Federal regulations mandate certain guidelines that any nursing home participating in Medicare must comply with when providing care to residents. These regulations can be found in the Omnibus Budget Reconciliation Act of 1987 (ORBA), which includes the Federal Nursing Home Reform Act (FNHRA). Nursing homes must specifically employ a “sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”
This means that each nursing home is required to hire and maintain sufficient numbers of staff members to meet all of the necessary care needs of all of its residents on a round-the-clock basis. Nursing staff members include not just registered nurses (RNs); but also licensed practical nurses (LPNs/LVNs), trained medication assistants (TMAs) and nursing aides (CNAs). Additionally, state regulations will often specifically set out staffing standards that must be met. Evidence demonstrates that understaffing in a nursing home facility frequently results in health and injury risks, if not death, to its residents.
In fact, statistics show that the higher staff levels and lower nurse turnover that a nursing facility maintains, the better medical care that residents receive.
This high level of staffing combined with low nurse turnover leads to:
- Fewer pressure ulcers (bedsores)
- Fewer patients requiring catheterization or treatment for urinary tract infections (UTIs)
- Less usage of antibiotics for infections
- Increased likelihood of the resident being released from the nursing home
- Reduced probability of death
- Overall improved patient outcomes
On the other hand, understaffing in a nursing home facility often results in:
- High usage of urinary catheterization
- Increased frequency of pressure ulcers and other skin conditions
- Poor feeding and malnutrition of residents
- Dehydration in patients
- Decreased participation in activities which could greatly benefit the resident
One of the biggest risks for residents in an understaffed nursing home is inadequate food or water intake. It is important for nursing staff members to feed residents who are unable to eat without assistance, encourage those patients who can feed themselves to do so regularly and to supervise patients at each mealtime. A failure to do this can result in malnourished or dehydrated patients — and in the most egregious cases, lead to resident starvation.
Another danger of understaffing in a nursing home facility is skin breakdown, which can lead to pressure ulcers (bedsores) or other skin conditions. It is extremely important that residents are regularly turned and repositioned, especially those confined to wheelchairs and beds. Studies show that patients in danger of skin breakdown should ideally be repositioned at least once every two hours.
In an understaffed facility, these residents will be at much greater risk of developing harmful skin conditions which could lead to a decline in their medical condition.
In order to prove that understaffing in a nursing home facility has led to nursing home abuse or neglect, it is important to consider the following issues:
- Productive (direct patient care) vs. nonproductive (administrative nursing staff) hours maintained by the facility
- Census, meaning the number of patients in the nursing home
- Acuity, or the level of complexity in care that a particular resident’s medical condition requires
- Per patient days (PPD), referring to the total nursing hours worked by all nurses on duty on a specific day, which is then divided by the total number of patients in the facility over the same time period
- Medicare and Medicaid cost reports, which details the nursing home’s annual operating expenses as well as its revenues, and can then be used to calculate the facility’s annual resident census
- Roster/Sample Matrix, which is used to list all current residents and detail all relevant care categories
- Posted nurse staffing information, showing the total number of hours actually worked by all nursing staff members and nursing aides — in addition to the patient census — on each and every day . This must be posted in a readily accessible and prominent place where patients and visitors can clearly see it
- Punch detail reports which reveal the actual staffing levels and time-clock “punches” performed by all nursing staff members
- Turnover reports showing monthly, quarterly, and yearly employee turnover rates for nursing staff;
- Schedules, representing the facility’s plans for staffing over a certain period of time, which can then be compared with the actual punch detail reports to show the actual time worked
- Daily aide assignment sheet, which shows the daily assignments given to each nursing aide at the beginning of a shift
- Witness testimony. Interviewing the former employees of a corporate defendant may be crucial for establishing understaffing in a nursing home facility and zeroing in on patterns of staff turnover, work overload, and gaps in meeting the required standards of care.
The Dysart Law Firm, P.C. is an experienced St. Louis personal injury law firm, and we have the knowledge it takes to establish understaffing in a nursing home facility has resulted in nursing home abuse or neglect. It may benefit the families of victims injured in a nursing home facility to contact our firm for a no-cost, obligation-free consultation. We work on a contingency-fee basis and only collect legal fees in the event that we succeed in gaining financial restitution for you or your loved one.
Disclaimer: The choice of a lawyer is an important decision and should not be based solely upon advertisements.
Source: “Nursing Home Litigation: The danger of understaffing,” by Mark Kosieradzki. August 2011, Volume 47, No. 08.