If your loved one is living in a nursing home and you notice bedsores, broken bones or other forms of abuse, you wonder how it happened. You did your research, regularly check in with staff and make frequent visits – how did your loved one end up injured? Although one or more employees may be involved, understaffing may be at the root of nursing home neglect or abuse.

How Some Homes Become Understaffed

Nursing home patient in wheelchairLooking to increase their profits, homes may intentionally understaff a facility. Paying hourly wages and salaries can become a facility’s greatest expense. In response, those overseeing its operations often stretch its trained nurses and CNAs to the limit.

As a result, one worker gets assigned to as many as 30 to 40 residents, employees have to work overtime to meet unreasonable demands and patients requiring a high degree of care don’t get the attention they need. These issues often get exacerbated in rural areas, where homes may not be able to find enough qualified staff.

Added to this, federal law throws in a few loopholes. Facilities that receive funds from Medicare or Medicaid must provide a round-the-clock nursing staff to meet residents’ needs and have a registered professional nurse available for at least eight hours each day, seven days a week. Yet, the Centers for Medicare & Medicaid Services waives this requirement on the following grounds:

  • The home is located in a rural area with a limited supply of qualified workers.
  • The facility has a full-time registered nurse on duty for at least 40 hours per week.
  • The facility’s patients do not require a registered nurse or physician for a 48-hour period.
  • The facility had made arrangements for a registered professional nurse or physician to provide care when a full-time professional isn’t present.

Due to these factors, homes can manage with the basic staff level or fewer-than-average employees. On the other hand, its residents may suffer in the following ways.

Inadequate Care

Patients with mobility issues experience the greatest impact when staffing is cut, and workers get stretched. Such individuals depend on aides for movement and other physiological needs. In response, they may be turned or moved less frequently and not bathed or groomed on a regular schedule. Especially if the patient is incontinent or needs assistance using the bathroom, bedsores and infections quickly develop and muscle atrophy poses a greater threat.

While this issue affects patients with the greatest degree of need, understaffing has a rippling effect throughout the home. Facilities classify such patients as requiring a one- or two-person assist and helping a resident turns into a time-consuming activity. A typical home with 35 patients generally has 20 requiring a one-person assist and at least one needing two people, as a mobility lift may be involved. Patients may need such assistance to:

  • Use the restroom, which takes three to 10 minutes per patient
  • Reach items
  • Feed themselves
  • Drink enough water
  • Take a shower
  • Maintain basic hygiene

In this scenario, a home may only have four CNAs on staff. As a result, the patient must wait at least 15 minutes for assistance. In the meantime, patients may wet themselves, increasing the chance of bedsores, or may attempt to walk to the toilet alone. This latter factor greatly increases slip and fall injuries, sprains and broken bones.

As well, having to wait or being completely ignored causes patients to develop:

  • Malnutrition
  • Weight loss
  • Dehydration
  • Pneumonia
  • Other heath complications

Furthermore, because of the workload, almost half of all nurses claim to miss changes in the patient’s condition and CNAs are known to falsify reports concerning residents’ care at the end of the night. As a result, employees in charge or administering medications may simply forget, cut corners to get everything completed or give the incorrect dosage or drug to a patient.


Studies have further identified a correlation between understaffing and greater levels of abuse, with overworked employees reporting high levels of stress from limited time to care for each patient. This occurrence, based on multiple statements, can cause workers to become impatient. They may use force to complete a task or lash out in frustration at the patient. Generally, the more understaffed a home is, the greater the incidence of abuse.

Yet, understaffing isn’t restricted to a handful of facilities. At one point or another, this issue exists for 90 to 95 percent of all nursing homes in the U.S. As a family member making a choice for your loved one’s care, you have the right to know if a facility has enough licensed nurses and CNAs.
If you’ve found that a home stretched the truth about its employees and your parent, spouse or other family member is suffering as a result, work with Trantolo & Trantolo to file a nursing home negligence claim. To learn about our services or to talk to a lawyer today, give one of our locations a call.