have the highest risk among all nursing home staff of being injured on the job. Working conditions in nursing homes worsen as shortages increase, putting residents at risk of neglect and abuse.
How Understaffing Leads to Nursing Home Abuse and Neglect
Nursing home staff are often dedicated workers overwhelmed by the strain of understaffing. Due to unrealistic resident-to-staff ratios, they must rush or delay care. They cannot provide all residents with appropriate supervision and assistance to prevent falls, elopements, choking, bedsores, and other injuries. They often cut corners to manage the workload, leading to errors and harm. Some experience constant frustration and lash out at residents with higher needs.
Residents pay the highest price for inadequate staffing in nursing homes. Many live with daily emotional and physical abuse. Residents who need assistance toileting may sit in soiled or wet diapers or linens for hours at a time. Some receive unnecessary indwelling catheters, resulting in an increased risk of infections. Residents who demand quality care are often given antipsychotic medications to sedate them—a form of chemical restraint.
Understaffing puts your loved one at risk of serious injuries and reduced quality of life from abuse and neglect. If you notice any of the following signs and symptoms, your loved one may be bearing the brunt of a short-staffed nursing home:
- Unexplained injuries
- Poor hygiene
- Declining health due to medication errors
- Emotional withdrawal
- Bedsores
- Infections
- Elopements
- Falls
- Malnutrition
- Dehydration
- Choking
- Depression
- Increased anxiety
- Unexpected death
State Regulations in California on Nursing Home Staffing Levels
California Code of Regulations Title 22 § 72329.2 requires nursing homes to employ enough staff to provide every resident with at least 3.5 hours of direct care per day, including 2.4 hours of care by certified nursing assistants. This total exceeds the federal requirement of 3.48 hours per resident per day. However, it is slightly short of the 2.45-hour requirement for CNA care.
State and federal requirements are lower than the 4.1 hours recommended by an influential 2001 ABT Associates study. Nursing homes that only meet the bare minimum requirements are poorly equipped to provide every resident with the dignified, quality care they deserve. Yet most nursing homes fall short of even this standard, putting residents at risk of abuse, neglect, and premature death.
Penalties for Staffing Violations
The California Department of Public Health imposes fines for violations that threaten the health and safety of residents. The fines vary based on the severity of the violation, as shown below:
| Type of Violation | Fine per Incident |
| B violation – related to resident health, safety, or long-term security | $100 to $1,000 |
| A violation – puts residents in imminent danger of death or serious harm | $1,000 to $10,000 |
| AA violation – played a substantial role in a resident’s death | $10,000 to $25,000 |
Repeat A or AA violations within 12 months can result in license suspension or revocation.
- Did you know?
The nursing home industry opposed the CMS final rule establishing minimum staffing standards in nursing homes, citing underfunding because of low Medicaid reimbursement. However, nursing home executives receive disproportionately high compensation. According to Skilled Nursing News, nursing home CEO salaries averaged from $439,768 to $822,507 in 2023, and these numbers are rising. They also receive exorbitant bonuses, with three CEOs receiving a combined $650 million from 2018 to 2024.
Nursing homes blame underfunding for staff on low Medicaid reimbursement, but nursing homes are often more profitable than they admit. A National Bureau of Economic Research study found that nursing homes hide 68 percent of their profits through a practice known as “tunneling” that transfers them to related entities their owners also own. These related entities are often real estate or management companies, which charge excessive fees, pocket the profits, and use the fees to make nursing homes look less profitable.
Nursing Home Understaffing in the News
COVID-19 brought on massive nursing home staff shortages during its peak in 2020. A study published in the Journal of the American Medical Directors’ Association found a positive correlation between nursing home understaffing in the United States and COVID-19 deaths during the pandemic. According to the New York Times, nursing homes were short-staffed before the pandemic. However, they still have not recovered staffing levels even to those pre-pandemic levels.
In 2021, over 400 California nursing homes received citations for understaffing, but regulators granted 236 waivers exempting them from fines, finding that there were not enough nurse aids available in the labor force.
What to Do If Your Loved One Suffers Neglect from Nursing Home Understaffing
If you suspect your loved one’s needs are not being met because of nursing home understaffing, contact our experienced California nursing home abuse lawyers as soon as possible. As one of the nation’s leading elder abuse law firms, we aim to provide a voice for the voiceless. We will advocate for your loved one’s right to compensation and quality care. We can investigate, report the neglect to the appropriate agencies, and help you file a lawsuit to hold the nursing home accountable for neglecting your loved one.
You can also report the nursing home to the following agencies:
- The Department of Public Health – Call (800) 554-0354.
- The California Department of Aging Long-Term Care Ombudsman CRISIS Line – Call (800) 231-4024.
Let Lanzone Morgan, LLP, Stand Up for Your Loved One
Understaffing in nursing homes is an important underlying cause of nursing home abuse and neglect, but it does not excuse it. Nursing homes have a legal duty to provide residents with a hospitable environment, a dignified existence, and quality care. If your loved one has received anything less, they deserve compensation.
We are exclusively focused on protecting the rights and welfare of the elderly community with a proven track record of holding nursing homes accountable. We handle cases across the entire state of California. When you work with us, everyone at our firm will have empathy and compassion for your loved one, and we will represent them as if they were our own family.
Contact us online today or call (888) 887-9777 to schedule your free consultation.
- Fact-Checked
This content has been legally reviewed and approved by nursing home abuse attorney, Anthony Lanzone. Anthony holds notable memberships with professional organizations including the American Association for Justice and Consumer Attorneys of California.
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- Fact-Checked
This content has been legally reviewed and approved by nursing home abuse attorney, Anthony Lanzone. Anthony holds notable memberships with professional organizations including the American Association for Justice and Consumer Attorneys of California.