Nursing Home Staffing and Neglect

A recent study by Healthcare Finance News on nursing home staffing levels revealed that “more than half of facilities met the expected level of staffing less than 20% of the time during the one-year study period.” Additionally, an estimated 95% of US nursing homes are understaffed. This is a serious concern because understaffing leads to the neglect of patients and can eventually lead to outright elder abuse. Such neglect and abuse should not be accepted, nor should the staffing issues that lead to it.

Nursing Home Staffing Issues

nursing home staffing

Understaffing occurs when a nursing home does not employ enough nurses, certified nurse aids (CNAs), or both, to adequately meet the needs of the residents. This leads to major problems for the residents as well as those who care for them. However, Medicare really has no minimum ratio of staff-to-resident for nursing homes, which makes it far easier for nursing home facilities to get by without enough staff. The primary staffing requirements are actually quite frightening: a registered nurse (RN) needs to be present for a minimum of eight hours a day, and either an RN or licensed practical nurse must be present at all times. While the requirement to have a nurse on duty at all times is necessary, this alone is insufficient. Since there are no requirements from Medicare to make sure that residents have enough staff on hand to care for them, things can and do go wrong with alarming regularity.

Results of Understaffing in a Nursing Home

When a nursing home is experiencing staffing issues, patients will invariably suffer from delays in both physical and medical care. Here are some examples of what these delays can involve:

  • Patients may be left in soiled diapers for extended periods of time
  • There may be a delay in residents receiving their medication in a timely manner, possibly leaving the patients in a state of discomfort or leading to fatal complications
  • Patients may not be escorted to the bathroom in time to prevent an accident
  • Fall-prone residents may not be adequately supervised
  • Bedsores may develop because staff does not have the time to change the position of the patient often enough
  • A lack of CNAs can lead to residents developing issues related to personal hygiene (dandruff, body odor, bad breath, soiled garments)
  • Some patients who require assistance with eating may be forced to wait until their food is cold before they can eat it
  • Preoccupied staff may not notice the signs of impending illness
nursing home walker

Another aspect of understaffing relates to how the staff is forced to deal with the stress and pressures of being overworked, being forced to work on their days off, and having widely varying schedules. This stress can manifest in a number of ways, including:

  • Taking out frustration on patients who cannot defend themselves (e.g., being too rough when moving patients, handling patients roughly when assisting them)
  • An impatient attitude with residents (e.g., responding in kind to difficult patients)
  • Outbursts of anger against patients, especially when accidents are involved (e.g., soiled garment, spilling water)
  • Ignoring patient requests for things such as medication, water, or general assistance
  • Making mistakes with medications because of fatigue, which can lead to fatal mistakes
  • Intentional neglect of certain patients so that others may be dealt with (e.g., more demanding, alert patients may receive care before non-communicative, complacent patients)

Such actions may be classified as abuse or neglect (both intentional and unintentional). When these kinds of actions are repeated, they can lead to serious medical complications, illnesses, psychological problems, depression, and even death. Understaffed nursing homes are a health threat to the residents, and especially to those who are immobile or unable to communicate — the most helpless of residents.

Common Signs of Neglect

nursing home neglect

Common signs of nursing home neglect include repeated falls, excessive bruising and skin tears around the arms and legs, signs of poor hygiene, the development of multiple bedsores, repeated infections (including UTIs), and sudden changes in behavior. Although the staff may seem to behave in a professional manner while you are visiting, that does not mean this is always the case. If you begin to suspect neglect, try changing up the schedule of when you visit the facility so that your appearance is more unpredictable.


If a nursing home does not have enough staff or a consistent level of staff, neglect (both unintentional and intentional) can result and eventually lead to nursing home abuse. Residents’ physical and medical needs may be neglected, which can lead to physical discomfort, frustration, poor hygiene, increased frequency of infections, the exacerbation of existing medical issues, and possibly death. Signs of neglect or abuse, which can include bruises, bedsores, skin tears, increased falls, and severe odor, should never be ignored or excused. Our nursing homes house the most helpless of society who should be treated with respect and compassion, not subjected to neglect and abuse due to nursing home staffing issues.

Donaghue & Labrum

If you suspect neglect or abuse due to understaffing at a nursing home, contact Donaghue & Labrum today. There are laws in place to protect your loved ones from this type of mistreatment, and they may be eligible for damages and the nursing home may be subject to fines. One of our areas of specialization is nursing home abuse and neglect, and our team can help you determine if neglect is taking place and what kind of legal remedies should be pursued. Contact us right away and let us help protect your loved one from nursing home malpractice.