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An empty hallway in a nursing home due to understaffing.


Understaffing in nursing homes and assisted living facilities poses a serious threat to the health, safety, and well-being of their residents. While state and federal regulations impose minimum staffing requirements, facilities often fail to adhere to them, leading to dire resident outcomes. Further, mere compliance with minimum staffing numbers is rarely sufficient to meet the needs of facility residents, an objective facilities are obligated to achieve.


Why Facilities Are Understaffed

There are several reasons why nursing homes or assisted living facilities might be understaffed.


  • First, staff is one of the most costly components of operating a nursing facility. Competent staff increases operational costs. Many facilities believe that reducing staff can help save costs and increase profits. However, the opposite is usually true as decreased staffing levels, often increase liability exposure when residents are abused and/or neglected.

  • Second, facilities with low staff morale and/or incompetent staff might experience high call-out and/or no-call, no-show rates. When staff members do not show up for work, the facility is at risk of being understaffed. This is further compounded when the facility is already staffed to state-imposed minimums (without even considering the needs of the residents). Regardless, nursing homes and assisted living facilities are responsible for ensuring sufficient staff to meet the needs of their residents every day.

  • Third, nursing homes and assisted living facilities often compete for qualified staff. Paying at or above market rate helps to ensure that facilities not only have sufficient staff to meet the needs of the residents, but that facilities also have qualified staff to meet the needs of the residents. In some instances, failing to pay market wages leads to high turnover rates and understaffing. This, in turn, increases liability exposure when residents are the victims of understaffed facilities.

  • Fourth, facilities that are run by incompetent management generally experience high turnover. This leads to inadequate staffing and the dire consequences associated with a lack of staff.


Dire Outcomes Associated with Understaffing

When nursing homes and assisted living facilities are understaffed, the residents suffer. Below are just some of the consequences of understaffing:


  • Insufficient Monitoring: Inadequate staffing levels result in compromised resident monitoring. Inadequate monitoring leads to delays in recognizing and addressing resident health issues. In these circumstances, changes in condition often go unnoticed and residents are deprived of critical medical care.


  • Increase in Traumatic Injuries: Understaffing also leads to more traumatic injuries. For example, residents who can no longer wait for assistance might be compelled to get out of bed without assistance (when assistance is otherwise required) and try to walk to the bathroom. This unnecessarily increases the risks of falls, fractures, and head injuries.


  • Inadequate Care and Treatment: When residents are deprived of necessary care and treatment, they are left to suffer. This is compounded by the fact that many nursing home residents (and some assisted living facility residents) are unable to speak up, get a nurse’s attention, identify the source of pain, explain a recent fall, and/or tell a family member what’s wrong. When a facility is understaffed, physician’s orders are overlooked, treatments are wrongfully withheld, and medications are not administered or are done so in error (see Medication Errors). In addition, residents who require turning and repositioning to avoid bed sores/pressure ulcers do not get the attention they need. These residents then develop bedsores/pressure ulcers that go unnoticed for far too long. This is unacceptable.


  • Malnutrition/Dehydration: When facilities are understaffed, residents who require assistance with feeding begin to suffer from malnutrition and/or dehydration. This leads to a host of cascading problems, all of which could have been prevented with proper staffing.

  • Neglect and Poor Hygiene: Understaffed facilities simply cannot meet the basic needs of residents, including assistance with personal hygiene. Neglect in these essential areas can lead to preventable illnesses, infections, and deterioration of residents’ overall health.


  • Preventable Infections and Illnesses: Understaffing may lead to lapses in infection control measures, contributing to the spread of infections within healthcare facilities.


  • Emotional and Social Isolation: Understaffing often limits the time staff can spend engaging with residents on a personal level, leading to social isolation and emotional distress. Loneliness and lack of social interaction can contribute to depression, anxiety, and a diminished overall sense of well-being.


  • Overwhelmed Staff: Staff members who do show up for work experience burnout and become resentful that they are working too hard for too little. Negative attitudes have the potential to manifest into abusive behaviors. This can have severe consequences for the physical and emotional well-being of residents under their care.


If you or your loved one was injured at the hands of a nursing home or assisted living facility, contact the experienced attorneys at FIDJ, before it’s too late.

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We Hold Nursing Homes, Assisted Living Facilities, Group Homes, and Adult Day Care Centers Accountable.

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