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Most neglect that takes place in our long-term care system can be traced to a lack of staffing, either in adequate numbers or with staffing that simply does not have the required knowledge or training. The national standard for staffing in nursing homes is actually quite good. A nursing home receiving federal funding must have sufficient nursing staff to provide nursing and related services to attain and maintain the highest practicable physical, mental and psychosocial wellbeing of each resident, as determined by that resident’s assessments and individual plans of care. See 42 C.F.R. §483.30 (nursing services). The facility must provide such staffing on a 24-hour basis to all residents in accordance with their applicable care plan. Similarly, the staff is to receive training and competency evaluation programs approved by the state. The facility must also provide regular in-service education to insure that all individuals used as nurse aides are competent to provide such services. See 42 C.F.R. §483.75 (Administration).
Regulations governing the staffing in assisted living facilities vary from state to state. However, most state regulations have a component that requires the facility to provide staffing sufficient to meet the needs of the residents.
Despite federal regulations mandating that nursing homes provide sufficient staffing to meet the highest practical needs of the residents, such high standards are not met in many facilities. Because of the subjectivity involved in the federal standard, regulatory officials are not always aggressive in citing nursing homes for inadequate staffing. Many times, staffing shortages are more frequent on the weekends when staffing patterns in the nursing home may change.
When visiting a loved one in a nursing home or assisted living facility, it is a good idea to sometimes visit on weekends or at odd times in the evening to see for yourself the actual levels of staffing on the floor. Clinical correlation between increased staff and the avoidance of adverse outcome is well-established in the long-term care setting. Early studies comparing pressure ulcer prevalence in 30 Virginia nursing homes found that higher pressure sore rates were prevalent in nursing homes with lower staffing levels. Comparison of Clinical Indicators in Two Nursing Homes, Rudman MD, Daniel and Mattson, Dale, American Geriatric Society, Vol. 41: 1317-1325) (Dec. 1993). Another study found that inadequate staffing placed residents at higher risk for dehydration. See, Factors Contributing to Dehydration in Nursing Homes, Inadequate Staffing and Lack of Professional Supervision, Kayser Jones–Geanie and Ellen S. Schell, Journal of American Geriatric Society, Vol. 47, pp. 1187-1194 (1999). This article explains how residents who are the most dependent on staff assistance with ADLs (Activities of Daily Living) are also the most vulnerable to the adverse impact of staffing fluctuations.
Some residents may require extensive assistance with meal consumption or fluid intake, which can take thirty minutes to an hour for a single resident. Many nursing homes do not allocate sufficient staffing to provide this degree of time for an individual resident. If you have a loved one in a nursing home you should give consideration to visiting during meal time to observe first hand what assistance your loved one actually requires and what he or she is actually receiving. Please check with the nursing staff before feeding any nursing home resident food as the resident may have dietary restrictions. For example, individuals with swallowing difficulties may be able to consume only softened food or thickened liquids.
If you have further questions about staffing issues please
contact us for a free consultation or additional information.
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